key: cord-0012711-6urg5kxr
authors: Lavelle, John P.
title: On when guidelines conflict: Patient safety, quality of life and CAUTI reduction in patients with spinal cord injury
date: 2019-06-10
journal: Spinal Cord Ser Cases
DOI: 10.1038/s41394-019-0199-3
sha: 386e300a88faf334a208d977d00015cd1cbd48d4
doc_id: 12711
cord_uid: 6urg5kxr

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of CAUTI to Mr. Jones, is that it affects the hospital's standing, in terms of HAIs and other surveillance metrics that are used to determine quality-of-care delivery and reimbursement.

Dr. Davis's case series illustrates the fallout from trying to decrease the CAUTI rates in hospital systems. Nursing services have pushed through protocols to remove urinary catheters early, which while laudable, and often appropriate, can, in special circumstances (as described in this case series), be dangerous to the patient with serious repercussions. This is clearly not the intent or the desired outcome of the protocols, which are designed to avoid inappropriate CAUTI assignments.

Interestingly, if all of Dr. Davis's patients had been converted into a suprapubic catheter management, earlier, or had an incontinent ileovesicostomy, then CAUTI could not be applied to his patients, as the definitions would not meet the NHSN guidelines to administratively assign a CAUTI by the hospital infection control. While SP indwelling catheters avoid the ugly-looking traumatic hypospadias in male patients or the disastrous bladder neck erosion in female patients, these patients can and do get symptomatic UTIs (cystitis and pyelonephritis). However, these do not count for CAUTI, which they clearly are. The CDC should consider revision of the CAUTI guideline definitions to allow for these special circumstances.

Conflict of interest The authors declare that they have no conflict of interest.

Publisher's note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The prevention and management of urinary tract infections among people with spinal cord injuries. National Institute on Disability and Rehabilitation Research Consensus Statement

Bladder Management for Adults with Spinal Cord Injury: A clincal practice guideline for health-care providers

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