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

Student Name

Western Governors University 

D219 Scholarship in Nursing Practice

Prof. Name

Date

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) remain one of the most prevalent hospital-acquired infections worldwide and pose a substantial burden on patients across care settings. These infections frequently result from extended use of indwelling urinary catheters, improper insertion techniques, breaches in aseptic maintenance, or delayed catheter removal. The prolonged presence of Foley catheters facilitates microbial colonization and biofilm development along the catheter surface, which significantly increases the risk of infection within the urinary tract.

For patients receiving care in home-based or long-term care environments, timely identification of urinary tract infections often depends on laboratory testing, which may delay diagnosis and intervention. Such delays can escalate clinical deterioration, leading to emergency department visits or hospital readmissions. Hospitalized patients face even greater risks, including fever, pain, delirium, sepsis, and the need for intravenous antimicrobial therapy. Recurrent CAUTIs further contribute to antimicrobial resistance, complicating treatment regimens and limiting therapeutic options.

Beyond physical complications, repeated infections adversely affect patients’ psychological well-being and independence. The discomfort, embarrassment, and restrictions associated with urinary catheterization can reduce mobility, hinder rehabilitation efforts, and negatively influence overall quality of life. Consequently, preventing CAUTIs is critical not only for improving clinical outcomes but also for preserving patient dignity and functional autonomy.

Impact of the Problem on the Organization

From an organizational standpoint, CAUTIs impose considerable financial and operational challenges on healthcare institutions. These infections are associated with increased length of hospital stays, elevated antimicrobial expenditures, and intensified utilization of nursing and infection prevention resources. Hospitals that fail to meet national quality benchmarks for infection prevention may experience reduced reimbursement or financial penalties from regulatory and accrediting bodies.

In addition to economic consequences, persistently high CAUTI rates can damage institutional credibility and patient trust. Poor infection outcomes often translate into lower patient satisfaction scores and diminished public reputation. Conversely, effective CAUTI prevention strategies demonstrate an organization’s commitment to patient safety, evidence-based practice, and quality improvement. Reducing CAUTI incidence therefore supports both clinical excellence and organizational sustainability.

Identification of PICO Components

Evidence-Based Practice (EBP) Question

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

This question seeks to evaluate whether noninvasive catheter alternatives can meaningfully reduce infection risk while maintaining effective urinary management.

Research Evidence: External Female Urinary Collection Devices

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

Background and Purpose

This retrospective study examined the clinical impact of implementing an external urinary collection device (EUCD), specifically the PureWick system, across medical units within a single healthcare institution. The investigation focused on departments including Internal Medicine, Family Medicine, and Neurology, while excluding specialized populations such as pregnant patients and incarcerated individuals. The primary objective was to determine whether introducing EUCDs reduced CAUTI rates when compared to traditional indwelling urinary catheters (IUCs).

Methodology

A non-experimental, retrospective observational design was used to analyze adult female inpatients who utilized either IUCs or EUCDs during hospitalization. Data were collected during two timeframes: a three-month period prior to EUCD implementation and a twelve-month period following implementation. CAUTI incidence was calculated as infections per 1,000 catheter days and per 10,000 patient days.

Patient variables included age, body mass index (BMI), comorbidities, and postoperative complications. Statistical analysis involved Chi-square testing for categorical variables and Mann–Whitney U testing for continuous data, with analysis performed using IBM SPSS Statistics (Version 24).

Level and Quality of Evidence

According to the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model, this study represents Level 3 evidence, as it is derived from non-experimental research. The overall quality rating was Level B (Good), indicating credible findings with reasonable methodological rigor.

Ethical Considerations

Institutional Review Board (IRB) approval was obtained prior to data collection. Because the study relied on retrospective chart review, informed consent was waived. The researchers adhered to STROBE guidelines to ensure ethical transparency and reporting accuracy.

Data Analysis and Findings

The study sample consisted of 848 female patients, of whom 292 received EUCDs and 656 used IUCs. Pre-implementation CAUTI rates for IUCs were 2.3 per 1,000 catheter days and 15.4 per 10,000 patient days. Post-implementation, CAUTI rates associated with IUCs increased to 9.3 per 1,000 catheter days and 70.7 per 10,000 patient days. In contrast, EUCD-related CAUTI rates were reported as 33.9 per 1,000 catheter days and 15.5 per 10,000 patient days.

Although the results did not reach statistical significance, trends suggested that EUCDs may reduce infection risk in selected patient populations. Variability in comorbidities and inconsistent adherence to device protocols were identified as potential confounding factors.

Alignment With the EBP Question

This study directly addresses the EBP question by comparing CAUTI outcomes between indwelling and external catheter devices. While definitive conclusions could not be drawn, the findings support further exploration of EUCDs as safer alternatives when applied within standardized care frameworks.

Quality Improvement Evidence

“Reducing the Risk of Indwelling Catheter–Associated Urinary Tract Infection in Female Patients by Implementing an Alternative Female External Urinary Collection Device”

Background and Intervention

This quality improvement project was conducted in a 386-bed community hospital in California with the goal of reducing CAUTI rates among female patients. The intervention involved implementing a female external urinary collection (FEUC) device with continuous suction, allowing nursing staff to initiate use independently without physician orders. This approach promoted early intervention and increased clinical flexibility.

Type and Level of Evidence

Under the JHNEBP framework, this initiative is classified as Level 5 evidence, reflecting organizational and experiential outcomes. Data were collected from multiple units, including medical-surgical, telemetry, intensive care, and rehabilitation departments.

Findings and Quality Appraisal

During the first year following implementation, the hospital observed a marked reduction in CAUTI rates. In the second year, rates stabilized, which the authors attributed to inconsistent compliance with established protocols. Overall, the project received a Quality B (Good) rating due to strong documentation and practical applicability.

Author Recommendations

The authors recommended incorporating EUCDs into comprehensive CAUTI prevention bundles that include continuous staff education, multidisciplinary engagement, and routine outcome monitoring to ensure sustained success.

Recommended Practice Change

Healthcare organizations should integrate evidence-based protocols that clearly define when EUCDs are appropriate alternatives to indwelling catheters. Ongoing staff education related to device application, perineal hygiene, skin integrity, and patient education is essential for consistent implementation and optimal infection prevention outcomes.

Indications and Contraindications for EUCD Use

Adapted from Eckert et al. (2020).

Key Stakeholders and Responsibilities

Barrier to Implementation

A primary obstacle to EUCD adoption is the initial financial investment required for device procurement and comprehensive staff training. Organizations may be reluctant to commit resources without immediate, measurable financial returns.

Strategy to Overcome the Barrier

Presenting leadership with a detailed cost-benefit analysis can mitigate financial concerns. Demonstrating long-term savings related to reduced infection rates, shorter hospital stays, and decreased antimicrobial use can support administrative buy-in and justify investment.

Indicators to Measure Outcomes

Program effectiveness should be evaluated through monthly audits comparing EUCD utilization rates with CAUTI incidence. Additional indicators include patient satisfaction scores, recurrence of infections, antibiotic usage, and average length of hospital stay.

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

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

Jasperse, N., Hernandez-Dominguez, O., Deyell, J. S., Prasad, J. P., Yuan, C., Tomy, M., Kuza, C. M., Grigorian, A., & Nahmias, J. (2022). A single institution pre-/post-comparison after the introduction of an external urinary collection device for female medical patients. Journal of Infection Prevention, 23(4), 149–154. https://doi.org/10.1177/1757177421106042