Impact of an evidence-based intervention on urinary catheter utilization

Catheter-associated urinary tract infections (CAUTI) are a well-known complication of urinary tract catheterization, with rates ranging from 0.2-4.8 per 1,000 catheter days. The aim of this study was to decrease urinary catheterization and consequently catheter-associated urinary tract infections (CAUTI) and non-infectious complications.

Findings
We included 25,880 patients [13,171 before the intervention (August-October 2016) and 12,709 after the intervention (August-October 2017)]. Catheter utilization dropped from 23.7% to 21.0% (p=0.001), and catheter-days per 100 patient-days from 17.4 to 13.5 (p=0.167). CAUTI remained stable on a low level with 0.02 infections per 100 patient-days (before) and 0.02 infections (after), (p=0.98). Measuring infections per 1,000 catheter-days, the rate was 1.02 (before) and 1.33 (after), (p=0.60). Non-infectious complications dropped significantly, from 0.79 to 0.56 events per 100 patient-days (p<0.001), and from 39.4 to 35.4 events per 1,000 catheter-days (p=0.23). Indicated catheters increased from 74.5% to 90.0% (p<0.001). Reevaluations increased from 168 to 624 per 1,000 catheter-days (p<0.001).

Conclusion
In this before/after intervention study of urinary catheter utilization, a straightforward bundle of three evidence-based measures (providing a catheter indication list, promoting daily catheter evaluation, and teaching state-of-the-art catheter insertion) reduced catheter utilization and led to increases in indicated urinary catheters and daily evaluations. The intervention had an impact on non-infectious complications, whereas the CAUTI rate remained on a low level.The next step is planning the national roll-out of both the surveillance module and the intervention bundle, the components of which have been made available to the public (surveillance module, intervention bundle)

Source
The Journal of Hospital Infection

Authors
Dr. Alexander Schweiger, Prof. Dr. med. Jonas Marschall, PD Dr. med. Stefan P. Kuster, Judith Maag, Prof. Hugo Sax, Swissnoso
Andrew Atkinson, Inselspital Bern
Dr. med. Sonja Bertschy, Kantonsspital Luzern
Emmanuelle Bortolin, Ente Ospidaliero Cantonale Bellinzona
Dr. Gregor John, Hôpital Neuchâtelois
PhD Andreas Limacher, Universität Bern
Prof. Dr. David Schwappach und Dr. Stephanie Züllig, Patientensicherheit Schweiz

Abstract