Quality Improvement Initiative: Foley Catheters in Patients Undergoing Pectus Deformity Repair

Background and Hypothesis: Pectus excavatum and carinatum are sternal deformities that often require surgeries with significant postoperative pain that can limit a patient’s ability to void. An indwelling urinary catheter is placed for the operation, but is often removed on the first postoperative day due to concerns of infection, which begs the necessity of these catheters in the first place. In this study, we hypothesized that there would be no increased risk of urinary retention or urinary tract infection irrespective of whether urinary catheters were utilized. Experimental Design: A pre/post quality improvement study was undertaken of patients undergoing pectus excavatum/carinatum repair between June 1, 2015 and May 31, 2022. The pre intervention group spanned from June 1, 2015 to May 31, 2021, where Foley catheters were placed intraoperatively and removed the first postoperative day. Pediatric surgery and anesthesia groups changed practice effective June 1, 2021 and decided to no longer utilize urinary catheters in pectus repairs. Pre-intervention patients were acquired through the surgery billing database. Post-intervention patients were acquired prospectively. Rates of urinary retention (any event requiring mechanical intervention for voiding) and urinary tract infections (UTI, >100,000 CFU bacteria/mL urine) were compiled into REDCap. Data are expressed as percent of the total cohort. Results: Of 179 patients undergoing pectus repair (162 Excavatum, 17 Carinatum), 12 patients (6.7%) in the pre-intervention group experienced urinary retention. Of these, 9 received in/out catheterization, 1 had a Foley catheter replaced, and 2 underwent in/out catheterization and had a Foley replaced. There were no urinary tract infections recorded among the pre-intervention group. Conclusion and Potential Impacts: Urinary retention and UTI are rare in patients who have an indwelling urinary catheter. Data acquired over the next year from the post-intervention group will help determine the true necessity for these catheters in the perioperative pectus population.

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Implementation of a Female External Urinary Catheter Reduces Indwelling Urinary Catheter Use and Catheter-Associated Urinary Tract Infections

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1158 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s482-s483

Author(s):

Paul Gentile ◽

Jesse Jacob ◽

Shanza Ashraf

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Urinary Catheter ◽

Improve Patient Safety ◽

Academic Medical Center ◽

Secondary Outcome ◽

Successful Implementation ◽

Urinary Catheters ◽

Tract Infections ◽

The Impact

Background: Using alternatives to indwelling urinary catheters plays a vital role in reducing catheter-associated urinary tract infections (CAUTIs). We assessed the impact of introducing female external catheters on urinary catheter utilization and CAUTIs. Methods: In a 500-bed academic medical center, female external catheters were implemented on October 1, 2017, with use encouraged for eligible females with urinary incontinence but not meeting other standard indications for urinary catheters. Nurses were educated and trained on female external catheter application and maintenance, and infection prevention staff performed surveillance case reviews with nursing and medical staff. We determined the number of catheter days for both devices based on nursing documentation of device insertion or application, maintenance, and removal. We used the CAUTI and DUR (device utilization ratio) definitions from the CDC NHSN. Our primary outcomes were changes in DUR for both devices 21 months before and 24 months after the intervention in both intensive care units (ICUs) and non-ICU wards. We used a generalized least-squares model to account for temporal autocorrelation and compare the trends before and after the intervention. Our secondary outcome was a reduction in CAUTIs, comparing females to males. Results: In total, there were 346,213 patient days in 35 months. The mean rate of patient days per month increased from 7,436.4 to 7,601.9 after the implementation of female external catheters, with higher catheter days for both urinary catheters (18,040 vs 19,625) and female external catheters (22 vs 12,675). After the intervention, the DUR for female external catheters increased (0 vs 0.07; P < .001) and for urinary catheters the DUR decreased (0.12 vs 0.10; P < .001) (Fig. 1). A reduction in urinary catheter DUR was observed in ICUs (0.29 vs 0.27; P < .001) but not wards (0.08 vs 0.08; P = NS) (Fig. 2). Of the 39 CAUTIs, there was no significant overall change in the rate per 1,000 catheter days (1.22 vs 0.87; P = .27). In females (n = 20 CAUTI), there was a 61% reduction in the CAUTI rate per 1,000 catheter days (0.78 vs 0.31; P = .02), but no significant change in the rate in males (0.44 vs 0.56; P = .64). The CAUTI rate per 1,000 catheter days among females decreased in the ICUs (1.14 vs 0.31; P = .04) but not in wards (0.6 vs 0.33; P = .96). Conclusions: In a setting with a baseline low UC DUR, successful implementation of female external catheters further modestly reduced UC DUR and was associated with a 61% decrease in CAUTI among females in the ICU but not in wards. Further interventions to better identify appropriate patients for female external catheters may improve patient safety and prevent patient harm.Funding: NoneDisclosures: None

