D219: Impact of External Female Catheters on CAUTI Prevention in Nursing

The Impact of the Use of External Female Catheters in Preventing Catheter-Acquired Urinary Tract Infections

Impact of the Problem on the Patient

Catheter-associated urinary tract infections (CAUTIs) are among the most frequent hospital-acquired infections globally. These infections commonly arise from prolonged or improper use of indwelling catheters, contamination during insertion, or lapses in aseptic maintenance techniques. Over time, the continued presence of a Foley catheter allows bacterial colonization and biofilm formation within the urinary tract, ultimately leading to infection.

For patients receiving care at home, diagnosing a urinary tract infection (UTI) often requires laboratory confirmation, which can delay timely treatment and elevate the risk of complications, including hospitalization. Hospitalized individuals are even more vulnerable, facing possible outcomes such as fever, discomfort, sepsis, and dependence on intravenous antibiotics. Recurrent CAUTIs can foster antimicrobial resistance, further complicating recovery. Moreover, repeated infections contribute to emotional distress, decreased autonomy, and diminished quality of life, thereby impeding rehabilitation and overall well-being.

Impact of the Problem on the Organization

From an institutional perspective, CAUTIs have significant implications for healthcare organizations. These infections increase overall hospital costs through extended patient stays, higher antibiotic use, and a greater demand on nursing and infection control teams. Hospitals exceeding infection benchmarks established by national agencies may also face financial penalties or reduced reimbursement.

Additionally, recurring CAUTI cases erode patient trust, negatively affect satisfaction scores, and tarnish an organization’s reputation. Reducing CAUTI rates not only enhances patient safety outcomes but also promotes operational efficiency and resource optimization. Successful CAUTI prevention demonstrates the organization’s commitment to quality improvement and patient-centered care.

Identification of PICO Components

Evidence-Based Practice (EBP) Question

In female patients with urinary catheters, does the use of external female catheters compared to indwelling Foley catheters reduce the risk of catheter-associated urinary tract infections (CAUTIs)?

“A Single Institution Pre-/Post-Comparison After Introduction of an External Urinary Collection Device for Female Medical Patients” (Research Article)

Background and Introduction

This retrospective investigation assessed the effects of implementing an external urinary collection device (EUCD)—specifically the PureWick system—across the Internal Medicine, Family Medicine, and Neurology departments of one healthcare institution. The study excluded specific populations such as pregnant individuals, incarcerated persons, and those admitted to specialized services. The primary goal was to compare CAUTI rates before and after the adoption of EUCDs and determine whether the intervention effectively reduced infection rates compared to indwelling urinary catheters (IUCs).

Methodology

A retrospective observational study design was employed to analyze adult female inpatients who had either IUCs or EUCDs during hospitalization. Data collection spanned two distinct periods: three months before and twelve months following EUCD implementation. Infection incidence was measured as episodes per 1,000 catheter days and per 10,000 patient days.

Variables such as patient age, body mass index (BMI), comorbidities, and postoperative complications were documented. Statistical analysis included Chi-square tests for categorical data and Mann–Whitney U tests for continuous data, using IBM SPSS Statistics (Version 24).

Level of Evidence

Based on the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) Model, this study qualifies as Level 3 evidence, representing non-experimental research that provides moderate-quality evidence derived from retrospective data.

Ethical Considerations

The project received approval from the Institutional Review Board (IRB). As the study used pre-existing medical records, informed consent was not required. Researchers followed the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines to maintain transparency, accuracy, and ethical integrity in reporting.

Data Analysis and Findings

A total of 848 female patients were included—292 received EUCDs, and 656 had IUCs. Before EUCD implementation, CAUTI rates for IUCs were 2.3 per 1,000 catheter days and 15.4 per 10,000 patient days. Post-implementation, rates for IUCs rose to 9.3 per 1,000 catheter days and 70.7 per 10,000 patient days, whereas EUCD-related CAUTI rates were 33.9 per 1,000 catheter days and 15.5 per 10,000 patient days.

