HOUDINI: Make that catheter disappear! Nurse Led Urinary Catheter Removal Protocol

Aneurin Bevan University Health Board

Urinary catheters are known to increase the daily risk of a urinary tract infection (UTI) by around 3-7% – the longer the catheter is in place, the greater the risk of a catheter-associated UTI (CAUTI). Urinary catheters are widely used in Welsh Hospitals - over 1000 Patients in Welsh Hospitals have a urinary catheter in place every day, while half of all patients with a healthcare associated UTI had a urinary catheter in place within seven days prior to onset of symptoms.

Colleagues at Aneurin Bevan University Health Board initiated a pilot project in two Community Hospital Wards with the aim to reduce urinary catheter use by 25% in six months, by ensuring that all patients with urinary catheters are reviewed daily for continuing indication according to the agreed HOUDINI criteria. The HOUDINI criteria to guide the daily review of continuing urinary catheter indication – facilitating timely removal of the urinary catheter as soon as it is no longer required, is based around the acronym H - Haematuria, O - Obstruction, U - Urological / Major Pelvic / Prolonger Surgery, D - Decubitus ulcer, I - Input / Output, N - Nursing (end of Life), I - Immobilisation / Neurogenic Bladder.

The two pilot wards reduced their catheter usage (catheter days per week) by 12% and 32% comparing catheter days per week from before the education intervention and afterwards. The successful pilot led to initiatives to ‘scale up and spread’ the project to other wards. Data from two of the subsequent wards following the pilot achieved 9% and 30% reductions in the number of ‘catheter days per week’.

Initial results indicate that the implementation of the project can achieve reductions in catheter usage and CAUTIs – ‘no catheter no CAUTI!’ Plans are in place to continue to promote and support the project roll-out, and to undertake further Plan-Do-Study-Act cycles to improve data collection.