Look at the instructions for any internal catheter and you will see “single use only,” a statement required by the Food and Drug Administration. But Medicare policy seems to say it’s fine to clean and re-use catheters, since it will only reimburse four catheters a month — unless you have two documented infections in a 12-month period. However, there are no accepted guidelines on the correct way to clean a single-use catheter.

How Medicare arrived at a “four catheter per month” policy remains a mystery. There are no studies that compare infection rates of single-use versus multi-use catheters. To make matters worse, more HMO and private insurance companies are following Medicare’s reimbursement guidelines. This may work fine for some, but for others, cleaning and re-using catheters puts them at risk for urinary tract infections and costly hospital stays, and could lead to permanent damage.

According to an article in The Arizona Republic titled “Medicare Challenged on Catheters,” the idea of re-using catheters started with the late Dr. Jack Lapides, a renowned urologist from the University of Michigan. In 1971 Lapides was successful in teaching people to catheterize at home, and part of the protocol included re-using catheters. Critics point out that it’s one thing to clean and re-use a catheter in your nice clean private bathroom, and quite another to do so in the real world of porta-potties and public restrooms. The article says that Lapides never tested the safety of re-using catheters. He simply declared re-use to be safe. Not only has there been no field (real-life) study that compares UTI rates in single-use vs. multi-use catheters, a number of improvements and options in catheters have become available since Lapides work. (See sidebar).

When it comes to re-using catheters, there is a myth that the bladder develops an immunity to bacteria over time. “People with frequent UTIs do not build up their immunity,” says Dr. Holly Zhao, assistant professor and attending physician of the department of physical medicine and rehabilitation at UC Davis Medical Center