Association for Professionals in Infection Control and Epidemiology Annual Conference
Association for Professionals in Infection Control and Epidemiology Annual Conference
June 14, 2019
3 min read

Female external catheters cut CAUTI rate by more than 50%

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PHILADELPHIA — A new type of female indwelling catheter technology reduced inpatient catheter-associated UTIs, or CAUTIs, by 51.7%, according to data presented at the annual conference of the Association for Professionals in Infection Control and Epidemiology.

“We had two consecutive quarters where our CAUTI rates were above the [standardized infections ratio (SIR)], which alerted us that our hospital had more CAUTIS than other hospitals, and that is a huge red alarm for us,” Brianna Episcopia, RN, BS, CIC, infection control director at the Coney Island Hospital, told Infectious Disease News.

According to researchers, the leading risk factor for CAUTI development is prolonged use of an indwelling Foley catheter. External catheters, which suction urine, are a noninvasive alternative for managing incontinent patients. Episcopia and colleagues implemented the device at a 300-bed community hospital in the Northeast for a year starting in October 2017. They compared in-patient CAUTI rates, Foley utilization rates and the standardized infection ratio (SIR) before and after implementation.

The researchers found a 51.7% reduction in CAUTIs. Additionally, the Foley utilization rate was reduced from 15.7% to 10.7%, and SIR decreased from 1.319 to 0.965, which is below the CDC’s National Healthcare Safety Network goal of less than one.

“We hope to spread awareness that this alternative exists. At first, it was difficult to get a buy in from the staff, but now, we have a hard time keeping it in stock. It’s the go-to,” Episcopia said. “So, when the clinicians are assessing the necessity of a Foley, they can add to the conversation if this external catheter is an option.”

Timothy Dublynn, RN, assistant director of nursing for infection control at Coney Island Hospital and a co-author on the study, added that patients took comfort in the new product.

“Another nice finding is there was a comfort measure that was taken. The noninvasive alternative provides a better patient experience for comfort.”

Additional findings

These data mirror findings of a second study presented at APIC that similarly showed a decrease in indwelling urinary catheter use in female patients — but not a reduction of CAUTIs — after external catheters were used. Cassandra Mueller, MSN, CIC, CNL, infection prevention consultant at Boone Hospital Center, and colleagues evaluated the technology in immobile female patients in the medical and critical care wards of their 394-bed acute care hospital.


“In 2016, 2017 and 2018, we had seven to eight CAUTIs each year, with at least half being in women. With that, our catheter utilization rate was over one,” Mueller told Infectious Disease News. “The number one way to prevent CAUTIs is to not have a catheter, so, we thought if we could reduce the usage, we could reduce the rates of CAUTIs.”

Their pilot evaluation received positive feedback, according to Mueller, and they found that the product accurately monitored urine output while avoiding skin moisture or breakdown. According to the study, the product was approved and implemented in all adult inpatient units in July 2018. The researchers found significant decreases in urinary catheter standardized utilization ratios (1.06 to 0.93; P < .001) but a nonsignificant increase in CAUTI SIR (0.53 to 0.62; P = .77). Mueller says this increase can be attributed to the decrease in catheter use days.

“Physicians’ biggest concern is if [external female catheters] can really monitor urine output because that’s how they make clinical decisions,” Mueller said. “This shows that there are alternatives that can successfully do that. Knowing and having trust that clinicians can diagnose appropriately based on the output is important to know moving forward.” – by Caitlyn Stulpin

Disclosures: Dublynn, Episcopia and Mueller report no relevant financial disclosures.


Dublynn, T, et al. Female external catheter use: A new bundle element to reduce CAUTI. Presented at: APIC 2019; June 12-14, 2019; Philadelphia.

Mueller, C, et al. Finally! An external female catheter device for women! Presented at: APIC 2019; June 12-14, 2019; Philadelphia.