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Jennifer Meddings, Sanjay Saint, Disrupting the Life Cycle of the Urinary Catheter, Clinical Infectious Diseases, Volume 52, Issue 11, 1 June 2011, Pages 1291–1293, https://doi.org/10.1093/cid/cir195
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(See the article by knoll et al, on pages 1283–1290.)
Kicking the catheter habit can be difficult. Indwelling urethral (or Foley) catheters are readily available, are easy to place, provide tempting fixes for inconveniences (such as wet sheets and obtaining urine samples), and are often forgotten about during the hectic nature of clinical care. The article by Knoll et al [1] in this issue of Clinical Infectious Diseases describes a 5-year hospital-wide “catheter quit program,” which is similar in its successes and challenges to aspects of other habit-changing programs such as treating an addiction to tobacco or chocolate chip cookies. The investigators implemented multiple educational interventions designed to increase awareness of the problem and to stigmatize it in order to motivate change. They limited access to the catheters by specifying appropriate catheter indications and requiring catheter orders, while acknowledging that catheter restriction is challenging given the ubiquitous nature of urinary catheters on hospital wards. The hiatus period in their study underscored the importance of relapse prevention. They then restarted the program with ambitious implementation of various types of reminders about catheters; a reward system to motivate workers and provide peer pressure, patient education, and patient empowerment; and feedback systems to track progress for nurses, physicians, and hospital leadership. Finally, a dedicated “Foley nurse” served as the reinforcer to help sustain practice change.
