Urinary Tract Infection Rates

Associated with Re-Use of Catheters

In Clean Intermittent
Catheterization of Male Veterans
Annie J. Kannankeril, Hong T. Lam, Emily B. Reyes, Joe McCartney

rinary retention is the

inability to voluntarily
urinate leading to incomplete bladder emptying.
There are many causes of urinary
retention. Some of the major causes can be categorized as obstructive (benign prostatic hyperplasia,
prostate cancer), infectious or
inflammatory (prostatitis), neurologic (spinal cord injury), and
pharmacologic (anticholinergic
agents). Post-operative complications or acute trauma can also
cause urinary retention (Society
of Urologic Nurses and Associates
[SUNA], 2006). Regardless of the
cause, urinary retention must be
resolved. Unresolved retention
can lead to immediate consequences, such as severely decreased renal function, or more
chronic consequences, such as
formation of bladder stones, urine
tract infection (UTI), or renal dysfunction (Moy & Wein, 2007).

Annie J. Kannankeril, PharmD, is a

Clinical Pharmacist, Internal Medicine,
Advocate Christ Medical Center, Oak Lawn,
IL. At the time of the study, Dr. Kannankeril
was a pharmacy resident at the Jesse
Brown VA Medical Center, Chicago, IL.
Hong T. Lam, PharmD, is a Clinical
Pharmacy Specialist, Genitourinary and
Gastrointestinal Ambulatory Care, Jesse
Brown VA Medical Center, Chicago, IL.
Emily B. Reyes, BSN, RN, is a Registered
Nurse, Genitourinary Clinic, Jesse Brown
VA Medical Center, Chicago, IL.

Clean intermittent catheterization used to manage urinary retention can be

complicated by urinary tract infection (UTI). This retrospective study
describes the frequency of antibiotic-treated UTI in patients undergoing
intermittent catheterization. Most patients did not have UTI; this supports
findings in previous studies.
2011 Society of Urologic Nurses and Associates
Urologic Nursing, pp. 41-48.

Key Words: Urinary tract infection (UTI) intermittent catheterization,

antibiotic-treated UTI, clean intermittent catheterization
(CIC).

Introduction
Re-use of single-use catheters for intermittent catheterization is a common practice. At the Jesse Brown VA Medical
Center (JBVAMC), catheters are re-used
for one-week intervals. The frequency of
urinary tract infection (UTI) in this patient
population has not yet been established.
Purpose
To determine the frequency of antibiotictreated UTI associated with re-use of
catheters for clean intermittent catheterization (CIC) at JBVAMC.
Methods
A retrospective chart review of adult
males who re-use catheters for CIC was
conducted.

Results
The majority of patients undergoing CIC
(59.7%) did not have a UTI, while 40.3%
did have at least one UTI.
Conclusions
The results of this study are similar to
previously reported data on frequency of
UTI with CIC. Only the number of daily
catheterizations differed significantly
between patients who had a UTI and
those who did not. The mode was two
catheterizations per day for both groups.
Level of Evidence VI
(Melnyk & Fineout-Overholt, 2011)

Joe McCartney, BSN, RN, is a Registered Nurse, Genitourinary Clinic, Jesse Brown VA
Medical Center, Chicago, IL.
Acknowledgement: The authors would like to acknowledge the statistical support of the
University of Illinois at Chicago (UIC) Center for Clinical and Translational Science (CCTS)
which was funded in part by the National Center for Research Resources, National Institutes
of Health.

