Diagnostic Precision: Exchanging Urinary Catheters Before Urine Specimen Collection to Reduce Catheter-Associated Urinary Tract Infection

BACKGROUND: Catheter-associated urinary tract infections are among the most prevalent and costly types of hospital-acquired infections. During the COVID-19 pandemic, growing numbers of critical care patients required indwelling urinary catheters, leading to higher infection rates. LOCAL PROBLEM: A critical care unit saw a 7-fold increase in the rate of catheter-associated urinary tract infection during the COVID-19 pandemic. A review of procedures showed that the current standard of care for preventing such infections was inadequate. In particular, patients who could not have indwelling urinary catheters promptly removed risked a potential false-positive diagnosis of catheter-associated urinary tract infection due to clinicians' use of long-term catheters to obtain urine specimens for microbiological evaluation. METHODS: A literature review was performed to gather evidence on best practices for urine specimen collection in the critical care unit. An interprofessional task force including frontline nurses advocated implementation of a pilot project in 2 critical care units involving exchange of catheters before obtaining urine specimens for microbiological evaluation in any patient who had an indwelling catheter in place for more than 24 hours. RESULTS: Implementation of the new protocol resulted in a major reduction in the diagnosis of catheter-associated urinary tract infection, with no incidents occurring for 2 consecutive quarters. Based on these results, the new evidence-based workflow was incorporated as the standard of care for all adult inpatients. CONCLUSION: Catheter exchange before collection of urine specimens in patients requiring urine culture evaluation can improve accuracy of diagnosis of catheter-associated urinary tract infection and promote antibiotic stewardship.