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Is there an opportunity to reduce urinary catheter-related infections? Exploring variation in catheterisation rates in care homes

Health Protection Agency Primary Care Unit, Microbiology Department, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN

J. Bowen

Health Protection Agency Primary Care Unit, (Now Medical Research Department, Health and Safety Laboratory, Harpur Hill, Buxton, Derbyshire SK17 9JN

C. Foy

Research and Development Support Unit, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN

K. Gunn

Health Protection Agency Shropshire and Staffordshire Health Protection Unit, Mellor House, Corporation Street, Stafford ST15 3SR

E. Freeman

Gloucestershire Research and Development Support Unit, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN

D. Tompkins

Health Protection Agency Yorkshire and the Humber, Bridle Path, York Road, Leeds LS15 7TR

A. Brady

Leeds Community and Mental Health Services Teaching NHS Trust, North Wing, St Mary's House, St Mary's Road, Leeds LS7 3JX

T. Ejidokun

Health Protection Agency Gloucestershire, Health Protection Team, Cheltenham and Tewkesbury Primary Care Trust, Unit 43 Central Way, Arle Road, Cheltenham GL51 8LX

I. Donald

Gloucestershire Hospitals NHS Trust, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN

G.E. Smith

Health Protection Agency West Midlands, Second Floor, Lincoln House, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS

rinary catheterisation in care homes is associated with increased morbidity, hospitalisation and mortality. The authors aimed to determine whether staffing, resident underlying illness or nursing band, or use of other toileting methods were responsible for the wide variation in urinary catheterisation rates found in English care homes. The authors approached randomly-selected registered care homes in three former health districts in England. A questionnaire survey was used to determine the number of residents in each nursing care band and with different medical conditions that were catheterised, and the home's management of residents' continence. The number of residents or staffing did not influence catheterisation rate. Higher catheterisation rate homes had a lower proportion of high band nursing residents and residents with incontinence, severe physical disability and dementia than the other homes. Only urinary retention (3 per cent of residents) was significantly more common in the higher catheterisation rate homes. There was no difference in continence care before inserting a catheter. The authors suggest that care culture and staff attitudes to catheterisation should be explored in greater depth using structured interviews or focus groups. This may allow the identification of key factors that can be targeted in order to reduce catheterisation rates and the associated morbidity.

Key Words: Urinary catheterisation • care homes • community • elderly • guidance • questionnaire

British Journal of Infection Control, Vol. 7, No. 1, 22-28 (2006)
DOI: 10.1177/14690446060070010701


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