UROLOGIC NURSING / January-February 2011 / Volume 31 Number 1

41

Intermittent catheterization
(IC) is an effective management
option for incomplete bladder
emptying for those who are not
candidates for surgery or who
have failed medical management.
IC is performed by inserting a
catheter into the bladder to drain
urine. The catheter is then removed immediately after urine
drainage is complete (Getliffe,
Fader, Allen, Pinar, & Moore,
2007). This process may be
repeated several times a day,
depending on severity of the
retention. IC can be performed by
a patient with good manual dexterity and coordination, or by a
caregiver or health care personnel, such as a nurse.
Catheter-associated UTI (CAUTI)
is defined as UTI signs or symptoms
without another identified source of
infection along with at least 103
colony-forming units of bacteria
in one urine sample in patients
who have used a catheter within
the last 48 hours (Hooton et al.,
2010). Lower colony counts may
also be reasonably interpreted as
CAUTI if patients have symptoms. Signs and symptoms can be
local or systemic, and may
include fever, malaise, flank pain,
acute hematuria, dysuria, pelvic
discomfort, and urinary frequency. In catheterized patients,
asymptomatic pyuria is not diagnostic of UTI, nor is the presence
or absence of odorous or cloudy
urine. Guidelines stress that
asymptomatic bacteriuria should
not be treated except in cases
when urologic procedures are
planned or during pregnancy
because treatment will unlikely
result in clinical benefit and can
increase the rate of antibiotic
resistant (Drekonja & Johnson,
2008; Hooton et al., 2010). This
goal has been reaffirmed by the
U.S. Preventive Services Task
Force (2008), stating that asymptomatic bacteriuria should not be
treated. The Centers for Medicare
and Medicaid Services (CMS) also
made modification of hospital
reimbursement to eliminate payments to hospitals for treatment of
preventable complications, such
as CAUTIs (Wald & Kramer,
2007). If treatment is indicated,

42

according to the guidelines, the

duration of antimicrobial treatment is typically seven days for
patients with early resolution of
their symptoms and may be as
long as 10 to 14 days in patients
who have delayed response to
treatment.
There are many types of urinary catheters, ranging from latex
to non-latex and lubricated to
non-lubricated. They are made
and packed individually in sterile
packaging. Per industry standards, catheters are intended for
one-time use. However, they may
be cleaned and re-used because of
cost and concern for the environment.
Literature Review
Urethral catheterization may
be necessary for patients with
unresolved or unmanaged urinary
retention. Complications can
exist, and a UTI is the most common complication. Other reported
complications can be trauma from
catheterization, renal and bladder
stone formation, fistula formation,
and incontinence (Getliffe et al.,
2007; Warren, 1997). The duration
and type of catheterization are
important considerations to minimized catheter-associated complications. Types of catheterization
include indwelling urethral catheterization, intermittent catheterization, suprapubic catheterization,
and external catheters, such as
condom catheters. A prospective
study by De Ruz, Leoni, and
Cabrera (2000) looked at the incidence of bacteriuria and UTIs
with different types of catheterization in spinal cord injury patients.
The incidence of bacteriuria was
5/100 person-days for indwelling
catheter, 2.95 for clean intermittent catheter, 2.41 for external
catheter, and 0.96 for suprapubic
catheterization in this study
group. This study demonstrated
an incidence of UTI that was
2.72/100 person-days for indwelling catheter, 0.41 for clean
intermittent catheterization (CIC),
0.36 for external catheter, and
0.34 for suprapubic catheterization. The incidence of bacteriuria
and UTI appeared to be higher in

