D219: Impact of External Female Catheters on CAUTI Prevention in Nursing

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Western Governors University

D218 Intrapersonal Leadership and Professional Growth

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The Impact of the Use of External Female Catheters in Preventing Catheter-Acquired Urinary Tract Infections

Impact of the Problem on the Patient

Catheter-associated urinary tract infections (CAUTIs) represent one of the most common healthcare-acquired infections worldwide. They typically occur due to prolonged or inappropriate use of indwelling urinary catheters, improper insertion, or inadequate maintenance. When Foley catheters remain in situ for extended durations, bacteria can colonize the urinary tract, leading to infection.

For home-bound patients, confirming a UTI requires laboratory testing, which delays treatment and increases the likelihood of complications or hospitalization. Hospitalized patients face additional risks such as pain, fever, sepsis, and the need for intravenous antibiotics. Recurrent infections can result in antimicrobial resistance and rehospitalization, causing both physical discomfort and psychological stress. Ultimately, CAUTIs diminish the patient’s overall quality of life and impede recovery.

Impact of the Problem on the Organization

From an organizational viewpoint, CAUTIs increase healthcare expenditures through longer hospital stays, higher medication use, and greater nursing workload. Hospitals may face penalties and reduced reimbursements if infection rates surpass national benchmarks. Furthermore, repeated CAUTI incidents reduce patient confidence, lower satisfaction scores, and may harm the facility’s reputation. By reducing CAUTI occurrences, organizations can enhance safety outcomes, improve efficiency, and optimize resource utilization.

Identification of PICO Components

Component	Description
P (Population)	Female patients using urinary catheters
I (Intervention)	Use of female external catheters
C (Comparison)	Indwelling Foley catheters
O (Outcome)	Reduction in catheter-associated urinary tract infections

Evidence-Based Practice (EBP) Question

In female patients with urinary catheters, does the use of external female catheters compared to indwelling Foley catheters reduce the risk of catheter-associated urinary tract infections (CAUTIs)?

“A Single Institution Pre-/Post-Comparison After Introduction of an External Urinary Collection Device for Female Medical Patients” (Research Article)

Background and Introduction

This retrospective review examined the introduction of an external urinary collection device (EUCD), the PureWick, in a single institution’s Internal Medicine, Family Medicine, and Neurology departments. Exclusions included pregnant individuals, prisoners, and patients admitted to specialty services. The study sought to compare CAUTI rates before and after EUCD implementation and evaluate whether EUCD use decreased infection incidence compared to indwelling urinary catheters (IUCs).

Methodology

A retrospective observational design was used to analyze adult female inpatients who received either IUCs or EUCDs. Data were collected over two time frames: three months before and twelve months after EUCD implementation. CAUTI rates were measured as infection episodes per 1,000 catheter days and per 10,000 patient days. Demographics such as age, BMI, comorbidities, and complications were included. Chi-square and Mann-Whitney U tests were employed for categorical and continuous variables, respectively, using IBM SPSS Statistics (Version 24).

Level of Evidence

According to the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) Model, this study qualifies as Level 3 evidence, representing non-experimental research.

Ethical Considerations

The Institutional Review Board approved this project. Because it was retrospective and used pre-existing data, no informed consent was required. The study adhered to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines, ensuring ethical and transparent reporting.

Data Analysis and Findings

Data from 848 female patients were analyzed—292 used EUCDs and 656 used IUCs. Prior to EUCD availability, IUC-related CAUTI rates were 2.3 per 1,000 catheter days and 15.4 per 10,000 patient days. After implementation, the rates increased for IUCs to 9.3 per 1,000 catheter days and 70.7 per 10,000 patient days, while EUCD-related CAUTI rates were 33.9 per 1,000 catheter days and 15.5 per 10,000 patient days.

Although not statistically significant, the data suggested that EUCDs may benefit select patient groups. Variations in comorbidities and inconsistent device use likely affected outcomes.

Quality Rating

Under the JHNEBP model, the article achieved a Good Quality (Level B) rating, indicating moderate reliability.

Alignment with the EBP Question

The study directly supported the EBP question by comparing infection rates between IUCs and EUCDs. While results were inconclusive, the trend toward reduced infection rates among EUCD users indicates the device’s potential in decreasing CAUTI risk when applied with standardized protocols.

“Reducing the Risk of Indwelling Catheter–Associated Urinary Tract Infection in Female Patients by Implementing an Alternative Female External Urinary Collection Device: A Quality Improvement Project” (Non-Research Article)

Background and Introduction

A 386-bed community hospital in California initiated a quality improvement (QI) project to reduce CAUTI rates among female patients. The intervention involved the use of a female external urinary collection device (FEUC) with suction, allowing nurses and nursing assistants to use the device without physician orders.

Type and Level of Evidence

This QI project represents Level 5 evidence under the JHNEBP model. Data were compared between pre- and post-implementation periods across multiple inpatient units, including telemetry, medical-surgical, intensive care, and rehabilitation.

Findings and Quality Rating

CAUTI rates decreased substantially in the first year of EUCD use, though results stabilized in the second year due to inconsistent protocol adherence. The project earned a Quality B (Good) rating, confirming credible outcomes supported by clinical data.

Author’s Recommendations

The authors concluded that incorporating EUCDs within CAUTI prevention bundles—combined with consistent education, monitoring, and interdisciplinary collaboration—can sustainably lower infection rates among hospitalized women.

Recommended Practice Change

To reduce CAUTI incidence, hospitals should establish standardized protocols for determining when to use an EUCD versus an IUC and deliver staff education on appropriate device use, hygiene, and peri-care procedures.

Indications and Contraindications for EUCD Use

Indications	Contraindications
Female patients requiring urine output monitoring without needing an IUC	Urinary retention or obstruction
Urinary incontinence or limited mobility	Agitation or combative behavior leading to device removal
Post-surgical or immobile patients	Frequent stool incontinence without management
Bed rest orders or difficulty accessing toilets	Active menstruation or postpartum vaginal discharge
Skin irritation from incontinence pads	Existing perineal skin breakdown

(Eckert et al., 2020)

Key Stakeholders

Stakeholder	Responsibilities
Healthcare Organization	Allocate funds for EUCD procurement, establish cost-effective training programs, and monitor infection control outcomes.
Nurse Managers	Oversee staff training, maintain compliance with protocols, and evaluate CAUTI trends.
Nurses and Caregivers	Apply EUCDs appropriately, ensure patient hygiene, document interventions, and educate patients about catheter options.

Barrier to Implementation

A primary barrier involves financial constraints associated with purchasing EUCD devices and implementing comprehensive staff training programs. Many organizations hesitate to invest without immediate evidence of cost savings.

Strategy to Overcome the Barrier

Presenting a cost-benefit analysis that demonstrates long-term savings—through reduced CAUTI rates, shorter hospital stays, and fewer antibiotic prescriptions—can help secure leadership support and funding for EUCD adoption.

Indicator to Measure Outcomes

Success can be measured through monthly audits comparing EUCD usage and CAUTI rates. Improved patient satisfaction, fewer infection cases, and reduced hospital stays will signify effective practice change implementation.

References

Eckert, L., Mattia, L., Patel, S., Okumura, R., Reynolds, P., & Stuiver, I. (2020). Reducing the risk of indwelling catheter–associated urinary tract infection in female patients by implementing an alternative female external urinary collection device: A quality improvement project. Journal of Wound, Ostomy & Continence Nursing, 47(1), 50–53. https://doi.org/10.1097/WON.0000000000000601