AUGS CONFERENCE SUBMISSION
Postoperative Catheter Management After Pelvic
Reconstructive Surgery: A Survey of Practice Strategies
Sarah S. Boyd, MD,* Elena Tunitsky-Bitton, MD,* David M. O'Sullivan, PhD,† and Adam C. Steinberg, DO*
Objective: The aim of this study was to evaluate practice preferences
in catheter management after a failed inpatient voiding trial after pelvic
reconstructive surgery.
Methods: This is a cross-sectional study of postoperative catheter man-
agement after pelvic reconstructive surgery after failed voiding trial. Physi-
cians practicing at ACGME-accredited residencies and fellowships in
Obstetrics and Gynecology (Ob/Gyn), Urology, and Female Pelvic Medi-
cine and Reconstructive Surgery (FPMRS) within the United States com-
pleted a Web-based questionnaire in March 2017. Respondents were
asked about voiding trial protocols, definitions of abnormal postvoid resid-
ual (PVR), type of catheterization used after failed voiding trials, and anti-
biotic use. Primary outcome was type of catheterization after failure of an
inpatient voiding trial. Data were analyzed using χ2 statistical tests.
Results: One hundred five respondents had a mean age of 36.5 years
(range, 36 years). A total of 45.9% of participants practiced in FPMRS,
36.5% in Ob/Gyn, and 17.6% in Urology. Catheters were discontinued
most frequently by postoperative day 1 after all procedures. Distribution
of catheterization by specialty differed. Clean-intermittent straight catheter-
ization had the greatest prevalence in all specialties and was the highest, by
percentage, in Urology (33% Ob/Gyn, 40.6% FPMRS, and 69% Urology);
P = 0.026. Type of catheterization differed significantly between Ob/Gyn
and FPMRS respondents (P = 0.045). A total of 77.7% measured PVR
by ultrasound and 22.3% performed catheterization. This distribution was
similar across the specialties (70% Ob/Gyn, 79% FPMRS, and 100% Urol-
ogy; P = 0.092). Abnormal PVR was defined most frequently as 150 mL or
greater (30.5%). A minority of respondents routinely administer antibiotics
during catheterization (17.1%). Duration and time until repeat voiding trial
varied from 1 day to 2 weeks.
Conclusions: Practice variability in catheterization after pelvic recon-
structive and incontinence surgery is high. Distribution of catheterization
type by specialty varies significantly, with clean-intermittent straight cath-
eterization most prevalent. Future studies are necessary to establish a con-
sensus on optimal catheterization management technique for patients with
acute postoperative voiding dysfunction.
Key Words: catheter, pelvic organ prolapse,
postoperative voiding dysfunction
(Female Pelvic Med Reconstr Surg 2017;00: 00–00)
P ostoperative voiding dysfunction can complicate up to 42% of
pelvic reconstructive procedures, depending on the surgery.1
The occurrence of urinary retention is not isolated to pelvic recon-
structive cases alone because the reported incidence of postopera-
tive urinary retention in surgical patients overall ranges from 14%
to 16%.2 Adequate drainage of the bladder is imperative
From the Departments of *Female Pelvic Medicine and Reconstructive Surgery,
and †Research Administration, Hartford Hospital, Hartford, CT.
Reprints: Sarah S. Boyd, MD, Department of Female Pelvic Medicine and
Reconstructive Surgery, Hartford Hospital, 85 Seymour St, Suite 525,
Hartford, CT 06106. E‐mail: sarah.boyd@hhchealth.org.
The authors have declared they have no conflicts of interest.
IRB approved: HHC-2016-0239.
Supplemental digital content is available for this article. Direct URL citations
appear in the printed text and are provided in the HTML and PDF versions
of this article on the journal’s Web site (www.fpmrs.net).
Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
DOI: 10.1097/SPV.0000000000000542
Female Pelvic Medicine & Reconstructive Surgery • Volume 00, Number 00, Month 2017
Copyright © 2017 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
postoperatively because complications of urinary retention in-
cluding infection and urosepsis are responsible for up to 20% to
25% of unplanned admissions after outpatient surgery, and persis-
tent retention can further worsen voiding function in the long
term.1,2 Management of patients with acute postoperative voiding
dysfunction can include the placement of indwelling transurethral
catheters (TUC), suprapubic tubes (SPC), and clean intermittent
self-catheterization (CISC). Furthermore, TUC and SPC can be
managed with continuous drainage or with intermittent drainage
using catheter valves or manually using plastic plugs. Typically,
patients who fail voiding trials after pelvic reconstructive surgery
are discharged home with 1 of the aforementioned catheter man-
agement techniques until a repeat voiding trial is performed in
the office.
Specific practices of catheter management by physicians in
the perioperative period can vary widely including duration of
catheterization, use of prophylactic antibiotics, and timing of
voiding trials both during initial hospitalization and on discharge
home.3 Prior studies have individually assessed outcomes such
as infection rates, patient satisfaction, and cost-effectiveness of
specific catheterization techniques without consensus on optimal
method of catheterization postoperatively.4–8 As such, there is cur-
rently no standard of care on management of patients with voiding
trial failure after pelvic reconstructive surgery, and strategies are
often provider dependent. We present data from a survey of physi-
cians practicing at Accreditation Council of Graduate Medical Ed-
ucation (ACGME)-accredited residency and fellowship programs
in Urology, Obstetrics and Gynecology (Ob/Gyn), and Female
Pelvic Medicine and Reconstructive Surgery (FPMRS) on periop-
erative catheter management of patients undergoing pelvic recon-
structive and incontinence surgeries. Specifically, our primary
outcome was to assess the type of catheterization technique used
after failed inpatient voiding trial. Secondary outcomes included
characteristics of the hospitals and respondents surveyed as well
as criteria for the diagnosis of urinary tract infections and use of
antibiotics during catheterization.
MATERIALS AND METHODS
This was a cross-sectional study of postoperative catheter
management after pelvic reconstructive surgery after failed
voiding trial. A Web-based survey (see Supplemental Digital
Content, http://links.lww.com/FPMRS/A55) was sent to physicians
practicing at ACGME-accredited Urology, Ob/Gyn, and FPMRS
residencies and fellowships within the United States using the
ACGME email correspondence list. A reminder was sent to
nonresponders 1 and 2 months after the first request. Hartford
HealthCare Institutional Review Board approval was obtained be-
fore dissemination of surveys.
The questionnaire addressed physician characteristics including
age, specialty (eg, Urology, Ob/Gyn, or FPMRS), role (eg, attend-
ing, fellow, or resident), private or hospital-affiliated practice, and
number of years practicing medicine. Additional topics included
characteristics of the hospital, details of voiding trials including
specific procedures in which voiding trials are performed, the def-
inition of abnormal postvoid residual (PVR), measurement of
PVR (eg, ultrasound of bladder or straight catheterization), number
www.fpmrs.net 1
Boyd et al Female Pelvic Medicine & Reconstructive Surgery • Volume 00, Number 00, Month 2017

