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To the Editor: In their article about patient safety, Dr Shojania and colleagues¹ recommend the use of silver alloy and suprapubic urinary catheters. However, they do not address avoidance of unnecessary catheter use. Urinary catheters are widely and inappropriately used in hospitals; physicians are often unaware that their patients have a catheter in place, and such unrecognized catheter usage is particularly likely to be inappropriate.² The Foley catheter has been derided as a "one-point restraint" that causes discomfort, poses an infectious risk, injures patients' dignity, and limits mobility.² Shojania et al do not discuss catheter avoidance and removal as important ways to promote patient safety, despite the absence of confirmatory clinical trials.

Moreover, the available data regarding silver alloy and suprapubic catheters are mixed or of uncertain relevance.³ Four early trials of the silver alloy catheter, all from a single hospital, were uniformly encouraging. A meta-analysis of these trials showed . . . [Full Text of this Article]

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