patients with indwelling catheters

than in those performing clean
intermittent catheterization (De
Ruz et al., 2000).
Avoidance of unnecessary
catheterization and prevention of
CAUTIs are a main focus in those
undergoing catheterization. The
Infectious Disease Society of
America (IDSA) and the European
and Asian guidelines recommend
using intermittent catheterization
rather than indwelling catheters
in appropriate patients due to
fewer complications (Hooton et al.,
2010; Tenke et al., 2008). In
patients undergoing intermittent
catheterization, different techniques have been considered, such
as sterile or clean technique, onetime or multiple-use catheters, or
coated (pre-lubricated) or uncoated catheters. In a 2007 Cochrane
Review (Moore, Fader, & Getliffe,
2007), there was no difference in
the risk of CAUTI with the use of
sterile or clean technique, single
or multiple-use catheters using
the clean technique, or the daily
or weekly use of the multiple-use
catheters. Further, these authors
did not show that using a prelubricated catheter helps in prevention of CAUTI (Moore et al.,
2007). The ISDA guidelines do
not recommend one technique
over another in the attempt to prevent CAUTI (Hooton et al., 2010).
Several modifiable risk-factors can be optimized to avoid
UTIs (Moy & Amsters, 2004).
These include avoiding bladder
distension from overfilling, using
frequent catheterizations, maintaining low residual bladder volume, ensuring good insertion
technique, and maintaining proper cleansing or discarding of used
catheters (Getliffe et al., 2007;
Moy & Amsters, 2004). Re-use of
catheters is common, but proper
cleaning of catheters for re-use has
not been clearly defined. Washing
with soap and water was reported
to decrease Escherichia coli
counts almost to zero in one study
(Lavalle et al., 1995). Besides
washing the catheter with soap
and water, it can also be boiled,
soaked in disinfectants, or
microwaved. Cleaned catheters
are air-dried and stored in plastic

UROLOGIC NURSING / January-February 2011 / Volume 31 Number 1

containers, Ziploc bags, or paper

bags (Getliffe et al., 2007).
Few studies have compared
the incidence of UTI in single-use
sterile catheters and re-used
catheters. A study conducted in a
spinal cord rehabilitation center
found 37% of patients developed
a symptomatic UTI using CIC,
while 45% (p > 0.05) developed
UTI using sterile catheterization
technique (Moore, Burt, &
Voaklander, 2006). One prospective study conducted in 80 male
veterans who undergo IC resulted
in treatment for symptomatic UTI
in 55% of patients who re-used
catheters for one-week intervals
and 62% in patients who did not
re-use catheters (Duffy et al.,
1995). The difference between
groups was not statistically significant. The study also found CIC
was more cost-effective than sterile catheterization. The recent
IDSA guidelines support the use
of clean, multiple-use catheters
over sterile, single-use catheters,
due to no increased risk of developing a UTI (Hooton et al., 2010).
Statement of the Problem
At the Jesse Brown VA
Medical Center (JBVAMC), CIC is
commonly recommended for
patients with urinary retention
who cannot be managed by medication or surgery. Patients are
provided education on how to
correctly insert a red rubber
catheter, how to remove and clean
the catheter, and how to store it
for re-use. Preparation for insertion includes washing hands and
the penis with water and soap,
and lubricating the catheter tip
with a water-based lubricant.
After use, the catheter should be
cleaned with water and soap, and
stored in a dry plastic container
for later use. Catheter care outlined for patients mimics the
guidelines for CIC provided by
SUNA (2006). Nurses at JBVAMC
are entrusted with providing
clean technique education upon
initiation of CIC and providing
documentation as a note in
patients electronic charts.
In December 2007, the Under
Secretary for Health issued an

informational letter to the Department of Veterans Affairs Veterans

Health Administration discussing
the policy of re-use of catheters.
The letter reinforced that re-use of
catheters for CIC has been successfully practiced for years. It
further states although the practice of re-use is common, the Food
and Drug Administration (FDA)
and manufacturers of catheters
consider them medical devices for
single use. The Under Secretary
for Health recommended using
catheters for CIC one time as the
manufacturer intends.
Purpose of the Study
The frequency of UTI in
patients with CIC who re-use
catheters for one-week intervals
has not yet been established. The
purpose of this study was to determine the frequency of UTI in male
patients associated with re-use of
catheters for CIC at JBVAMC.
Research Questions
The primary endpoint of this
study was the assessment of a UTI
present in an individual patient,
which was defined by the frequency of antibiotics prescribed
due to and for the treatment of
UTI. Secondary endpoints included medical specialty of the treating provider, rationale for antibiotic therapy, documentation of
clean technique education, frequency of antibiotic use associated with compliance of clean technique, the individual inserting
catheter (self vs. caretaker), and
number of daily catheterizations.
Methods

Sampling Technique
This study was a retrospective electronic chart review of
JBVAMC patients undergoing CIC
from January 1, 2002, to
December 31, 2007. A computergenerated list of patients receiving
red rubber catheters during the
study period was used to select
patients. This study was approved
by the institutions Investigational
Review Board (IRB). Patient con-

UROLOGIC NURSING / January-February 2011 / Volume 31 Number 1

sent was waived, since no patients were contacted, and there

was no follow up after the results
of the study were compiled.