declared for all results yielding P value less than 0.05. The SPSS
TABLE 1. Characteristics of Survey Respondents (N = 105) v. 21 (IBM, Armonk, NY) was used for all data analyses.
Characteristic n (%)
RESULTS
Specialty of practice*
A total of 105 respondents completed surveys. Participants
- Ob/Gyn 27 (36.5)
had a mean age of 36.5 years (range, 36 years) and averaged
- FPMRS 34 (45.9) 5.7 years of clinical practice (range, 34 years). Table 1 shows char-
- Urology 13 (17.6) acteristics of the responding physicians.
Type of hospital Table 2 contains responses regarding type of catheterization
- University affiliated 88 (83.8) after voiding trial failure by specialty, region of practice, and hos-
- Community based 17 (16.2) pital setting. Distribution of catheterization by specialty differed.
Role of provider CISC had the greatest prevalence in all specialties and was the
- Resident 39 (37.1) highest, by percentage, in Urology (33% Ob/Gyn, 41% FPMRS,
- Fellow 28 (26.7) and 60% Urology; P = 0.026; Table 2). Type of catheterization dif-
- Attending 38 (36.2) fered significantly between Ob/Gyn and FPMRS respondents
(P = 0.045). There was no difference in type of catheterization
Region of practice
by region or hospital setting. Furthermore, there was no difference
- Northeast 37 (35.2) in type of catheterization when comparing physicians in Urology
- Midwest 23 (21.9) to Ob/Gyn (P = 0.125) or FPMRS (P = 0.219).
- South 38 (36.2) Table 3 depicts responses regarding initial duration of catheter
- West 7 (6.7) use based on procedures performed. Catheters were discontinued
most frequently (93.4%–98%) by postoperative day 1 across all
*n = 75.
procedures evaluated in the survey. Survey participants most fre-
quently performed voiding trials after incontinence procedures
of void attempts before voiding trial failure, and management of ab- and least frequently after vaginal hysterectomy alone and poste-
normal PVR including type of catheter, administration of antibi- rior repair alone (95% vs 57% and 59%, respectively).
otics, and duration of catheterization until repeat voiding trial. Table 4 shows the responses to questions regarding the as-
Providers were asked if their standard management included 1 of sessment and definition of abnormal PVR. The definition of ab-
the following techniques of postoperative catheterization: CISC, normal PVR varied. Responses included defined cutoffs ranging
TUC with continuous drainage, TUC drained intermittently by from 50 to 250 mL and proportions of urine voided out of volume
the patient (“plug-unplug” method or catheter valve), SPC, or pa- instilled. Measurement of PVR was performed most frequently
tient preference. In the plug-unplug method, the TUC is plugged using a bladder scanning device and least frequently by bladder
with a plastic cap and unplugged by the patient when she has an urge catheterization (77.7% vs 22.3%). However, this difference was
to urinate or at set time intervals. The plug-unplug method is similar not significant when comparing by specialty (P = 0.092). A total
in concept to catheter valves, which allow the intermittent drainage of of 48.6% of participants defined voiding trial failure after 1 mea-
urine from the bladder at the patient's discretion; however, the for- surement directly after the first void, whereas 37.1% performed 2
mer technique has not been evaluated in a controlled setting. measurements after 2 separate voids, and 2.9% defined voiding
Survey respondents were also asked their definition of urinary trial failure by 1 measurement after the patient's second void.
tract infection (UTI) and indications for antibiotic administration. When comparing measurement techniques for PVR and number
Descriptive data analyses included frequencies for nominal of measurements before voiding trial failure, there was no difference by
data and were reported as percentages. The χ2 tests were used for type of catheterization (P = 0.692 and P = 0.423, respectively).
comparison of categorical variables. Statistical significance was When asked to note duration of time until patients underwent a