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592 Prevention of CAUTIs in a Burn ICU

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.218 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S138-S138

Author(s):

Vina Vargas ◽

Emiko Rivera ◽

Teresa Sidhu ◽

Lea Lyn Zaballero ◽

Yvonne L Karanas

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Infection Prevention ◽

Urinary Catheter ◽

Antimicrobial Use ◽

Research To Practice ◽

Urinary Catheters ◽

Open Forum ◽

Excellent Care ◽

Tract Infections

Abstract Introduction Catheter-associated urinary tract infections (CAUTIs) are the most common hospital-associated infection (HAI). Urinary catheter use is associated with urinary tract infections (UTIs) that can lead to complications such as cystitis, pyelonephritis, bacteremia, septic shock, and death. CAUTIs are associated with an excess length of stay of 2–4 days, increase costs of $0.4–0.5 billion per year nationally, and lead to unnecessary antimicrobial use. Through numerous implementations, a Burn ICU was able to drastically decrease their incidence of CAUTIs. Methods A Burn ICU implemented several interventions to reduce CAUTI rates. These interventions included: Results When this project was initiated in September of 2017, there were 9 CAUTIs identified in a Burn ICU, per the hospital’s Infection Prevention Department. By the end of 2017, there were 11, which equated to a rate of 14.67 per 1000 urinary catheter days. In 2018, the Burn ICU had 1 CAUTI, with a rate of 1.92 per 1000 urinary catheter days. In 2019 (through quarter 2), the Burn ICU has not had a CAUTI per the Infection Prevention Department. We believe the interventions made have drastically decreased the incidence of CAUTIs. Conclusions A Burn ICU implemented many new practices in 2017 when the CAUTI rate and SIR were above the hospital’s overall SIR. The Burn ICU staff now practice proper care and maintenance of urinary catheters and continue to provide excellent care. Although we have decreased our incidence of CAUTIs for 2018 and 2019, it is equally important we sustain this improvement. Therefore, we will continue to provide an open forum for discussion with staff so we can all do our part in keeping patients safe. Applicability of Research to Practice A Burn ICU decreased the incidence of CAUTIs by educating staff on proper care and maintenance of urinary catheters, removing catheters as soon as possible, and testing for UTIs upon admission to determine the patient’s baseline. By doing so, CAUTI rates went from 14.67 to 0 per 1000 urinary catheter days.

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Preventing Catheter-Associated Urinary Tract Infections in the Pediatric Intensive Care Unit

Critical Care Nurse ◽

10.4037/ccn2020438 ◽

2020 ◽

Vol 40 (1) ◽

pp. e12-e17

Author(s):

Megan D. Snyder ◽

Margaret A. Priestley ◽

Michelle Weiss ◽

Cindy L. Hoegg ◽

Natalie Plachter ◽

...

Keyword(s):

