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

Impact of the Problem on the Patient

Catheter-associated urinary tract infections (CAUTIs) represent one of the most common types of hospital-acquired infections worldwide. These infections frequently occur due to extended use of indwelling catheters, contamination during catheter insertion, or breaches in aseptic techniques during maintenance. When a Foley catheter remains in place for prolonged periods, bacteria can colonize and form biofilms within the urinary tract, increasing the likelihood of infection.

For patients managed at home, diagnosing urinary tract infections (UTIs) often depends on laboratory testing, which may delay treatment and increase the risk of severe complications such as hospitalization. Hospitalized patients are particularly vulnerable to developing fever, pain, sepsis, and often require intravenous antibiotics. Recurrent infections also contribute to antimicrobial resistance, complicating treatment regimens further. Beyond the physical health risks, recurrent CAUTIs negatively impact patients’ emotional well-being, autonomy, and overall quality of life, hindering rehabilitation and recovery.

Impact of the Problem on the Organization

What are the organizational consequences of CAUTIs?

From the perspective of healthcare institutions, CAUTIs significantly raise healthcare costs by prolonging hospital stays, increasing antibiotic consumption, and demanding more intensive nursing and infection control resources. Institutions that fail to meet infection rate benchmarks set by regulatory bodies risk financial penalties and diminished reimbursement rates.

Furthermore, frequent CAUTI cases damage patient trust, lower patient satisfaction scores, and harm the institution’s reputation. Conversely, successfully reducing CAUTI rates enhances patient safety, optimizes resource allocation, and highlights the organization’s commitment to quality improvement and patient-centered care.

Identification of PICO Components

Evidence-Based Practice (EBP) Question

In female patients requiring urinary catheterization, does using external female catheters, compared to indwelling Foley catheters, reduce the incidence 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 study evaluated the impact of introducing an external urinary collection device (EUCD), specifically the PureWick system, in the Internal Medicine, Family Medicine, and Neurology departments of a single healthcare institution. The study excluded pregnant patients, incarcerated individuals, and those in specialized services. The primary objective was to assess changes in CAUTI rates before and after the adoption of EUCDs and to compare their effectiveness against traditional indwelling urinary catheters (IUCs).

Methodology

The study employed a retrospective observational design focusing on adult female inpatients who utilized either IUCs or EUCDs during hospitalization. Data were collected over two periods: three months prior to and twelve months following EUCD implementation. Infection rates were calculated as episodes per 1,000 catheter days and per 10,000 patient days.

Key variables included patient age, body mass index (BMI), comorbidities, and postoperative complications. Statistical analyses utilized Chi-square tests for categorical data and Mann–Whitney U tests for continuous variables, conducted with IBM SPSS Statistics (Version 24).

Level of Evidence

According to the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) Model, this investigation provides Level 3 evidence, classified as moderate-quality non-experimental research derived from retrospective data.

Ethical Considerations

Institutional Review Board (IRB) approval was obtained for the study. Since it involved retrospective review of existing medical records, informed consent was waived. The research adhered to STROBE guidelines, ensuring ethical integrity, transparency, and accuracy in reporting.

Data Analysis and Findings

A total of 848 female patients were studied, with 292 using EUCDs and 656 using IUCs. Post-implementation, CAUTI rates for IUCs increased, whereas EUCD-related rates remained comparatively lower per 10,000 patient days. Though differences were not statistically significant, results indicated potential infection control benefits of EUCDs in certain patient groups. Variability in patient comorbidities and inconsistent device application likely affected the findings.

Quality Rating

This study received a Good Quality (Level B) rating under JHNEBP criteria, indicating that the results are reasonably reliable and contribute valuable evidence for nursing practice.

Alignment with the EBP Question

Does this study address the EBP question?

Yes, this study directly compares CAUTI rates between external female collection devices and traditional indwelling catheters. While it does not definitively prove infection reduction, the findings suggest that EUCDs could be effective alternatives when used with standardized 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

A quality improvement (QI) project conducted in a 386-bed community hospital in California targeted CAUTI reduction among female patients by implementing a female external urinary collection device (FEUC) equipped with continuous suction. This approach empowered nursing staff to apply the device without physician orders, accelerating adoption and ongoing surveillance.

Type and Level of Evidence

Based on JHNEBP guidelines, this project is classified as Level 5 evidence, representing experiential data and organizational insights. The intervention spanned multiple departments, including medical-surgical, telemetry, intensive care, and rehabilitation units, comparing CAUTI rates before and after FEUC adoption.

Findings and Quality Rating

The first year after FEUC implementation showed a significant decline in CAUTI rates. The second year reflected stabilization, attributed to inconsistent adherence to the protocol. The project earned a Quality B (Good) rating, validating its reliability and contribution to practice improvement.

Author’s Recommendations

Authors recommend integrating EUCDs within comprehensive CAUTI prevention bundles, emphasizing continuous staff education, multidisciplinary teamwork, and rigorous monitoring to sustain infection reductions among female inpatients.

Recommended Practice Change

What changes should hospitals adopt to reduce CAUTI?

Hospitals should establish evidence-based protocols guiding when EUCDs can replace indwelling catheters. Training on device application, hygiene, perineal care, and patient education is critical to ensure consistent implementation and infection prevention success.

Indications and Contraindications for EUCD Use

(Eckert et al., 2020)

Key Stakeholders and Their Responsibilities

Barriers to Implementation and Solutions

Barrier:
Financial constraints related to device costs and comprehensive staff training can deter healthcare facilities from adopting EUCDs.

Strategy to Overcome:
Present a detailed cost-benefit analysis to hospital leadership, emphasizing long-term savings from reduced infection rates, lower antibiotic use, and shorter hospital stays. This evidence can help secure administrative support for device integration.

Indicators to Measure Outcomes

• Monthly audits assessing EUCD usage rates and CAUTI incidence
• Patient satisfaction surveys
• Monitoring reductions in infection recurrence and average hospital stay length

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