TABLE 2. Type of Catheterization by Specialty, Hospital Setting, and US Region; n (%)

CD PUP CISC Patient Preference P*

Specialty (n = 69)
- Ob/Gyn 7 (29) 5 (21) 8 (33) 4 (17) 0.026
- FPMRS 9 (28) 0 13 (41) 10 (31)
- Urology 2 (15) 0 9 (60) 2 (15)
Hospital setting (n = 98)
- University affiliated 19 (23) 4 (5) 36 (43) 24 (29) 0.219
- Community based 6 (18) 2 (11) 5 (28) 2 (11)
Region of United States (n = 98)
- Northeast 7 5 18 7
- Midwest 8 1 7 6 0.340
- South 8 0 14 11
- West 2 0 2 2
*Values in bold are significant at less than 0.05.
CD indicates indwelling transurethral catheter to continuous drainage; and PUP, indwelling transurethral catheter to plug-unplug.

2 www.fpmrs.net © 2017 Wolters Kluwer Health, Inc. All rights reserved.

Copyright © 2017 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Female Pelvic Medicine & Reconstructive Surgery • Volume 00, Number 00, Month 2017 Preferences in Catheter Management

TABLE 3. Duration of Standard Initial Catheterization by Type of Surgery (%)

Type of Surgical Procedure

No. Postoperative Days AR (n = 103) PR (n = 102) A&P(n = 101) Apical (n = 96) Incontinence (n = 99)
0 45.7 46.7 31.4 18.8 68.7
1 50.5 46.7 62.9 79.2 29.3
2 0 0 0 0 0
3 1.9 1.9 1.9 1 1
Other 0 1.9 0 1 1
A&P indicates combined anterior and posterior repair; AR, anterior repair alone; and PR, posterior repair alone.

