Consent For Urinary Catheters Should Be Mandatory
The presence of a urinary catheter is the single
most important risk factor for healthcare associated infections.
A urinary catheter is a hollow flexible tube inserted into the
bladder to drain urine. This catheter drains urine from your
bladder into a bag outside your body. Common reasons for a urinary
catheter include urine leakage (incontinence), not able to urinate,
and surgery lasting more than three hours.
If you have a urinary catheter, germs can travel along the catheter
and cause an infection in your bladder or kidney. This is called
a catheter-associated urinary tract infection. The bacteria
that cause the infection may enter the bladder during the insertion
of the urinary catheter or during manipulation of the catheter.
Urinary catheters are
the number one cause of hospital-acquired infections
Urinary catheter-associated infections are the most
common hospital-acquired infection amounting to 23% of all healthcare
associated infections. The presence of a urinary catheter
is the most important risk factor for hospital-acquired infections.
About 80% of hospital-acquired urinary tract infections are
related to urinary catheters. A urinary tract infection can
lead to kidney damage or kidney stones and bladder stones.
Since October 1, 2008, the Centers for Medicare
and Medicaid Services (“CMS”) refuse to pay for
extra treatment relating to catheter-associated urinary tract
infections. The reasoning of the CMS is that such catheter-associated
infections are “reasonably preventable”. Catheter-associated
infections fall into the category of the federal government’s
list of “never events”, i.e., preventable medical
conditions caused by medical errors, including decubitus ulcers,
injury due to fall or trauma and a venous thromboembolic condition
(blood clots in the deep veins of the leg).
In order for a patient to undergo an operation or receive anesthesia,
they must sign a consent informing them of the benefits and
complications associated with the operation and anesthesia.
The operation will not begin until the patient signs the consent.
Once the advantages and disadvantages of the operation have
been explained in writing and verbally with the patient, the
operation can begin.
Why is there no informed
consent for urinary catheters?
No such informed consent is required for urinary
catheterization. Despite the common use of urinary catheters
and the well-known infection risks associated with urinary catheters,
patients are not asked to sign a written consent that discloses
the advantages and disadvantages of urinary catheters. Rarely
are patients informed verbally of the risks of urinary catheters.
In 21 years of evaluating hospital care throughout New York,
I have not seen a single consent form for urinary catheters.
Since patients with urinary catheters have a much higher chance
of getting a urinary tract infection than those who do not have
a catheter, the question must be posed: why is there no informed
consent for urinary catheters?
Do patients really give “implied
consent” to urinary catheterization?
Physicians will explain the patients give “implied
consent” to urinary catheterization based on the theory
that urinary catheterization is a common and routine part
of hospital treatment. Understandably, patients cannot be
asked to give their written consent for the most basic medical
treatment, as this might flood hospitals with forms that make
the patients’ experience even more intimidating and
However, in this author’s opinion, urinary catheter
infections pose such a common and significant risk to patients
that their consent should be informed. In
order for a patient to be catheterized, it should be required
that they give permission for the procedure. Once given information
about the risks and benefits of urinary catheterization, the
patient can make a fully informed decision whether they wish
to accept the risk.
What is the downside of consent for urinary catheterizations?
A little more paperwork for hospital nurses, but isn’t
a fully informed patient worth this minor sacrifice? Patients
should be informed that urinary catheter insertion involves
the risk of infection and a specific consent relating to the
pluses and minuses of a urinary catheter should be signed
by the patient.
How Consent for Urinary Catheters
can improve patient care
Patients should be informed about the risks
of infection associated with urinary catheters so they can
take steps to prevent infection. Patients, for example, can
insist that nurses always clean their hands before and during
catheter care. Once patients are informed about the reasons
for catheterization and its risks, they can become much better
advocates for their medical care.
Patients should be informed that the duration of catheterization
is strongly associated with the risk of infection, i.e., the
longer the catheter is in place, the higher the incidence
of urinary tract infection. With such knowledge of the risks
associated with prolonged urinary catheterization, patients
may opt for more limited use of urinary catheters in order
to reduce the risk of infection.
When weighing the benefits of informed consent for urinary
catheterization versus the cost of additional consent forms,
the goal of patient education regarding the high risk of infection
associated with urinary infections outweighs the minor inconvenience
to the hospital nurses of an additional consent form that
must be signed.
What you can do
if you want more information about urinary catheter infections
John H. Fisher is a medical malpractice attorney
in New York and he is the author of the book, The
Seven Deadly Mistakes of Malpractice Victims, a book
dedicated to providing malpractice victims with the answers
to the most common mistakes made in medical malpractice law.
John offers his book free to the public through his website,
You can order a free copy of John’s book through his
website or by calling 1-866-889-6882.