Eligibility Criteria
Criteria for inclusion were
male veterans at JBVAMC, 18 years
of age and older, and who had used
CIC for at least three months.
Exclusion criteria were patients
taking prophylactic antibiotics and
those who sought care for catheter
management from a provider outside of the Veterans Health
Administration. Patients lost to follow up prior to three months of
CIC, patients who concurrently
used other forms of catheterization, and patients who explicitly
did not re-use catheters for oneweek intervals were also excluded.

Data Collection
All clinician notes and medication records of patients who
met eligibility criteria from
January 1, 2002, to December 31,
2007, were reviewed. Indication
for CIC, number of daily catheterizations, documentation of education regarding clean technique,
and patient compliance with
clean technique were gathered via
retrospective chart review. The
medical specialty of the treating
physician, rationale for antibiotic
use along with urinalysis and culture, and antibiotic prescribed
with length of treatment were also
included. Antibiotic use was
determined by reviewing outpatient prescriptions for antibiotics
during the study period, as well as
by reviewing clinician notes to
capture inpatient administration
of antibiotics. All other data were
also collected by reviewing clinician notes.
All data were manually
entered into a Microsoft Excel
spreadsheet by one investigator.
Patient identifiers were removed
from the data, and each patient
was linked to a unique study
number when compiled into the
spreadsheet. A master list linking
identifiers to a unique study number was stored in a secure, password-protected computer file on a
secure electronic network.

43

Data Analysis
All data were analyzed using
descriptive statistics to determine
primary and secondary outcomes.
An external statistician also analyzed individual catheter insertion and documentation of clean
technique education versus incidence of UTI using the Chisquared test. Age, average number
of daily catheterizations, and
length of catheterization were
analyzed using Wilcoxon RankSum test.

Characteristics of the Sample

Five-hundred, fifteen (515)
patients received red rubber
catheters from January 1, 2002, to
December 31, 2007, at JBVAMC.
Of these, 356 were excluded
because eligibility criteria were
not met (see Table 1). One hundred fifty-nine (159) patients
remained who were eligible for
inclusion in the study.
Characteristics of the sample
are listed in Table 2. The average
age of the 159 patients was 69
11.3 years. Average length of CIC
use was 26.1 months (range 3 to
144 months). Patients performed
catheterization from once per
month to eight times daily, with
an average of twice daily catheterization. Only six of the 159
patients (3.78%) had a caretaker
perform catheterization; all other
patients self-catheterized. The
most common reason for catheterization was urinary retention due
to benign prostatic hyperplasia
(BPH) followed by retention due
to urethral stricture.

Table 1.
Initial Study Population (N = 515); Excluded Patients (n = 356)
Number of
Excluded Patients

Reason for Exclusion

CIC less than 3 months

132

Never started CIC

121

Received care from outside provider

36

Lost to follow up

29

Refused CIC

13

Female patients

11

Using prophylactic antibiotics (long-term)

10

Also using condom catheter

Using single-use catheter

Total Excluded Patients

356

Table 2.
Final Study Population Patient Characteristics (N = 159)
Average Age

69 11.3 years

Average Length of CIC

26.1 months (range 3 to 144)

Number of Daily Catheterizations

Once/month 8 daily (mode = 2 daily)

CIC Performed by Self or Caretaker

Self = 153
Caretaker = 6
Education documented = 144
No documentation = 15

Documentation of Clean Technique

Education
Indication for CIC

BPH = 71
Urethral stricture = 40
Neurogenic bladder = 27
Bladder neck contracture = 15
Other = 6

