A chart audit of factors related to urine flow and urinary tract infection

Background. Clients with long-term urinary catheters are at risk for urinary tract infection (UTI) and catheter blockage that disrupt client/family daily activities. The United States Centers for Disease Control guideline strongly recommends keeping urine flowing to help prevent UTI in this population, but little is known about factors associated with urine flow and how they are related to UTI. Aim. The purpose of this descriptive study was to identify urine flow factors contributing to UTI in home care clients who had had an indwelling urinary catheter for at least 3 months. Methods. Twenty-four records were reviewed from one home care agency. The sample of 12 males and 12 females ranged in age from 31-102 (mean 70 years, sd 17.2) and they had used a catheter from 5 to 105 months (mean 27.9, sd 32). Findings. Catheter blockage and low urine output were the only 'urine flow indicators' that were significantly related to UTI. Other 'urine flow indicators' were not related to UTI, including bloodstained urine, pulling on the catheter, leakage, and sluggish urine. Thirteen people experienced blockage and 11 did not. Of the 13 with blockage, six had UTI and seven did not, during the 6 months of the review. It was particularly notable that, of the 11 people with no blockage, none went on to experience UTI. Conclusion. This finding raises questions about why some people with blockage developed UTI and some did not. We suggest that nurses taught their clients what to do to get the urine flowing, such as, increasing fluid intake or checking for proper placement. Identifying more information from clients about how they monitor and adjust urine flow will be the next step toward understanding how to prevent UTI in those with long-term catheters.