Pilot Study of Avoidance of Bladder Catheters in Stroke Patients to Avoid Urinary Tract Infections

This study has been terminated.
(Investigator no longer at institution-no data analyzed)
Sponsor:
Information provided by (Responsible Party):
University of California, San Francisco
ClinicalTrials.gov Identifier:
NCT01275261
First received: January 7, 2011
Last updated: November 13, 2012
Last verified: November 2012
  Purpose

The purpose of this study is to determine whether bladder catheterization can be safely avoided in patients admitted to the hospital with stroke using a nursing protocol, and whether this decreases the incidence of urinary tract infections. The investigators hypothesize that the protocol will be tolerated by nurses and patients, and that patients without bladder catheters will have fewer urinary tract infections and better outcomes.


Condition Intervention Phase
Stroke
Catheter Associated Urinary Tract Infection
Behavioral: Nursing protocol to avoid Foley catheter placement
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Prevention
Official Title: Pilot Randomized Trial of a Nursing Protocol to Avoid Bladder Catheterization in Patients With Stroke

Resource links provided by NLM:


Further study details as provided by University of California, San Francisco:

Primary Outcome Measures:
  • Patient comfort. [ Time Frame: On discharge (average 4 days after stroke) ] [ Designated as safety issue: No ]
    This will be assessed using a questionnaire at discharge addressing comfort of urinary care.

  • Amount of time spent by nurses on patient urinary care [ Time Frame: Will be measured at the end of each nursing shift during the patients hospitalization. ] [ Designated as safety issue: No ]
    This will be assessed using a questionnaire filled out at the end of each nursing shift addressing time management and comfort with the urinary care of the patient.


Secondary Outcome Measures:
  • Incidence of Urinary Tract infection [ Time Frame: during acute hospitalization, average 4 days after stroke ] [ Designated as safety issue: No ]
    Determined using UTI symptoms and urinalysis and urine culture findings.

  • Stroke Functional Outcome [ Time Frame: 90 days ] [ Designated as safety issue: No ]
    Using the modified Rankin Scale by telephone interview.


Enrollment: 5
Study Start Date: January 2011
Study Completion Date: September 2011
Primary Completion Date: September 2011 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
No Intervention: Foley catheter
Usual care - patients will have a Foley catheter placed on admission.
Experimental: Nursing protocol to avoid Foley Catheter
No catheter will be placed on admission, and a nursing order protocol will be followed to avoid catheterization and avoid complications.
Behavioral: Nursing protocol to avoid Foley catheter placement
A specific nursing order protocol will be followed addressing urinary care to try to avoid the use of Foley catheters.

Detailed Description:

Medical complications, both minor and serious, play a large role in post-stroke management and outcome. Infection, especially pneumonia and urinary tract infections (UTI), is one of the most common medical complications of stroke. In addition, immunosuppression secondary to stroke may increase the risk of infection after stroke, and fever secondary to infection may result in poor outcomes. UTIs occur in 3 to 16% of patients within the first week to month after a cerebrovascular event. Compared with patients who do not develop post-stroke UTIs, those who do have a UTI have poorer outcomes; such patients have an approximately 3-fold increased odds of a higher mRS, and a 4.5-fold higher odds for the combined endpoint of death or disability.

Between 15% and 25% of all hospitalized patients receive short-term indwelling urinary catheters, often unnecessarily. In the general medical population, the risk of UTI ranges from 3%-10% per day of catheterization, and approaches 100% after 30 continuous days. Catheter-associated UTI (CAUTI) is the second most commonly reported healthcare-associated infection in acute care hospitals, accounting for approximately one-third of all infections reported to the National Healthcare Safety Network in 2006-2007, and is the leading cause of secondary nosocomial bloodstream infections. CAUTIs have been estimated to cost $589 to $758 per infection, and between 17 and 69% may be preventable.

The recently released draft guidelines from the Centers for Disease Control and Prevention (CDC) for prevention of CAUTI suggest appropriate indications for indwelling urethral catheter use, including acute urinary retention or obstruction, need for accurate measurements of urinary output in critically ill patients, and prolonged immobilization, but an estimated 20 to 50% of hospitalized patients have urinary catheters placed without clear indications.

We will conduct a pilot RCT to determine the tolerability and efficacy of a protocol to avoid catheter placement in patients admitted to the UCSF neurovascular service with ischemic stroke or intracerebral hemorrhage. There are two study arms: a usual care control group will have catheter placement on admission, and the intervention group will not have a catheter placed on admission. The intervention arm will be treated using a protocol, developed with a multidisciplinary team, and instituted by nurses to avoid the need for catheter placement. The sample will be followed during hospital admission, with the main outcome measures being the tolerability of the protocol by the nursing staff, patient comfort and the incidence of UTI during hospitalization. The subjects will be followed during their hospitalization and a follow-up telephone call will be made to them at 90-days post-stroke.

We hypothesize that limiting the use of Foley catheters to the medical indications noted in the CDC guidelines, which is not current standard practice, will decrease the number of catheters placed, and thereby reduce the number of UTIs in stroke patients. The ultimate goal of this study is to improve clinical outcomes, decrease hospital length of stay, cost of care, and time to rehabilitation among patients who suffer a stroke.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Adults aged ≥18
  • Admission to the neurovascular service at UCSF (from the ED or from an outside hospital)
  • Diagnosis of acute stroke or intracerebral hemorrhage

Exclusion Criteria:

  • Glasgow Coma Scale (GCS) <9
  • Need for intubation or sedation
  • An active medical problem requiring the use of a bladder catheter (e.g., congestive heart failure exacerbation, acute bladder outlet obstruction)
  • Subarachnoid hemorrhage
  • Patients who are asymptomatic or have minimal symptoms from stroke
  • Bladder catheter already in place for >12 hours
  • Contraindication for bladder catheterization
  • Evidence of UTI on admission
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT01275261

Locations
United States, California
University of California San Francisco
San Francisco, California, United States, 94143
Sponsors and Collaborators
University of California, San Francisco
Investigators
Principal Investigator: Sharon N Poisson, MD University of California, San Francisco
  More Information

Publications:
Responsible Party: University of California, San Francisco
ClinicalTrials.gov Identifier: NCT01275261     History of Changes
Other Study ID Numbers: 10-00820
Study First Received: January 7, 2011
Last Updated: November 13, 2012
Health Authority: United States: Institutional Review Board

Keywords provided by University of California, San Francisco:
Stroke
Urinary Tract Infection

Additional relevant MeSH terms:
Stroke
Cerebral Infarction
Urinary Tract Infections
Cerebrovascular Disorders
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Vascular Diseases
Cardiovascular Diseases
Brain Infarction
Brain Ischemia
Infection
Urologic Diseases

ClinicalTrials.gov processed this record on April 17, 2014