The problem is that in many hospital settings too many nurses and doctors are inserting "the Foley" for their own convenience, without regard for whether the patient really needs what should be regarded as a potentially dangerous invasive device, he says. And too many nurses and doctors fail to assess on a daily basis whether it's time for the catheter to come out, a proven strategy that reduces CAUTI rates.
In part, Saint blames the fact that what we measure in terms of outcomes in catheter use is all wrong. We only measure when their use results in an infection. What we also should measure, he says, are events like falls that occur when patients try to get up to use the toilet and trip on the catheter tubing.
There are also a lot of other uncounted adverse events linked to catheters, such as "trauma at the time of Foley insertion, or inadvertent removal with the balloon fully inflated that can lead to urethral trauma and blood in the urine," he says.
The people who measure outcomes from catheter use should also consider the pain and discomfort the catheters cause patients who have to live with them. Worse, perhaps, is that the immobility they encourage can lead to pressure ulcers and blood clots. "There are all these non-infectious complications associated with the Foley," he says.
Do most providers appreciate that? No, he says. Part of the issue is that unlike its more serious kin, the central line-associated bloodstream infection or CLABSI, whose infection rates have been dramatically reduced, CAUTI rates have stayed relatively static.