Choosing Wisely:

Don’t place an indwelling urinary catheter to manage urinary incontinence.

Rationale and Comments: The most common source of bacteremia in the post-acute and long-term care setting is the bladder when an indwelling urinary catheter is in use. The federal Healthcare Infection Control Practices Advisory Committee recommends minimizing urinary catheter use and duration of use in all patients. Specifically, the Healthcare Infection Control Practices Advisory Committee recommends not using a catheter to manage urinary incontinence in the post-acute and long-term care setting. Appropriate indications for indwelling urinary catheter placement include acute retention or outlet obstruction, to assist in healing of deep sacral or perineal wounds in patients with urinary incontinence, and to provide comfort at the end of life if needed.
Sponsoring Organizations:
  • Society for Post-Acute and Long-Term Care Medicine
  • Sources:
  • Infectious Diseases Society of America guidelines
  • Disciplines:
  • Geriatric Medicine
  • Urologic
  • References: • CMS Manual System Pub. 100-07 State Operations Provider Certification. Transmittal 8. Revision of Appendix PP–Section 483.25(d)–Urinary Incontinence, Tags F315 and F316. Centers for Medicare and Medicaid Services, U.S. Department of Health and Human Services; 2005 Jun 28 [cited 2014 Dec 31]. Available from: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/r8som.pdf.
    • Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA; Healthcare Infection Control Practices Advisory Committee. Guideline for prevention of catheter-associated urinary tract infections 2009. Infect Control Hosp Epidemiol. 2010 Apr;31(4):319-26.
    • Hooton TM, Bradley SF, Cardenas DD, Colgan R, Geerlings SE, Rice JC, Saint S, Schaeffer AJ, Tambayh PA, Tenke P, Nicolle LE; Infectious Diseases Society of America. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis. 2010 Mar;50(5):625-63.

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