Poor communication can lead to catheter infection

Indwelling devices like catheters are believed to cause around 25% of hospital infections, but ongoing efforts to reduce catheter use and misuse haven’t succeeded as much as healthcare workers would like. The main reason for this? Poor communication among healthcare works.

That’s according to researchers from the University of Michigan (U-M), who claim that even routine catheter use can cause serious problems for patients. That was their conclusion after interviewing a small group of nurses, physician assistants, nurse practitioners and physicians about problems monitoring and communicating among their teams about patients’ indwelling catheters, with the results published in the American Journal of Critical Care.

The study estimates that 60–90% of intensive care patients, and 10–30% outside the ICU, have urinary catheters — but often they remain in too long, which can cause infection, or they aren’t necessary at all. And given that catheters tend to be hidden beneath blankets, physicians don’t automatically know who’s using one — especially if a nurse isn’t there to point it out.

“Any foreign object in the body carries an infection risk, and a catheter can serve as a superhighway for bacteria to enter the bloodstream or body,” said lead author Milias Manojlovich, a professor at the U-M School of Nursing.

All respondents to the study said poor communication delayed removal of unnecessary catheters. Communication broke down for various reasons, including poor relationships between doctors and nurses, hierarchical differences and misalignment of workflows that prevented nurses from being present for daily rounds. Electronic health records also caused confusion — sometimes nurses and doctors have different information, or there’s a lag updating charts, or a reliance on both paper and computer records causes problems.

“Even those mundane, simple things can have unintended consequences way beyond their scope,” Prof Manojlovich said.

Prof Manojlovich acknowledged that some patients and caregivers request catheters, believing they’re preferable to getting up to use the toilet. She said patients should understand that catheters bring risk of infection, and non-infection risks such as pain, trauma or bleeding, and should talk to their nurse or physician about complications.

“People get catheters all the time, but meanwhile they cause lots of harm, so we need to talk about them,” Prof Manojlovich said. “This study found a whole host of factors that affected the ability to discuss this issue.”

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