Intensive Care Unit ◽

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Urinary Tract Infections ◽

Urinary Catheter ◽

Pediatric Intensive Care ◽

Urinary Catheters ◽

Bundle Compliance ◽

Tract Infections

Background Catheter-associated urinary tract infections are common health care–associated infections and have been associated with increased mortality, morbidity, length of stay, and cost. Prevention strategies are grouped into bundles focused on reducing unnecessary catheter use and promptly removing urinary catheters. Before intervention in the study institution, no urinary catheters were unnecessarily used and compliance with the catheter-associated urinary tract infection bundle was 84%. Objective To increase bundle compliance by using targeted rounds specifically focused on eliminating dependent loops in drainage tubing and ensuring appropriate catheter use to reduce the incidence of catheter-associated urinary tract infections. Methods A multidisciplinary team was formed to identify misperceptions, highlight best practices, and eliminate barriers to success over 1 year in a single pediatric intensive care unit. The team completed a quality improvement project of daily targeted rounding for patients with an indwelling urinary catheter. The goals were to assess appropriateness of catheterization, increase bundle compliance, and decrease catheter-associated urinary tract infection risk. Targeted rounds were conducted in addition to the medical team rounds. Results Bundle compliance supported by targeted rounding increased from 84% to 93% and helped reduce the overall catheter-associated urinary tract infection rate from 2.7 infections per 1000 catheter-days at baseline to 0. This change was sustained for 1 year. Conclusion Targeted rounding for pediatric patients with an indwelling urinary catheter is an effective and sustainable strategy to reduce catheter-associated urinary tract infections. The ease of implementation for this intervention lends itself to generalizability to other patient populations.

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A Multimodal Intervention to Reduce Urinary Catheter Use and Associated Infection at a Veterans Affairs Medical Center

Infection Control and Hospital Epidemiology ◽

10.1086/670624 ◽

2013 ◽

Vol 34 (6) ◽

pp. 631-633 ◽

Cited By ~ 11

Author(s):

Brady L. Miller ◽

Sarah L. Krein ◽

Karen E. Fowler ◽

Karen Belanger ◽

Debbie Zawol ◽

...

Keyword(s):

Quality Improvement ◽

Urinary Tract ◽

Urinary Tract Infections ◽

Urinary Catheter ◽

Medical Center ◽

Veterans Affairs ◽

Quality Improvement Intervention ◽

Tract Infections ◽

The Impact ◽

Improvement Intervention

We assessed the impact of a quality improvement intervention to reduce urinary catheter use and associated urinary tract infections (UTIs) at a single hospital. After implementation, UTIs were reduced by 39% (P = .04). Additionally, we observed a slight decrease in catheter use and the number of catheters without an appropriate indication.

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Using A Criteria-Based Reminder To Reduce Use Of Indwelling Urinary Catheters And Decrease Urinary Tract Infections

American Journal of Critical Care ◽

10.4037/ajcc2013464 ◽

2013 ◽

Vol 22 (2) ◽

pp. 105-114 ◽

Cited By ~ 27

Author(s):

Yin-Yin Chen ◽

Mei-Man Chi ◽

Yu-Chih Chen ◽

Yu-Jiun Chan ◽

Shin-Shang Chou ◽

...

Keyword(s):

Urinary Tract ◽

Relative Risk ◽

Urinary Tract Infections ◽

Intervention Group ◽

Utilization Rate ◽

Control Group ◽

Urinary Catheterization ◽

Urinary Catheters ◽

Urinary Infections ◽

Tract Infections

Background Duration of indwelling urinary catheterization is an important risk factor for urinary tract infection. Objectives To determine whether a reminder approach reduces the use of urinary catheters and the incidence of catheter-associated urinary tract infections. Methods A randomized control trial was performed in 2 respiratory intensive care units in a 2990-bed tertiary referral medical center. Patients who had urinary catheters in place for more than 2 days from April through November 2008 were randomly assigned to either the intervention group (use of a criteria-based reminder to remove the catheter) or the control group (no reminder). Results A total of 278 patients were recruited. Utilization rate of indwelling urinary catheters was decreased by 22% in the intervention group compared with the control group (relative risk, 0.78; 95% CI, 0.76-0.80; P < .001). The intervention significantly shortened the median duration of catheterization (7 days vs 11 days for the control group; P < .001). The success rate for removing the catheters in the intervention group by day 7 was 88%. The reminder intervention reduced the incidence of catheter-associated infections by 48% (relative risk, 0.52; 95% CI, 0.32-0.86; P = .009) in the intervention group compared with the control group. Conclusions Use of a criteria-based reminder to remove indwelling urinary catheters can diminish the use of urinary catheterization and reduce the likelihood of catheter-associated urinary infections. This reminder approach can prevent catheter-associated urinary infections, and its use should be strongly considered as a way to enhance the safety of patients. (American Journal of Critical Care. 2013;22:105–114)

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In Situ Deposition of Green Silver Nanoparticles on Urinary Catheters under Photo-Irradiation for Antibacterial Properties

Processes ◽

10.3390/pr8121630 ◽

2020 ◽

Vol 8 (12) ◽

pp. 1630

Author(s):

