Does Consciousness Level Determine the Timing of Successful Removal of Urinary Catheters at Neurosurgery Intensive Care Unit – Implication to Nosocomial Infection Prevention

Abstract

Abstract Objective This study aimed to investigate whether the level of consciousness can be used as an indicator to determine the successful removal of urinary catheters in post-stroke patients admitted to the neurosurgical intensive care unit (NICU). Methods The study included 97 patients who had urinary catheters in NICU and were divided into three groups based on their level of consciousness. Our analyses was performed by various statistical methods, including the chi-square test, one-way ANOVA, univariate and multivariate regression. Results The overall success rate of catheter removal was found to be 62.9%. On average, the catheters were retained for 6.3 ± 3.6 days. The presence of diabetes mellitus was identified as the only factor that significantly influenced the successful removal of catheters (Adjusted Odds Ratio = 0.236, p = 0.035). No significant differences were observed among patients with different degrees of consciousness impairment. Implementing a nursing-driven circle strategy and bladder sonography scan protocol significantly could decrease the catheter-associated urinary infection (CAUTI) rate from 10.25/1,000 catheter days to 6.69/1,000 catheter days. Conclusions Based on our findings, we recommend removing urinary catheters five days after initial placement for patients with a Glasgow Coma Scale (GCS) score greater than eight and for non-intubated patients, as well as for intubated patients and aphasic patients in the NICU with a GCS score greater than 4. This protocol can potentially prevent CAUTI cases resulting from delayed UC removal. Trial registration: ISRCTN, ISRCTN11643929. Registered 17 July 2023, http://www.isrctn.com/ISRCTN12345678