Adoption of Single-Use Clean Intermittent Catheterization Policies Does Not Appear to Affect Genitourinary Outcomes in a Large Spinal Cord Injury Cohort

Abstract

Introduction: In April 2008, Medicare amended their policy for clean intermittent catheter (CIC), increasing coverage from 4 re-used catheters per month to up to 200 single-use catheters. The primary reason for the policy change was an assumed decrease in risk of urinary tract infection (UTI) with single-use catheters. Given its economic/environmental impact (∼50-fold increase in cost and plastic waste) and a paucity of supporting evidence, we retrospectively evaluate the policies’effect in a prospective spinal cord injury (SCI) registry. Methods: We accessed data for the years 1995 to 2020 from The National Spinal Cord Injury Database focusing on 1-year follow-up in those unable to volitionally void after injury. We asked two questions: 1) Did hospitalizations for genitourinary reasons decrease after the CIC policy change; and 2) Did CIC adoption and adherence increase after the CIC policy change? Results: During the study period, 2657 of the 6843 (38.8%) participants unable to volitionally void after SCI were hospitalized during their first follow-up year. Of the cohort performing CIC, fewer individuals were hospitalized for genitourinary reasons prior to the CIC policy change compared to after (10.6% versus 14.6%, p <0.001), a finding that persisted on multivariate logistic regression (OR=0.67, p <0.001). In addition, the number of individuals performing CIC at 1-year follow-up was less after the policy change compared to prior (57.0% vs 59.1%, p=0.044). Conclusion: Our findings suggest the 2008 policy change shifting CIC coverage from catheter reuse to single-use did not decrease hospitalizations for UTI or increase CIC uptake in individuals with SCI.