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Why Consent For Urinary Catheters Should Be Mandatory

By: John H. Fisher

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 confusing.

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.

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