Abstract
Objective: Long-term use of indwelling catheters induces UTIs and decreases walking ability in hospitalized elderly patients. This quasi-experimental study evaluated the efficacy of a comprehensive continence care program for the removal of indwelling catheters. Method: Participants were elderly patients with indwelling catheters in an acute hospital（intervention group: n=202, control group: n=165）. Intervention was comprised of early catheter removal, tailored ultrasound-assisted prompted voiding, and intermittent catheterization, and was based on the individual's bladder volume as monitored with an ultrasound device and a voiding diary. The control group received existing continence care. Result: The incidence of UTIs in the intervention group was lower than in the control group（5.0% vs. 10.9%, p ＝ 0.032）. Patients who used indwelling catheters for more than 9 days comprised 27.1% of the intervention group as compared with 36.4% of the control group（p=0.059）. The percentage of patients confined to bed for more than 3 days tended to differ between the two groups（42.5% vs. 53.4%, p=0.040）. No differences in falling, pressure ulcers, or walking ability at discharge were noted in the two groups. After adjustment for other factors, intervention was shown to decrease the incidence of UTIs（adjusted odds ratio 0.375 ［95% confidence interval 0.134-0.959］, p=0.040）. The length of hospital stay for patients with UTIs was significantly longer than for patients without UTIs（45.0 ± 22.5 vs. 22.1 ± 20.8, p<0.001）. Conclusion: This study demonstrated that comprehensive continence care aimed at the removal of indwelling catheters lowered the incidence of UTIs by reducing the number of days elderly patients use indwelling catheters.