Fueangfahkan Chutrakulwong ◽

Kheamrutai Thamaphat ◽

Sukon Tantipaibulvut ◽

Pichet Limsuwan

Keyword(s):

Silver Nanoparticles ◽

Antibacterial Activity ◽

Urinary Tract ◽

Urinary Tract Infections ◽

Urinary Catheter ◽

Silver Content ◽

High Price ◽

Urinary Catheters ◽

Tract Infections ◽

Durian Rind

Urinary tract infections, especially catheter-associated urinary tract infections (CAUTIs), are the most common type of nosocomial infections. Patients with chronic indwelling urinary catheters have a higher risk of infection due to biofilm formation on the urinary catheter surface. Therefore, in this work, a novel, cost-effective antimicrobial urinary catheter was developed using green technology. Silver nanoparticles (AgNPs) synthesized from Mon Thong durian rind waste were used as an antimicrobial agent for the prevention of infection. Flavonoids, phenolic compounds, and glucose extracted from durian rind were used as a reducing agent to reduce the Ag+ dissolved in AgNO3 solution to form non-aggregated AgNPs under light irradiation. The AgNPs were simultaneously synthesized and coated on the inner and outer surfaces of silicone indwelling urinary catheters using the dip coating method. The results showed that the antimicrobial urinary catheter fabricated using a 0.3 mM AgNO3 concentration and 48 h coating time gave the highest antibacterial activity. The as-prepared spherical AgNPs with an average diameter of 9.1 ± 0.4 nm formed on catheter surfaces in a monolayer approximately 1.3 µm thick corresponding to a 0.712 mg/cm2 silver content. The AgNP layer was found to damage and almost completely inhibit the growth of Escherichia coli cells with antibacterial activity by 91%, equivalent to the commercial, high-price antimicrobial urinary catheter. The cumulative amount of silver released from the coated catheter through artificial urine over 10 days was about 0.040 µg/mL, which is less than the silver content that causes tissue and organ toxicity at 44 µg/mL. Thus, we concluded that the developed antimicrobial urinary catheter was useful in reducing the risk of infectious complications in patients with indwelling catheters.

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Guideline compliance related to indwelling urinary catheters in 43 Norwegian nursing homes - findings and implications

10.7287/peerj.preprints.1820v1 ◽

2016 ◽

Author(s):

Laila Aarnes ◽

Karin Harris ◽

Aase I Skaare ◽

John R Andersen

Keyword(s):

Health Care ◽

Urinary Tract ◽

Nursing Homes ◽

Quality Assessment ◽

Urinary Tract Infections ◽

Best Practice ◽

Urinary Catheter ◽

Urinary Catheters ◽

Tract Infections ◽

Indwelling Urinary Catheter

Background For patients in health institutions urinary tract infections often have significant negative health consequences. Indwelling urinary catheters and inappropriate practice related to this is a strong risk factor for urinary tract infections. Thus, a national guideline promotes best practice for handling indwelling urinary catheters. The aim of this study was to assess the prevalence of patients with indwelling urinary catheters in 34 Norwegian nursing homes. Furthermore, we wanted to study whether health professionals followed the national guidelines related to indwelling urinary catheters. If the study reveals room for improvements, it may indicate interventions can contribute to improvements in the health care institutions. Methods We conducted a quantitative survey in health care professionals who worked in nursing homes in from Sogn og Fjordane county (Norway), and asked them how to which extent guidelines related to indwelling urinary catheters were used in at their work place. The study also included data on the prevalence of indwelling urinary catheters in 830 patients (565 women and 265 men) in the 34 nursing homes. We also conducted a clinical audit in these nursing homes in order to study the how the guidelines were implemented. An overall assessment was made (satisfactory or not satisfactory) on whether 11 dimensions of the guidelines were followed (Table 2). When ≥ 80% of the nursing homes had a score = yes/usually to the items above it was considered satisfactory. The evaluations from the clinical audits were based on an overall judgment of the finding at the nursing homes. The study was approved by the Western Norway Hospital Trust as part of a quality assessment strategy. An approval from the regional ethical committee was not needed as the study was a quality assessment project and did not include any individual patient data. Results Our findings shows that 92 of 830 patients had a indwelling urinary catheter the day of prevalence assessment, and significantly more men (21.1%) than women (6.7%) had a indwelling urinary catheter (Fisher's exact test; P <0.001. Overall, the survey showed that compliance with the guidelines was unsatisfactory with one exception; the doctor prescribed the posting of indwelling urinary catheters (Table 2 and 3). Conclusions In conclusion, most areas we investigated need improvements. The survey itself may be a key to change the nursing staff`s attitudes and culture and to gain increased competence. In addition, it seems necessary to have good data solutions as well as leadership anchoring in further work on implementing best practice in handling indwelling urinary catheters. w