Table 3.
Average Number of Daily Catheterizations (N = 159)
Number of Daily Catheterizations

No UTI (n = 95)

UTI (n = 64)

Less than 1

26 (27.4%)

11 (17.2%)

Results

23 (24.2%)

13 (20.3%)

Regarding the primary endpoint, 95 patients (59.7%) did not

have a UTI, while 64 patients
(40.3%) were given antibiotic for
the presumed UTI. In both
groups, patients most often catheterized twice daily (see Table 3).
However, the median number of
daily catheterizations was significantly higher in the UTI group
(see Table 4). The UTI group also
had more instances in which
clean technique education was
not documented by nursing or
medical staff (11% vs. 8% in the

28 (29.5%)

21 (32.8%)

10 (10.5%)

10 (15.6%)

44

(5.3%)

6 (9.4%)

(1.1%)

1 (1.6%)

(2.1%)

1 (1.6%)

1 (1.6%)

UROLOGIC NURSING / January-February 2011 / Volume 31 Number 1

Table 4.
Patient Characteristics UTI Group vs. No-UTI Group (N = 159)
Median (Interquantile Range)
Variable
Age

UTI = 0
(n = 95)

UTI > 0
(n = 64)

p Value*

70.00 (60.00, 77.00)

73.00 (64.00, 78.50)

0.2033

1.50 (0.50, 2.50)

2.00 (1.00, 3.00)

0.0241

16.00 (8.00, 33.00)

16.00 (9.00, 32.00)

0.7651

Average number of daily

catheterizations
Length of CIC (in months)

* p-value obtained by Wilcoxon Rank-Sum test

Figure 1.
Documentation of Clean Technique Education (N = 159)
UTI=0

UTI>0

8%

11%

92%

89%

Documentation Completed
No Documation

Table 5.
Patient Characteristics UTI Group vs. No-UTI Group (N = 159)
Percentage
Variable

UTI = 0
(n = 95)

UTI > 0
(n = 64)

1.0002

Self/Caretaker
Self
Caretaker

95.79

96.88

4.21

3.13
0.85581

Clean technique education

RN note

25.26

23.44

MD note

66.32

65.63

8.42

10.94

No documentation
1
2

p Value

p-value obtained by Chi-square test

p-value obtained by Fisher Exact test

UROLOGIC NURSING / January-February 2011 / Volume 31 Number 1

non-UTI group) (see Figure 1).

The majority of patients who had
caretakers perform the catheterization did not have a UTI (66.7%
vs. 33.3%) (see Table 5). The average age of patients in the non-UTI
group was 69 10.7 years versus
70 12.0 years in the UTI group.
The average length of CIC use was
similar between groups (26.2
months in the non-UTI group and
26.1 months in the UTI group).
In the UTI group, patients had
more UTIs during the first six
months of catheterization than the
second six months, as illustrated in
Figure 2. Of the 64 patients with
UTIs, some had multiple occurrences of UTI, totalling 147 cases of
UTIs. Of these, 82 (55.8%) UTIs
were treated with antibiotics
because patients complained of
symptoms of UTI with a positive
urinalysis and/or culture, 21
(14.3%) UTIs were treated for UTI
symptoms without a positive urinalysis or culture, and 43 (29.23%)
UTIs were treated for positive urinalysis and/or culture without
symptoms, but 11 of these were
treated because patients were
undergoing a genitourinary (GU)
procedure (such as a cystoscopy).
One patient (0.6%) was treated
prior to a procedure without UTI
symptoms or positive urinalysis or
culture. Therefore, in 103 (70%)
cases, antibiotics were given due to
symptoms, while in 44 (30%)
cases, antibiotic treatment was due
to positive urinalysis and/or culture or prior to a urologic procedure. Table 6 shows that most UTIs
were treated as outpatient by GU
service (n = 75), followed by primary care service (n = 56).

