805 - A Single Institution Pre/Post Comparison After Introduction of an External Urinary Collection Device for Female Medical Patients

Background: Catheter associated urinary tract infections (CAUTIs) are the most common hospital acquired infections in the United States. External urinary collection devices (EUCDs) may serve as an alternative to indwelling urethral catheters (IUCs) and decrease the rate of CAUTIs. PureWick® is a novel female EUCD, with early case reports suggesting safe and efficacious use. However, no study has definitively proven benefit of PureWick® regarding reduction of CAUTIs. We sought to compare the CAUTI rate and median indwelling catheter days before and after availability of PureWick® at a single academic institution, as well as provide a descriptive analysis on female medical patients receiving an EUCD.

Methods: We performed a retrospective review of adult female patients admitted to our institution on a medical service who received an IUC and/or an EUCD. Patients admitted in the 3 months before (PRE) and 12 months after (POST) PureWick® availability were included. Two groups were compared: PRE patients who received an IUC vs. POST patients who received an IUC and/or EUCD.

Results: Out of 866 female patients, 296 received an EUCD in the POST cohort and overall, 673 received an IUC (261 (100%) PRE vs. 412 (68.1%) POST). There were no differences in the cohorts regarding age and comorbidities (all p >0.05). Compared to the PRE cohort, the POST cohort had a higher number of IUC days (median, 3 vs. 2 days, p< 0.001) and a higher rate of CAUTI (infections per 1,000 catheter days, 11.8 vs. 4.1, p=0.003) while overall UTI rate was similar (infections per 1,000 patient days, 19.1 vs. 14.12, p=0.410). In the POST cohort, the rate of UTI associated with EUCD use was 11.6 infections per 1,000 device days. Measurement of strict ins and outs (56.8%) was the most common indication for use of EUCD.Table 1. Characteristics and comorbidities of female catheterized patients admitted to a medical service before (PRE) and after (POST) PureWick implementation.
Table 2. Urinary tract infection rates of female catheterized patients PRE and POST PureWick implementation.
Table 3. Characteristics of hospitalized female patients admitted to a medical service who received a PureWick catheter.


Conclusion: While EUCDs might appear to be a promising alternative to IUCs for female patients, this single center pre/post analysis found that both the median number of IUC days and the CAUTI rate increased after introduction of a single EUCD. This may be related to selection bias, with EUCDs being ordered for patients who would not have otherwise received an IUC. Further research is needed to clarify if female EUCDs can be effective in decreasing IUC days and/or CAUTI rates prior to any widespread adoption.