Although statistical significance was not achieved, findings suggested that EUCDs could offer infection reduction benefits for select patients. Variability in comorbid conditions and inconsistent device usage may have influenced results.

Quality Rating

Under the JHNEBP appraisal, the study received a Good Quality (Level B) rating, indicating reasonably reliable results that contribute to evidence-based nursing practice.

Alignment with the EBP Question

The study closely aligns with the EBP question, as it directly compares infection outcomes between traditional indwelling catheters and external female collection devices. While the reduction in CAUTI incidence was not definitive, results indicated that EUCDs might serve as a viable alternative when applied under standardized care protocols.

“Reducing the Risk of Indwelling Catheter–Associated Urinary Tract Infection in Female Patients by Implementing an Alternative Female External Urinary Collection Device: A Quality Improvement Project” (Non-Research Article)

Background and Introduction

In a 386-bed community hospital in California, a quality improvement (QI) project aimed to reduce CAUTI rates among female patients. The initiative incorporated a female external urinary collection device (FEUC) featuring continuous suction. This intervention empowered nursing staff to utilize the device autonomously, without requiring physician authorization, thereby facilitating early adoption and continuous monitoring.

Type and Level of Evidence

According to the JHNEBP hierarchy, this QI project is classified as Level 5 evidence, which reflects experiential and organizational-level findings. The intervention was evaluated across several departments, including medical-surgical, telemetry, intensive care, and rehabilitation units, by comparing pre- and post-implementation CAUTI data.

Findings and Quality Rating

During the initial year following FEUC introduction, CAUTI rates dropped significantly. However, the second year showed a stabilization trend, likely due to inconsistent adherence to new procedures. The project was awarded a Quality B (Good) rating, reflecting reliable and well-documented outcomes that support ongoing practice improvement.

Author’s Recommendations

The authors advocated for integrating EUCDs within comprehensive CAUTI prevention bundles. This strategy should include ongoing staff education, multidisciplinary collaboration, and robust monitoring systems to ensure sustainable infection reduction among hospitalized female patients.

Recommended Practice Change

To effectively decrease CAUTI rates, hospitals should adopt evidence-based protocols to guide when EUCDs are appropriate alternatives to indwelling catheters. Staff training on device use, hygiene, perineal care, and patient education is essential to ensure consistent implementation and infection control success.

Indications and Contraindications for EUCD Use

(Eckert et al., 2020)

Key Stakeholders

Barrier to Implementation

A key barrier to EUCD adoption is the financial investment required for device procurement and comprehensive staff training. Healthcare facilities may hesitate to allocate funds without immediate proof of cost savings or infection reduction outcomes.

Strategy to Overcome the Barrier

To address financial hesitations, a cost-benefit analysis should be presented to leadership, demonstrating long-term savings through reduced infection rates, decreased antibiotic use, and shorter hospital stays. These findings can strengthen administrative support for integrating EUCDs into standard care practices.

Indicator to Measure Outcomes

Program success should be measured using monthly audits comparing EUCD utilization rates and CAUTI incidence. Additional outcome indicators include enhanced patient satisfaction, decreased infection recurrence, and reduced average hospital stay durations.

References

Eckert, L., Mattia, L., Patel, S., Okumura, R., Reynolds, P., & Stuiver, I. (2020). Reducing the risk of indwelling catheter–associated urinary tract infection in female patients by implementing an alternative female external urinary collection device: A quality improvement project. Journal of Wound, Ostomy & Continence Nursing, 47(1), 50–53. https://doi.org/10.1097/WON.0000000000000601

D219: Impact of External Female Catheters on CAUTI Prevention in Nursing

Jasperse, N., Hernandez-Dominguez, O., Deyell, J. S., Prasad, J. P., Yuan, C., Tomy, M., Kuza, C. M., Grigorian, A., & Nahmias, J. (2022). A single institution pre-/post-comparison after the introduction of an external urinary collection device for female medical patients. Journal of Infection Prevention, 23(4), 149–154. https://doi.org/10.1177/17571774211060423