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In Reply: We share Dr Johnson's concern about the need to decrease inappropriate catheter use. However, our intent was to identify practices with supporting evidence, not strategies based on common sense or current theories of patient safety.

Evidence addressing the potential impact of automatic stop orders for urinary catheters appeared in abstract form¹ after we published our article. However, even with reduced inappropriate use, millions of patients each year will continue to receive urinary catheters and thus would benefit from strategies that reduce catheter-associated infection.

A meta-analysis² found that silver alloy catheters reduce catheter-associated infection. Johnson argues that the best-designed of these studies "lost statistical significance in a multivariate analysis." The study to which he refers reported a 30% reduction (P = .04) in catheter-associated infections.³ Further multivariate analysis increased the associated P value to .08. However, we believe that such additional analysis was overly conservative, as this was . . . [Full Text of this Article]

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