ISR 70 - Review of Scientific Literature on External Collection Devices (ECD) in the Prevention of Catheter-associated Urinary Tract Infections (CAUTI)

Background: CAUTI are the most frequent healthcare-associated infections and are correlated with serious complications, secondary infections, and increased cost of care. Published expert guidelines recommend the use of alternate devices in lieu of indwelling catheters. Use of ECDs for urine management provides potential benefits such as reduced indwelling catheter days and decreases in CAUTI rates. A review of the published ECD literature of the last five years was conducted to investigate extent of use, type, design, effect on infection outcomes, and association with patient mobility.

Methods: PubMed and MEDLINE databases were queried using the following parameters: human adult trials published within the last five years; included all study levels; guidelines and reviews; conference abstracts; various key terms included urinary catheters, ECDs, and preventive bundles.

Results: Extent of use: 14 [46.6%] of 30 CAUTI prevention studies identified ECDs as an intervention; 21.4% of ECD studies examined the devices as a singular intervention, 78.6% used ECDs as part of a multi-intervention methodology; Type of device: 42.8% indicated use of male/female ECDs, 28.5% only a female ECD, 28.7% used an “alternate device”; Design of device: only one study identified the specific design of the ECD device; Outcomes: CAUTI rates and catheter utilization decreased in ranges from 14.0% to 100% and from 8.0% to 64.0%, respectively. Mobility: mobility assessment not identified in any study.

Conclusions: This review identified a wide variation in ECD use, type, and outcomes. Further research is needed to examine the impact of ECDs on outcomes as either a singular intervention or as part of standardized healthcare protocols. Such studies should assess results by male and female populations, by design of ECDs, and by consideration of patient mobility.