PICO question: Is there an association between inserting the smallest bore indwelling urinary catheter and a decreased CAUTI (catheter associated urinary tract infection) rate? Nurse was “looking for evidence-based practice, guideline, high level of evidence to support question.”

Here’s how to access a collection of 7 articles in PubMed.
a. Go to the Woodruff Health Sciences Center Library homepage (http://health.library.emory.edu)
b. Click on PubMed.
c. Then copy and paste the following link into your browser:
https://www-ncbi-nlm-nih-gov.proxy.library.emory.edu/sites/myncbi/1HMKnKhQm_d5i/collections/59174578/public/
d. The references will appear in PubMed. Click on a reference and you will see a Find it at Emory on the right side of the page which will provide links to full text within Emory University’s licensed resources. Emory Healthcare staff may send citations of needed articles they are unable to access to Ask a Librarian; a library staff person will request the article(s) from an outside library and email them to the EHC staff person upon arrival

Here’s notes about items in the collection.

Table 3 in the 2017 systematic review by Meddings et al states for catheter size, “The smallest bore catheter possible with consistent good drainage is recommended to avoid black neck and urethral mucosa trauma.” The two items it cites by Godfrey and Gould are in the PubMed collection.

Table 3 in article by Gao et al. states simply, “Choose a urethral catheter of the right size and right material, based on the patient’s age, sex, and urethral condition, among other characteristics” without any citing any evidence.

The entry for Catheter-associated Urinary Tract Infection (CAUTI) in DynaMed states, “consider using smallest bore catheter possible, with good drainage, to minimize bladder neck and urethral trauma unless not appropriate clinically” and cites and annotates the following guidelines by Gould and Lo that are in the PubMed collection.

Centers for Disease Control and Prevention Healthcare Infection Control Practices Advisory Committee (CDC HICPAC) recommendation grading system
• Category IA – strong recommendation supported by high- to moderate-quality evidence suggesting net clinical benefits or harms
• Category IB – strong recommendation supported by low-quality evidence suggesting net clinical benefits or harms or an accepted practice (for example, aseptic technique) supported by low- to very low-quality evidence
• Category IC – strong recommendation required by state or federal regulation
• Category II – weak recommendation supported by any quality evidence suggesting a trade-off between clinical benefits and harms
• No recommendation/unresolved issue – unresolved issue for which there is low- to very low-quality evidence with uncertain trade-offs between benefits and harms
• Reference – CDC HICPAC guideline on prevention of catheter-associated urinary tract infections

Society for Healthcare Epidemiology of America/Infectious Diseases Society of America (SHEA/IDSA) quality of evidence grades
• Grade I – high-quality evidence
o highly confident that true effect lies close to that of estimated size and direction of effect
o wide range of studies with no major limitations, little variation between studies, and summary estimate has a narrow confidence interval
o true effect is likely to be close to estimated size and direction of the effect, but there is a possibility that it is substantially different
• Grade II – moderate-quality evidence
o only a few studies and some have limitations but not major flaws
o some variation between studies, or the confidence interval of the summary estimate is wide
o true effect may be substantially different from estimated size and direction of the effect
• Grade III – low-quality evidence
o when supporting studies have major flaws, important variation between studies, the confidence interval of the summary estimate is very wide
o no rigorous studies, only expert consensus
• Reference – SHEA/IDSA practice recommendations on strategies to prevent catheter-associated urinary tract infections in acute care hospitals

Here are two of the search strings I used. I skimmed the most recent five years and did not include choose articles that studied only pediatric populations.

(CAUTI OR CAUTIs OR CA-UTI OR CA-UTIs OR catheter associated urinary tract infection OR catheter associated urinary tract infections OR catheter-associated urinary tract infection OR catheter-associated urinary tract infections) AND (small OR smaller OR smallest OR large OR larger OR largest OR size OR sizes OR bore OR bores OR caliber OR calibers)

(bundle OR bundles OR multipronged OR 6-c OR 6c OR toolkit OR toolkits) AND (CAUTI OR CAUTIs OR CA-UTI OR CA-UTIs OR catheter associated urinary tract infection OR catheter associated urinary tract infections OR catheter-associated urinary tract infection OR catheter-associated urinary tract infections) AND (lower OR lowers OR lowered OR lowering OR decrease OR decreases OR decreased OR decreasing OR reduce OR reduces OR reduced OR reducing OR reduction OR reductions OR improve OR improves OR improved OR improving OR improvement OR improvements OR better OR best)

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Important message for Emory Decatur Nurses. The links will not work for you. To access these articles contact the Emory Decatur Library:

Emory Decatur Hospital
Jessica Callaway (Jessica.callaway@emoryhealthcare.org)
404.501.1628