Intermittent versus indwelling catheters for older patients with hip fractures.

Nursing staff identified postoperative urinary tract infection (UTI) in patients with hip fracture as an increasing problem. A quality improvement project was carried out to investigate the problem and to reduce the incidence. The aim of the study was to describe the occurrence of UTI among patients with hip fracture before and after surgery, to assess whether the decision to use intermittent catheters instead of indwelling catheters was adopted and to test the hypothesis that hospital stay is significantly longer for patients with UTI than for those without infection. One hundred and forty-four patients were investigated for bacteriuria before the first catheterization and 1 week after the last catheterization. Positive urine cultures on admission to hospital were found in 38% of patients. Among those free from bacteria on admission, 61% had a positive urine culture after indwelling catheterization compared with 32% in the group treated with intermittent catetherization. A significantly longer hospital stay (P </= 0.05) was found among patients with UTI. The reason for using an indwelling catheter was not found in any medical or nursing documentation for 29% of the patients. The study points to the necessity for systematic assessment to detect and prevent UTI among older patients with hip fracture.