45

Figure 2.
Months Since Start of CIC When UTI Occurred (n = 64)
50

45

40
27

30
20
10
0

0-6

Months

7 - 12

Table 6.
Prescribing Provider for UTI Treatment (n = 64)
Prescribing
Service
Number
of UTIs

Genitourinary Primary Care

Service
Provider
75

56

ER
Physician

Inpatient
Physician

Table 7.
Number of UTIs per Patient (n = 64)
Number of UTIs

Number of Patients

27

18

Greater than 5

Multiple
UTIs
(n = 37)

Note: Total of 147 case of UTIs.

The majority of patients with

UTIs had multiple UTIs (see Table
7). In Tables 8 and 9, patients were
divided into groups based on the
number of UTIs recorded; patient
characteristics were then assessed
for each group. The number of
UTIs was not significantly affected by patient characteristics.
Discussion
In this study, all patients
underwent CIC, but not all
required antibiotic treatment for
UTI. The majority (59.7%) of
patients did not have a UTI, while
40.3% of the study population
were given at least one course of
antibiotics. The actual number of
UTIs may be less because some
courses of antibiotics were given
46

due to positive urinalysis/culture

or prior to urologic procedure.
This is similar to UTI rates found
in other studies (Duffy et al., 1995;
Getliffe, et al., 2007). UTIs were
slightly more common in patients
who did not have documented
clean technique education; however, this difference was not statistically significant. In this retrospective study, it is unclear if
patients who did not have education documented actually did not
receive education regarding technique for CIC. Compliance with
clean technique was rarely documented; thus, results for this
parameter were not included.
Proper care and disposal of
catheters are important to help
reduce the risk of UTIs; providers
should assure that clean tech-

nique is used, especially in

patients who have multiple UTIs
(Getliffe et al., 2007). The majority
of patients in this study who had
caretakers perform catheterization
did not have UTIs, although
observations were limited. This
finding may be the result of several factors, including improved
dexterity of the caregiver and
more attention to catheter care
and insertion technique while
caring for loved ones.
The average length of CIC use
was similar between non-UTI and
UTI groups; it appears patients
who use CIC for several years are
not at more risk of a UTI than
patients only performing CIC for a
few months. The same is true for
the number of daily catheterizations, which was the only characteristic significantly different
between UTI and non-UTI groups.
Although there was a difference,
the average for both groups was
two catheterizations per day. It is
sometimes assumed that more frequent daily catheterization would
lead to more incidence of UTIs;
however, this was not a finding of
this study. No connection
between the number of daily
catheterizations and number of
UTIs per patient was found in this
current study. It could be that
patients should self-catheterize as
often as is necessary to avoid
bladder over-distension, and
reducing the number of daily
catheterizations may not affect
UTI risk. The number of UTIs
decreased after the first six
months of catheterization compared to the second six months. It
must be noted that UTIs prior to
2002 were not assessed, even
though some patients were utilizing CIC prior to the study period,
so this parameter may be skewed.
However, a decrease in UTIs is
likely because patients become
familiar with technique and
catheter care over time, leading to
less traumatic or contaminated
catheterizations.
Seventy percent (70%) of
UTIs were treated due to symptoms, which is appropriate in
catheterized patients. Although
30% of patients with an asymptomatic UTI were given an antibiot-

UROLOGIC NURSING / January-February 2011 / Volume 31 Number 1

Table 8.
Patient Characteristics vs. Number of UTIs (n = 64)
Median (Interquantile Range)
Variable

UTI = 1
(n = 27)

UTI = 2
(n = 18)

UTI = 3
(n = 8)

UTI = 4
(n = 6)

UTI = 5
(n = 5)

p Value*

75.00
(63.00, 80.00)

72.50
(64.00, 77.00)

69.00
(67.00, 71.50)

74.50
(59.00, 77.00)

76.00
(65.00, 80.00)

0.7064

Average number of
daily catheterizations

2.00
(0.50, 3.00)

