It is not news to readers, but when we talk to people about the fact that urinary tract infections (UTIs) are the second most common kind of infection after chest infections, they are amazed.  

Of course, one of the reasons for that is that a UTI is not a condition that people tend to talk about.  

At The Urology Foundation (TUF), a UK charity working to improve and transform the nation’s urology care, we are well aware that for many people there is a stigma about discussing any kind of urological issue. We promote the message that although it may be uncomfortable to discuss when and how you urinate, urinary infections must be addressed and can be treated swiftly. It is important to deal with a UTI before it potentially spreads to the kidneys. 

However with an estimated 90,000 long-term catheter users in the UK (Gafe et al, 2017), the issue of catheter-acquired urinary tract infections (CaUTIs) is something that nurses will come across regularly. Indeed, infections caused by catheters are one of the most common types of healthcare-associated infections. Long-term catheter use is associated with a wide range of urological complications, including blockages, which increase the risk of infection, stone disease and acute kidney injury (AKI). These complications and high morbidity of long-term catheters cause a considerable demand on the health system and emergency departments (Smith et al, 2019).  

At TUF, we like to champion the excellent nurses working in urology who go above and beyond to improve their patients’ treatment and care. Nurses like Julia Taylor, who led a quality improvement project to reduce CaUTIs in Salford.  

Julia recognised this problem and led a multidisciplinary team to gather the data and evidence to reduce the number of patients with catheters in the hospital and community, lessen the length of times catheters remained in situ, and cut the number of CaUTIs for hospital inpatients. In fact, Julia’s work led to a 22% reduction in catheter use in the hospital, a 20% overall reduction in catheterised patients in the community, and a 55% reduction in catheter-related infections. 

By reducing or eliminating unnecessary catheter use and related infections, Julia has transformed practice for the better and improved patient outcomes and patient care, and most likely helped to improve survival and quality of life too. She also saved her hospital an estimated average of £532 per patient in direct hospital costs, allowing those funds to be spent on other aspects of care.  

For this, she was awarded The Urology Foundation’s inaugural Urology Nurse of the Year Award, and in recognition of her many contributions to urological nursing, she was recognised in the Queen’s 2020 honours’ list.  

The British Association of Urological Surgeons (BAUS) and British Association of Urological Nurses (BAUN) have recently published a consensus document on the management and complications of long-term indwelling catheters (Reid et al, 2021). The main aim of the paper is to share best practice to minimise the frequency, severity and impact of these problems. This comprehensive report contains a list of recommendations and a trouble shooting table to help further with the management of issues and complications that can arise from long-term catheter use.  

With an increasing ageing population — the Office of National Statistics (ONS) estimated in 2016 that the proportion of the population aged 85 and over would double in the next 25 years (ONS, 2019) — the ongoing management of long-term catheter users will be an ongoing, not to say increasing issue, for those responsible for their health care.