When urinary catheters stay too long: the hidden link between constipation, prolonged indwelling urinary catheterisation and urinary tract infections in neurosurgical inpatients.

OBJECTIVE: Urinary catheterisation is common in neurosurgical perioperative care, but inconsistent guideline adherence contributes to variable practice and complication risk. Over five years, linked audits and quality improvement projects (QIPs) at the National Hospital for Neurology and Neurosurgery investigated high urinary tract infection (UTI) rates, identified root causes and implemented targeted interventions.

METHODS: This single-centre prospective quality improvement initiative included three sequential audits and six linked QIPs from January 2020 to December 2024. Projects assessed UTI incidence, inappropriate catheterisation, early trial without catheter (TWOC) and constipation prevention. Sample sizes, eligibility criteria and outcomes varied. Interventions included tailored protocols, staff education and clinical champions.

RESULTS: Initial audit showed a 94% UTI rate with indwelling catheters (IDUC), prompting nurse-led TWOC, early physiotherapy and bowel care. IDUC use fell from 25.6% in 2020 to 11% by end-2023, and catheter associated UTI (CAUTI) to 45.5% by 2024. TWOC within 24 h rose from 3% in 2021 to 93% in 2024. Gains were sustained through quarterly education, biannual data review and QI cycle re-evaluation.

CONCLUSION: This longitudinal quality improvement initiative improved catheter safety, reducing UTI rates and inappropriate catheterisation through early, mainly nurse-led TWOC and increased focus on modifiable risk factors such as opioid-induced constipation.