repeat voiding trial, participants most frequently reported imple-
mentation within 7 days of initial voiding trial failure (89%).
Table 5 depicts responses regarding antibiotic administration
after voiding trial failure. Respondents were allowed to mark all
that applied to their daily practice. Antibiotics were administered
most frequently based on urine culture alone (92.4%), with
58.1% of antibiotic therapy based on cultures with greater than
100,000 bacterial colony-forming units (CFU). A total of 17.1%
of survey participants routinely administered antibiotics during
or after catheterization.
DISCUSSION
Postoperative voiding dysfunction is common after pelvic re-
constructive surgery, and its management varies widely among
practitioners of all training levels.1,3 Commonly used techniques
for bladder drainage include CISC, SPC, and TUC managed with
either continuous drainage or intermittent drainage using catheter
valves or plugs. Standardizing short-term catheterization tech-
niques in patients with acute postoperative voiding dysfunction
is difficult because one must consider factors such as infection
risk, patient satisfaction, invasiveness of the method, impact on
surgical recovery, and cost. Current evidence to support the use
of each catheterization method is varied, making a consensus on
optimal method difficult to determine.
When evaluating patient satisfaction with surgical experi-
ence, the placement of a urinary catheter and use on hospital dis-
charge is a common area of dissatisfaction.9,10 A study by Elkadry
et al9 on patients' perceptions of postoperative outcomes reported
TABLE 4. Assessment and Definition of Abnormal PVR
Protocol N %
Technique of residual volume measurement
- Bladder scanner 80
- Catheterization 23
Definition of abnormal residual volume
- 50 mL 2 1.9
- 100 mL 22
- 150 mL 32
- 200 mL 24
- 250 mL 19
- Proportion voided > ½ of volume 29
instilled in bladder
- Proportion voided > 2/3 of volume 27
instilled in bladder
- Patient reported incomplete emptying 9 8.6
after fluid instilled in bladder
- Other 11
up to 9% of patients viewed postoperative catheterization as a sur-
gical complication, and 15% considered catheterization to be the
worst aspect of the surgical experience. At 1 year follow-up,
Mahajan et al10 found that 15% of patients from the original co-
hort continued to cite catheter-associated complaints as the worst
aspect of the surgical experience. Patient satisfaction with specific
catheter type is an area of limited study. One recent prospective
trial comparing valve catheters and traditional drainage catheters
found patients with valve catheters had better satisfaction overall
compared with drainage catheters and scored more favorably on
quality of life measures, specifically a decreased limitation in so-
cial activities and less frustration.4 With the current era of health
care quality improvement based largely on patient satisfaction
scores regarding hospital stay and interventions coupled with the
large percentage of patients that consider catheterization to be
one of the worst aspects of their hospital stay, further studies eval-
uating patient satisfaction with specific catheterization types are
necessary to optimize patient experience.
Regarding the rates of UTIs associated with types of cathe-
terization, a recent meta-analysis reported no difference in UTI
rates between SPC, CISC, and TUC if duration of catheterization
was less than 5 days.7 This analysis identified 14 randomized con-
trolled trials including 1391 patients. Four compared CISC with
TUC, 3 compared SPC with CISC, and 7 studies compared TUC
with SPC.7 There were no randomized controlled trials that directly
compared intermittent drainage catheter techniques with the other
methods. Similarly, a recent Cochrane review, including 42 trials
on short-term bladder catheterization defined as catheterization
for 14 days or less, determined there was not enough evidence
to conclude whether 1 route was superior in reducing UTI.11
The Cochrane review did conclude that SPC decreased the num-
ber of patients with asymptomatic bacteriuria, recatheterization,
76.2 TABLE 5. Antibiotic Administration After Voiding Trial Failure*
21.9
Indication for antibiotic therapy N %
Routinely during or after catheterization 18 17.1
21.0 Symptoms without confirmation of urinalysis or culture 20 19.0
30.5 Treatment based on urinalysis alone 70 66.7
22.9 - Leukocyte positive only 4 3.8
18.1 - Nitrite positive only 30 28.6
27.6 - Both nitrite and leukocyte positive 36 34.3
Treatment based on culture alone 97 92.4
25.7 - 1000 CFU on culture 8 7.6
- 10,000 CFU on culture 28 26.7
- 100,000 CFU on culture 61 58.1
10.5 *Responses are not mutually exclusive.