2.00
(1.00, 3.00)

2.00
(1.00, 2.41)

2.50
(1.50, 3.50)

2.50
(2.00, 3.00)

0.6882

Length of CIC

15.00
(5.00, 31.00)

13.50
(9.00, 36.00)

20.50
(13.50, 46.00)

17.50
(16.00, 20.00)

60.00
(26.00, 72.00)

0.1138

Age

* p-value obtained by Kruskal-Wallis Test

Table 9.
Secondary Endpoint Data vs. Number of UTIs (n = 64)
Percentage
Variable

UTI = 1
(n = 27)

UTI = 2
(n = 18)

UTI = 3
(n = 8)

UTI = 4
(n = 6)

UTI 5
(n = 5)

1.0002

Self/Caretaker
Self
Caretaker

96.30

94.44

100.00

100.00

100.00

3.70

5.56

0.00

0.00

0.00
0.72591

Clean technique education

1
2

p Value

RN note

25.93

11.11

25.00

33.33

40.00

MD note

11.11

22.22

0.00

0.00

0.00

No docuementation

62.96

66.67

75.00

66.67

60.00

p-value obtained by Chi-square test

p-value obtained by Fisher Exact test

ic due to a positive urinalysis

and/or culture, 9% were undergoing an outpatient GU procedure,
thus necessitating the need for a
sterile bladder prior to the procedure. Most UTIs were treated by
GU service, which is to be expected in this patient population,
which is closely followed by GU
practitioners.
Limitations
There were several limitations to this study. First, as a retrospective analysis, conclusions are
based heavily on documentation
that is not always complete or
objective. Although patients were
counseled to re-use catheters for
one-week intervals, compliance
with one-week re-use was not
assessed in this study. Some
patients may have re-used catheters for longer or shorter periods
unknown to the investigators.

Only UTIs treated at JBVAMC

were captured, and any UTIs that
occurred in study patients prior to
2002 were not counted. Without
these two factors, data might
under-represent the actual number of UTIs in this patient population.
The decision to treat was
based on provider judgment and
not on any facility-wide protocol
or guideline, which is another
limitation. Study data suggest the
majority of patients were treated
due to symptoms of UTI with or
without positive laboratory findings, and this is consistent with
published guidelines (Hoorton, et
al., 2010). However, without a
standardized practice policy, it is
uncertain whether all cases of
symptomatic UTI or bacteriuria
were managed in the same way by
different providers.

UROLOGIC NURSING / January-February 2011 / Volume 31 Number 1

Implications
Despite these limitations,
findings from this study are of
interest and can be expanded in
the future. Since the informational letter from the Under Secretary
for Health was issued, the
JBVAMC has now begun providing patients with catheters for single-use. It would be interesting to
study the frequency of UTIs in the
single-use catheter and compare
these data to the current study,
noting if there are any changes
incidence of UTIs.
After initiation of this study,
CMS also began mandating insurance coverage of up to 200
catheters per month for patients
who intermittently catheterize to
avoid re-use of catheters (Howard,
2009). These recommendations
contrast with IDSA guidelines,
which state the re-use of catheters
is acceptable, as well as with this
current study results showing the
47

majority of patients who undergo

CIC do not have UTI. Future studies looking at frequency of UTI in
the single-use catheter population
may be conducted and compared
to the current study to assess any
differences between these patient
populations.
Urethral catheterization will
remain a logical option in the
management of urinary retention.
Management of CAUTI can be
challenging because published
studies seem to vary on the definition and treatment of CAUTIs and
catheter-associated asymptomatic
bacteriuria. Discrepancies exist
between treatment guidelines and
clinical practice, but awareness of
the issue can bring some focus to
the care of these patients.
References
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(2000). Epidemiology and risk factors
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Moore, K.N, Fader, M., & Getliffe, K. (2007).

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UROLOGIC NURSING / January-February 2011 / Volume 31 Number 1

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