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1464. The Utility of Double Balloon Urinary Catheter in Reducing Rates of Catheter-Associated Urinary Tract Infections in a Tertiary Care Teaching Hospital

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1328 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S534-S534

Author(s):

Ju Hee Katzman ◽

Cristina Vanessa Garcia ◽

Seetha Lakshmi ◽

Peggy Thompson ◽

Lennox Archibald

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Urinary Catheter ◽

Temperature Sensing ◽

Hospital Length Of Stay ◽

Urinary Catheters ◽

Double Balloon ◽

Catheter Design ◽

History Of ◽

Tract Infections

Abstract Background Catheter-associated urinary tract infections (CAUTI) have been shown to increase hospital length of stay, healthcare costs, morbidity, and mortality. Studies that evaluate the role of urinary catheter design in preventing CAUTI are lacking. One such design is the double-balloon (DB) urinary catheter that has a second distal balloon; this design is aimed at reducing mucosal injury and inhibiting coiling of the in situ catheter. We carried out a comparative study to (a) determine whether CAUTI rates differ for different types of urinary catheters, and (b) identify risk factors associated with the acquisition of CAUTI in patients with DB vs. non-double-balloon (NDB) urinary catheters. Methods We conducted a retrospective cohort study of all patients who acquired CAUTI from January 2017 through December 2018. We collected age, sex, body mass index, medical history including benign prostatic hypertrophy, urinary tract infection (UTI), prostate cancer, stroke, surgery within the last 30 days including the type of surgery, indication for indwelling urinary catheter, location of catheter insertion, duration of catheterization, presence of pyuria, and type of catheter used. Statistical analyses were carried out using IBM SPSS software. Test statistics included independent sample t-test. CAUTI rates were expressed per 1000 catheter-days. Results Sixty-seven patients acquired CAUTI during the study period. NDB catheters included the following types: Foley, temperature sensing catheters, and coude catheters. Patients with DB and NDB catheters were similar in age, gender, diabetes, history of stroke, history of recent surgery, or history of UTI. CAUTI rates among patients with the DB catheters was 28 events per 29,018 catheter-days vs. 39 events per 33,579 catheter days for NDB type (P = NS). On stratification, CAUTI rates for foley, temperature sensing catheters, and coude catheters were 1.12, 1.27 and 2.70, respectively (P = NS). Conclusion There were no statistically significant differences in CAUTI rates at our facility among patients with DB vs. NDB urinary catheters. The decision on the choice of the catheter for use in our facility will likely depend on the comparative costs of the respective catheters. Disclosures All authors: No reported disclosures.

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Guideline compliance related to indwelling urinary catheters in 34 Norwegian nursing homes - findings and implications

10.7287/peerj.preprints.1820 ◽

2016 ◽

Author(s):

Laila Aarnes ◽

Karin Harris ◽

Åse I Skare ◽

John R Andersen

Keyword(s):

