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Nursing2015

January 2013, Volume 43 Number 1 , p 16 - 20

Authors

  • Vikrant Uberoi MD
  • Nahomy Calixte MD
  • Vanessa R. Coronel RN
  • Debra J. Furlong RN
  • Ralph P. Orlando MD
  • Lori B. Lerner MD

Abstract

GIVEN THE SIGNIFICANT morbidity, cost, and decreased reimbursement for healthcare-associated infections, the importance of preventing catheter-associated urinary tract infections (CAUTIs) has never been higher.1 Over 80% of hospital-acquired urinary tract infections (UTIs) are associated with catheters, spurring many hospitals to develop initiatives to aggressively reduce catheter days.2In 2008 at Boston Veterans Hospital, the CAUTI rate in surgical patients (2.6%) was above the national average (1.9%). A full retrospective review revealed that after hip and knee replacement surgery, 8% of patients developed symptomatic acute urinary retention (AUR) after catheter removal and required intervention. Recognizing that postoperative urinary retention poses a risk for CAUTI, an effort was made to reduce recatheterization rates.1 This article describes our project and results.Surgical patients who develop AUR are at particularly high risk for repeated catheterization, prolonged catheter days, and CAUTI. By one estimate, the incidence of postoperative urinary retention is 5%; however, rates vary greatly.3 Orthopedic patients, for example, are at particular risk due to postoperative immobility, use of opioids, and advanced age. A recent study found a 38% incidence of urinary retention.2Patients who develop AUR postoperatively require intervention with either an indwelling catheter or intermittent catheterization. The rate of bacteriuria associated with short-term catheterization is 5% to 10% for each day of catheterization.4 As catheter duration increases, so does the risk of hospital-acquired UTIs.The section of urology at VA Boston Healthcare, in conjunction with nursing staff, designed a bladder management protocol (BMP) for orthopedic patients undergoing primary total hip or knee replacements. We set out to answer four questions: * Does the identification of preoperative urinary retention in patients undergoing total joint replacement surgery decrease the incidence of postoperative

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