© 2017 Wolters Kluwer Health, Inc. All rights reserved. www.fpmrs.net 3

Copyright © 2017 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Boyd et al Female Pelvic Medicine & Reconstructive Surgery • Volume 00, Number 00, Month 2017
and pain compared with indwelling catheters. However, evidence
regarding SPC compared with intermittent catheterization was
lacking.11 Furthermore, evidence was inconclusive regarding
symptomatic UTI in the setting of SPC compared with indwelling
or intermittent urethral catheters. This review did not have suf-
ficient data to compare intermittent catheterization with in-
dwelling catheterization directly.7,11 Future high-quality studies
evaluating infection rates in the setting of intermittent drainage
catheters such as catheter valves, the plug-unplug technique, and
CISC are warranted.
The CISC was the most prevalent technique reported by all
respondents surveyed in the current study. Although evidence is
inconclusive regarding optimal short-term catheterization tech-
niques, both CISC and SPC have been shown to have lower rates
of UTI in patients requiring long-term catheterization compared
with indwelling transurethral catheters.7,12 In addition, CISC has
the advantage of decreased surgical complications compared with
SPC.12 Although respondents were not queried on reason behind
their choice of catheterization in patients who failed inpatient
voiding trials, CISC may have been more commonly chosen for
these reasons.
Hakvoort et al3 performed a similar survey of perioperative
catheter management across hospital systems within the Netherlands
in 2008. Surveys were distributed to entire hospital systems rather
than individual practitioners to assess presence of bladder cathe-
terization protocols, assessment, and management of abnormal
PVR. Whereas the current study assessment of individual practi-
tioners across the United States showed CISC to be the most com-
mon catheterization for postoperative voiding dysfunction, Hakvoort
et al3 found 57% of hospitals within the Netherlands preferred in-
dwelling transurethral catheters. In addition, all respondents in our
study reported removing postsurgical urethral catheters by postop-
erative day 1 regardless of the procedure performed, which is in
contrast to Hakvoort et al,3 who noted initial catheterization for
up to 3 days after anterior repair alone. A recent Cochrane review
stated a 5% cumulative daily risk of developing bacteriuria in the
setting of catheterization, with up to 20% of these patients devel-
oping symptomatic UTI.13 Limiting duration of catheterization to
no more than 24 hours greatly decreases the risk of symptomatic
UTI in this patient population, and our findings are consistent
with this recommendation.13,14
Similarities between the current study and that by Hakvoort
et al3 include the heterogeneity of responses regarding abnormal
PVR and routine administration of antibiotics during prolonged
catheterization by 20% of respondents in the Netherlands study
compared with 17% of respondents in the current study. The Cen-
ters for Disease Control (CDC) has strict definitions for symptom-
atic UTI, catheter-associated UTI and non–catheter-associated
UTI with the requirement in all definitions of “urine culture with
no more than 2 species of organisms identified, at least 1 of which
is a bacterium of greater than or equal to 105 CFU/mL”.15 It is
reassuring to note that whereas the majority of hospitals in the
Netherlands study diagnosed UTI by the presence of symptoms
alone, individual practitioners surveyed in the current study diag-
nosed and treated UTIs by urine culture (74% vs 92%), and 58.1%
of respondents diagnosed UTI by urine culture with presence of
greater than 105 CFU/mL of bacterium.
Strengths of our study include the even distribution of respon-
dents across all clinical training levels, individual responses, and the
evaluation of practice characteristics in 3 specialties that commonly
perform pelvic reconstructive and incontinence procedures.
Response bias is an important limitation inherent to survey
studies and is reflected in the complete survey response total
and may affect generalizability. Although surveys were completed
by respondents in all regions of the United States, the number of
4 www.fpmrs.net
Copyright © 2017 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
surveys completed by practitioners in the western United States
was low. Furthermore, surveys were distributed only to practitioners
in ACGME-accredited programs. Therefore, we cannot comment
on the practice of clinicians in nonteaching practices, which also
decreases the generalizability of our findings.
Postoperative catheter management among practicing physi-
cians in the fields of Urology, FPMRS, and Ob/Gyn widely vary.
Our findings show consistency with national guidelines of cathe-
ter management including the emphasis on shortened duration of
postoperative catheterization and limited use of antibiotic therapy
during catheterization unless urine culture results in growth of a
large volume of UTI-associated bacterium. In addition, the study
shows significant differences in distribution of responses in regards
to the type of catheterization after failed voiding trial. Clean-
intermittent straight catheterization was more prevalent among
all survey respondents and had the highest percentage of use
among urologists compared with other catheterization techniques.
The reason behind this choice for short-term catheterization is un-
clear considering the inconclusive evidence available regarding
superiority of a specific short-term catheterization technique. The
plug-unplug technique of catheter management has never been
studied in a clinical setting, and thus, future studies are necessary
to evaluate its efficacy in the management of patients with acute
postoperative voiding dysfunction. The optimal method of post-
operative catheterization has yet to be determined, and future stud-
ies to determine a superior method are necessary to reveal an
underlying clinical impact or improved patient satisfaction.
REFERENCES
1. Baessler K, Maher C. Pelvic organ prolapse surgery and bladder function.
Int Urogynecol J 2013;24(11):1843–1852.
2. Kowalik U, Plante MK. Urinary retention in surgical patients. Surg Clin
North Am 2016;96(3):453–467.
3. Hakvoort RA, Burger MP, Emanuel MH, et al. A nationwide survey to
measure practice variation of catheterisation management in patients
undergoing vaginal prolapse surgery. Int Urogynecol J Pelvic Floor
Dysfunct 2009;20(7):813–818.
4. Kandadai P, Duenas-Garcia OF, Pilzeck AL, et al. A randomized
controlled trial of patient-controlled valve catheter and indwelling foley
catheter for short-term bladder drainage. Female Pelvic Med Reconstr Surg
2016;22(2):88–92.
5. Sabbuba NA, Stickler DJ, Long MJ, et al. Does the valve regulated
release of urine from the bladder decrease encrustation and blockage of
indwelling catheters by crystalline proteus mirabilis biofilms? J Urol 2005;
173(1):262–266.
6. Jannelli ML, Wu JM, Plunkett LW, et al. A randomized controlled trial of
clean intermittent self-catheterization versus suprapubic catheterization after
urogynecologic surgery. Am J Obstet Gynecol 2007;197(1):72.e1–72.e4.
7. Han CS, Kim S, Radadia KD, et al. Comparison of urinary tract infection
rates associated with transurethral catheterization, suprapubic tube and
clean intermittent catheterization in the postoperative setting: a network
meta-analysis. J Urol 2017;198(6):1353–1358.
8. Tunitsky-Bitton E, Murphy A, Barber MD, et al. Assessment of voiding
after sling: a randomized trial of 2 methods of postoperative catheter
management after midurethral sling surgery for stress urinary incontinence
in women. Am J Obstet Gynecol 2015;212(5):597.e1–597.e9.
9. Eman AA, Kenton KS, Fitzgerald MP, et al. Patient-selected goals:
a new perspective on surgical outcome. Am J Obstet Gynecol 2003;
189(6):1551–1557.
10. Mahajan ST, Elkadry EA, Kenton KS, et al. Patient-centered surgical
outcomes: the impact of goal achievement and urge incontinence on
patient satisfaction one year after surgery. Am J Obstet Gynecol
2006;194(3):722–728.
© 2017 Wolters Kluwer Health, Inc. All rights reserved.
Female Pelvic Medicine & Reconstructive Surgery • Volume 00, Number 00, Month 2017 Preferences in Catheter Management

