Abstract
BackgroundUrinary and (peripheral and central) intravenous catheters are widely used in hospitalized patients. However, up to 56% of the catheters do not have an appropriate indication and some serious complications with the use of these catheters can occur. The main objective of our quality improvement project is to reduce the use of catheters without an appropriate indication by 25–50%, and to evaluate the affecting factors of our de-implementation strategy.MethodsIn a multicenter, prospective interrupted time series analysis, several interventions to avoid inappropriate use of catheters will be conducted in seven hospitals in the Netherlands. Firstly, we will define a list of appropriate indications for urinary and (peripheral and central) intravenous catheters, which will restrict the use of catheters and urge catheter removal when the indication is no longer appropriate. Secondly, after the baseline measurements, the intervention will take place, which consists of a kick-off meeting, including a competitive feedback report of the baseline measurements, and education of healthcare workers and patients. Additional strategies based on the baseline data and local conditions are optional. The primary endpoint is the percentage of catheters with an inappropriate indication on the day of data collection before and after the de-implementation strategy. Secondary endpoints are catheter-related infections or other complications, catheter re-insertion rate, length of hospital (and ICU) stay and mortality. In addition, the cost-effectiveness of the de-implementation strategy will be calculated.DiscussionThis study aims to reduce the use of urinary and intravenous catheters with an inappropriate indication, and as a result reduce the catheter-related complications. If (cost-) effective it provides a tool for a nationwide approach to reduce catheter-related infections and other complications.Trial registrationDutch trial registry: NTR6015. Registered 9 August 2016.
Highlights
Urinary and intravenous catheters are widely used in hospitalized patients
The use of invasive medical devices (e.g., urinary catheters, peripheral intravenous catheters (PIVCs) and central venous catheters (CVCs)) are important risk factors for the development of Healthcare-associated infection (HAI), which have prevalence of 7.1% measured in a combined point prevalence survey in Europe [1]
In this de-implementation study we aim for a 25–50% reduction of the number of urinary and intravenous catheters without an appropriate indication, which will lead to a reduction of the number of catheter days and catheter-related complications
Summary
Urinary and (peripheral and central) intravenous catheters are widely used in hospitalized patients. Up to 56% of the catheters do not have an appropriate indication and some serious complications with the use of these catheters can occur. The main objective of our quality improvement project is to reduce the use of catheters without an appropriate indication by 25–50%, and to evaluate the affecting factors of our de-implementation strategy. The use of invasive medical devices (e.g., urinary catheters, peripheral intravenous catheters (PIVCs) and central venous catheters (CVCs)) are important risk factors for the development of HAIs, which have prevalence of 7.1% measured in a combined point prevalence survey in Europe [1]. An efficient way to reduce HAIs is to avoid insertion of catheters without an appropriate indication and to reduce the number of catheter days. The incidence of unwarranted placement of urinary catheters in hospitalized patients is 14–65% [5,6,7,8,9,10]
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