Quality standard

Quality statement 2: Diagnosing urinary tract infections in adults with catheters

Quality statement 2: Diagnosing urinary tract infections in adults with catheters

Quality statement

Adults with indwelling urinary catheters do not have dipstick testing to diagnose urinary tract infections (UTIs). [2015, updated 2023]

Rationale

A catheter-associated UTI is a symptomatic infection of the bladder or kidneys in a person with a urinary catheter. Dipstick testing is not an effective method for detecting UTIs in adults with indwelling urinary catheters. Catheters quickly become colonised with bacteria and give a positive dipstick result. However, this does not indicate that the bacteria are causing an infection in the bladder or kidneys. To ensure that UTIs are diagnosed accurately, dipstick testing should not be used. Instead, signs and symptoms are assessed to diagnose UTIs with urine culture and sensitivity testing used to support the diagnosis and guide treatment. Minimising the risk of infection through procedures for the safe insertion, maintenance and removal of a catheter is covered by statement 4 of NICE's quality standard on infection prevention and control.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

Evidence of a register of people with an indwelling urinary catheter in the community.

Data source: No routinely collected data for this measure has been identified. Data can be collected from information recorded locally by provider organisations, for example from patient electronic medical records. If a list of people with indwelling urinary catheters is not available, a list could be developed by cross-referencing information on people prescribed catheter items, district nurse records, and continence team records.

Process

a) Proportion of episodes of suspected UTI in adults with indwelling urinary catheters that are investigated using dipstick testing.

Numerator – the number in the denominator investigated using dipstick testing.

Denominator – the number of episodes of suspected UTI in adults with indwelling urinary catheters.

Data source: No routinely collected data for this measure has been identified. Data can be collected from information recorded locally by provider organisations, for example from patient records using a local audit. The RCGP TARGET antibiotics toolkit hub includes a UTI audit toolkit for catheterised patients.

b) Proportion of episodes of suspected catheter-associated UTI in adults where a urine sample is sent to laboratories for culture and sensitivity testing.

Numerator – the number in the denominator where a urine sample is sent to laboratories for culture and sensitivity testing.

Denominator – the number of episodes of suspected catheter-associated UTI in adults.

Data source: No routinely collected data for this measure has been identified. Data can be collected from information recorded locally by provider organisations, for example from patient records, laboratory records and request forms.

Outcome

Antibiotic prescription rates for adults with indwelling urinary catheters.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records and prescribing systems.

What the quality statement means for different audiences

Service providers (such as hospitals, GPs, community services and care homes) ensure that training, education programmes and written procedures are kept up to date so that healthcare professionals do not use dipstick testing to diagnose UTIs in adults with indwelling urinary catheters.

Healthcare professionals (GPs, physician associates, hospital doctors and community pharmacists) do not use dipstick testing to diagnose UTIs in adults with indwelling urinary catheters. Instead, they assess signs and symptoms to diagnose a UTI and use urine culture and sensitivity testing to support the diagnosis.

Integrated care systems lead on antimicrobial stewardship in their area.

Adults with indwelling urinary catheters do not have UTIs diagnosed by dipstick testing.

Source guidance

Definitions of terms used in this quality statement

Catheter-associated UTI

A symptomatic infection of the bladder or kidneys in a person who is catheterised or who has had a urinary catheter in place within the previous 48 hours. [NICE's clinical knowledge summary on urinary tract infection (lower) – women, background information – definition]