11. Kidd EA, Stewart F, Kassis NC, et al. Urethral (indwelling or intermittent)
or suprapubic routes for short-term catheterisation in hospitalised adults.
Cochrane database Syst Rev 2015;12:CD004203.
12. Healy EF, Walsh CA, Cotter AM, et al. Suprapubic compared with
transurethral bladder catheterization for gynecologic surgery: a systematic
review and meta-analysis. Obstet Gynecol 2012;120(3):678–687.
13. Lam TB, Omar MI, Fisher E, et al. Types of indwelling urethral catheters
for short-term catheterisation in hospitalised adults. Cochrane Database
Syst Rev 2014;9(9):CD004013.
14. Gould CV, Umscheid CA, Agarwal RK, et al. Guideline for prevention of
catheter-associated urinary tract infections 2009. Infect Control Hosp
Epidemiol 2010;31(4):319–326.
15. Centers for Disease Control and Prevention. Urinary tract infection
(catheter-associated urinary tract infection [CAUTI] and
non-catheter-associated urinary tract infection [UTI]) and other
urinary system infection [USI]) events. 2016 NHSN Patient Saf
Compon Man 2016:1–16. http://www.cdc.gov/nhsn/pdfs/pscmanual/
7psccauticurrent.pdf.

© 2017 Wolters Kluwer Health, Inc. All rights reserved. www.fpmrs.net 5

Copyright © 2017 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.