Background: Urinary catheters are used peri-operatively for patients with hip fracture. Complications include discomfort, haematuria, infection and bypassing. Catheter associated urinary tract infections (CAUTI) are an increasingly important issue with the identification of multi-resistant bacteria which can have serious consequences. The risk of complications occurring increases with the duration of catheter. To reduce the risk of CAUTI and other complications, early catheter removal is important.
Innovation: HOUDINI1,2 checklist is an evidence-based protocol for the assessment and timely removal of urinary catheters. HOUDINI is an acronym for haematuria, obstruction, urological surgery/intervention, decubitus ulcer, input/output monitoring, nursing care and immobility.
With agreement of the Infection Prevention Society Research and Development group we modified the original HOUDINI protocol with the addition of ‘B’ for ‘bowels moved’ to make the criteria more specific to patients with hip fracture. Nursing staff were trained in the use of the HOUDINI(B) checklist, the risks of CAUTI and continence care before the checklist was introduced.
Evaluation: Data was collected on length of time to catheter removal following implementation of the HOUDINI(B) checklist and compared to previously collected catheter removal data. Prior to the use of the HOUDINI(B) checklist 45% (10/22) catheters were removed within one week of insertion. After implementing the HOUDINI(B) checklist an 82% (23/28) increase in the removal of catheters within one week of insertion was demonstrated. Fisher's exact test: p-value = 0.015.
Conclusions: The results demonstrate that use of the HOUDINI(B) checklist in association with staff education assists in the early removal of urinary catheters in patients with hip fractures. Ongoing data collection is required to demonstrate the impact of the HOUDINI(B) checklist on infection and other complication rates.