Health Care ◽

Urinary Tract ◽

Nursing Homes ◽

Quality Assessment ◽

Urinary Tract Infections ◽

Best Practice ◽

Urinary Catheter ◽

Urinary Catheters ◽

Tract Infections ◽

Indwelling Urinary Catheter

Background For patients in health institutions urinary tract infections often have significant negative health consequences. Indwelling urinary catheters and inappropriate practice related to this is a strong risk factor for urinary tract infections. Thus, a national guideline promotes best practice for handling indwelling urinary catheters. The aim of this study was to assess the prevalence of patients with indwelling urinary catheters in 34 Norwegian nursing homes. Furthermore, we wanted to study whether health professionals followed the national guidelines related to indwelling urinary catheters. If the study reveals room for improvements, it may indicate interventions which can contribute to improvements in the health care institutions. Methods We conducted a quantitative survey in health care professionals who worked in nursing homes in from Sogn og Fjordane county (Norway), and asked them to which extent guidelines related to indwelling urinary catheters were used at their work place. The study also included data on the prevalence of indwelling urinary catheters in 830 patients (565 women and 265 men) in the 34 nursing homes. We also conducted a clinical audit in these nursing homes in order to study the how the guidelines were implemented. An overall assessment was made (satisfactory or not satisfactory) on whether 11 dimensions of the guidelines were followed (Table 2). When ≥ 80% of the nursing homes had a score = yes/usually to the items above it was considered satisfactory. The evaluations from the clinical audits were based on an overall judgment of the finding at the nursing homes. The study was approved by the Western Norway Hospital Trust as part of a quality assessment strategy. An approval from the regional ethical committee was not needed as the study was a quality assessment project and did not include any individual patient data. Results Our findings shows that 92 of 830 patients had a indwelling urinary catheter the day of prevalence assessment, and significantly more men (21.1%) than women (6.7%) had a indwelling urinary catheter (Fisher's exact test; P <0.001. Overall, the survey showed that compliance with the guidelines was unsatisfactory with one exception; the doctor prescribed the posting of indwelling urinary catheters (Table 2 and 3). Conclusions In conclusion, most areas we investigated need improvements. The survey itself may be a key to change the nursing staff`s attitudes and culture and to gain increased competence. In addition, it seems necessary to have good data solutions as well as leadership anchoring in further work on implementing best practice in handling indwelling urinary catheters.

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Guideline compliance related to indwelling urinary catheters in 34 Norwegian nursing homes - findings and implications

10.7287/peerj.preprints.1820v2 ◽

2016 ◽

Author(s):

Laila Aarnes ◽

Karin Harris ◽

Åse I Skare ◽

John R Andersen

Keyword(s):

Health Care ◽

Urinary Tract ◽

Nursing Homes ◽

Quality Assessment ◽

Urinary Tract Infections ◽

Best Practice ◽

Urinary Catheter ◽

Urinary Catheters ◽

Tract Infections ◽

Indwelling Urinary Catheter

Background For patients in health institutions urinary tract infections often have significant negative health consequences. Indwelling urinary catheters and inappropriate practice related to this is a strong risk factor for urinary tract infections. Thus, a national guideline promotes best practice for handling indwelling urinary catheters. The aim of this study was to assess the prevalence of patients with indwelling urinary catheters in 34 Norwegian nursing homes. Furthermore, we wanted to study whether health professionals followed the national guidelines related to indwelling urinary catheters. If the study reveals room for improvements, it may indicate interventions which can contribute to improvements in the health care institutions. Methods We conducted a quantitative survey in health care professionals who worked in nursing homes in from Sogn og Fjordane county (Norway), and asked them to which extent guidelines related to indwelling urinary catheters were used at their work place. The study also included data on the prevalence of indwelling urinary catheters in 830 patients (565 women and 265 men) in the 34 nursing homes. We also conducted a clinical audit in these nursing homes in order to study the how the guidelines were implemented. An overall assessment was made (satisfactory or not satisfactory) on whether 11 dimensions of the guidelines were followed (Table 2). When ≥ 80% of the nursing homes had a score = yes/usually to the items above it was considered satisfactory. The evaluations from the clinical audits were based on an overall judgment of the finding at the nursing homes. The study was approved by the Western Norway Hospital Trust as part of a quality assessment strategy. An approval from the regional ethical committee was not needed as the study was a quality assessment project and did not include any individual patient data. Results Our findings shows that 92 of 830 patients had a indwelling urinary catheter the day of prevalence assessment, and significantly more men (21.1%) than women (6.7%) had a indwelling urinary catheter (Fisher's exact test; P <0.001. Overall, the survey showed that compliance with the guidelines was unsatisfactory with one exception; the doctor prescribed the posting of indwelling urinary catheters (Table 2 and 3). Conclusions In conclusion, most areas we investigated need improvements. The survey itself may be a key to change the nursing staff`s attitudes and culture and to gain increased competence. In addition, it seems necessary to have good data solutions as well as leadership anchoring in further work on implementing best practice in handling indwelling urinary catheters.

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