Inappropriate Use Of Urinary Catheters Research Articles

A nurse-led multifaceted intervention for the optimal use of indwelling urinary catheters at a tertiary care center: A before-after trial

BackgroundFew interventional studies of catheter-associated urinary tract infection (CAUTI) have been conducted to optimize indwelling urinary catheter (IUC) use in Japan. MethodsThe nurse-led, before-after study was conducted at a tertiary care center from June 2018 through May 2022. The intervention included 1) the provision of appropriate indications for IUC use, 2) prospective feedback to the primary care providers by ward nurses on unnecessary/inappropriate IUC use with two, separate interventional phases, the first involving intensive care units (ICU) only, the second involving ICU and general wards, and 3) proactive feedback by Infectious diseases physicians in the Infection Control department to the primary care providers regarding IUC discontinuation upon discharge from the ICU. ResultsDuring the first phase involving the implementation of the intervention only in the ICU, the indwelling urinary catheter-device utilization ratio (IUC-DUR) trend in the general wards decreased by 1.5 % (P = 0.01). However, the addition of the intervention to the general wards in the second phase led to a 2 % increase in the trend (P = 0.010). The CAUTI incidence in neither the ICU nor the general wards changed significantly. ConclusionsAlthough providing feedback on IUC removal at discharge from the ICU and appropriate indications for urinary catheter insertion can reduce inappropriate urinary catheter use, the nurse-led intervention alone was inadequate for reducing the CAUTI incidence.

Patient engagement to counter catheter-associated urinary tract infections with an app (PECCA): a multicentre, prospective, interrupted time-series and before-and-after study

The risk of urinary tract infections (UTIs) is increased by unnecessary placement and prolonged use of urinary catheters. To assess whether inappropriate use of catheters and catheter-associated UTI were reduced through patient participation. In this multicentre, interrupted time-series and before-and-after study, we implemented a patient-centred app which provides catheter advice for patients, together with clinical lessons, feedback via e-mails and support rounds for staff members. Data on catheter use and infections were collected during a six-month baseline and a six-month intervention period on 13 wards in four hospitals in the Netherlands. Dutch Trial Register: NL7178. Between June 25th, 2018 and August 1st, 2019, 6556 patients were included in 24 point-prevalence surveys, 3285 (50%) at baseline and 3271 (50%) during the intervention. During the intervention 249 app users and a median of seven new app users per week were registered (interquartile range: 5.5-13.0). At baseline, inappropriate catheter use was registered for 175 (21.9%) out of 798 catheters, compared to 55 (7.0%) out of 786 during the intervention. Time-series analysis showed a non-significant decrease of inappropriate use of 5.8% (95% confidence interval: -3.76 to 15.45; P= 0.219), with an odds ratio of 0.27 (0.19-0.37; P < 0.001). Catheter-associated UTI decreased by 3.0% (1.3-4.6; P= 0.001), with odds ratio 0.541 (0.408-0.716; P < 0.001). Although UTI significantly decreased after the implementation, patient participation did not significantly reduce the prevalence of inappropriate urinary catheter use. However, the inappropriate catheter reduction of 5.8% and an odds ratio of 0.27 suggest a positive trend. Patient participation appears to reduce CAUTI and could reduce other healthcare-associated infections.

On Low-Value Nursing Care: Part 2, De-implementing Practices in Your Unit.

On Low-Value Nursing Care: Part 2, De-implementing Practices in Your Unit.

Reducing Inappropriate Urinary Catheter Use by Involving Patients Through the Participatient App: Before-and-After Study

BackgroundThe risk of urinary tract infections is increased by the inappropriate placement and unnecessary prolongation of the use of indwelling urinary catheters. Sustained behavior change in infection prevention could be promoted by empowering patients through a smartphone app.ObjectiveThe aim of this study is to assess the feasibility and efficacy of implementation actions on patients’ use of the Participatient app on a clinical ward and to compare 3 survey methods for urinary catheter use.MethodsParticipatient was introduced for all admitted patients at the surgical nursing ward in a university hospital in the Netherlands. Over a period of 3 months, the number of new app users, days of use, and sessions were recorded. In a comparison of urinary catheter use before and after the implementation of the app, 3 methods for point prevalence surveys of catheter use were tested. Surveys were conducted through manual parsing of the text in patients’ electronic medical records, parsing a survey of checkbox items, and parsing nursing notes.ResultsIn all, 475 patients were admitted to the ward, 42 (8.8%) installed the app, with 1 to 5 new users per week. The actions with the most ensuing app use were the kick-off with the clinical lesson and recruiting of the intake nurse. Between the survey methods, there was considerable variation in catheter use prevalence. Therefore, we used the standard method of manual parsing in further analyses. Catheter use prevalence decreased from 38% (36/96) to 27% (23/86) after app introduction (OR 0.61, 95% CI 0.32-1.14).ConclusionsThe clinical application of Participatient, the infection prevention app for patients, could be feasible when implementation actions are also used. For surveying indwelling urinary catheter use prevalence, manual parsing is the best approach.

Registration of catheter-related complications in adverse events reporting systems: a major underestimation of the real complication practice.

Reporting and learning from preventable adverse events is crucial to improve patient safety. Although physicians should file and analyse adverse events by law in The Netherlands, it is unknown if these reporting systems are sufficiently used in clinical practice. This study is a substudy of the multicenter RICAT trial, a successful quality improvement project to reduce inappropriate use of intravenous and urinary catheters in medical wards in seven hospitals, in which we screened 5696 patients and documented 803 catheter-related complications. We also checked the adverse events reporting systems of these patients and found that only 13 (1.6%) of 803 catheter-related complications were registered. Of the infectious complications only five (10.9%) of 46 catheter-associated bloodstream infections and urinary tract infections were registered. We conclude that the reported complications were a major underestimation of the real complication practice in medical wards in The Netherlands.The RICAT trial is registered at Netherlands Trial Register, trial NL5438.

Pull the Foley: Improved Quality for Middle-Aged and Geriatric Trauma Patients Without Indwelling Catheters.

Urinary tract infection (UTI) complications are often attributed to the inappropriate use of urinary catheters. We sought to examine the effectiveness of a hospital-wide policy aimed at reducing the use of indwelling Foley catheters. We completed a retrospective review of prospectively collected data on 577 hip and femur fracture patients aged 55 years and older who were operatively treated at a Level 1 trauma center between October 2014 and March 2019. New standard-of-care guidelines restricting the use of indwelling Foley catheters were implemented starting January 2018, and we compared perioperative outcomes between cohorts. Over a 50% absolute reduction in indwelling Foley catheter use and a near 30% relative reduction in hospital-acquired UTI were achieved. Postpolicy cohort patients without indwelling Foley catheters experienced lower odds of hospital-acquired UTI, higher odds of home discharge, as well as decreased time to surgery, shorter length of stay, and lower total inpatient cost compared with those with indwelling Foley catheters. The policy of restricting indwelling Foley catheter placement was safe and effective. A decrease in indwelling Foley catheter use led to a decrease in the rate of hospital-acquired UTI and positively affected other perioperative outcomes.

How many urinalysis and urine cultures are necessary?

BackgroundUrinalysis and urine culture are two of the most commonly ordered tests. A positive urine test in asymptomatic patients often leads to overtreatment. Antimicrobials for asymptomatic bacteriuria is one of the most common unnecessary treatments. We aimed to explore the current ordering patterns of urinalysis and cultures. MethodsThis is a substudy of the multicentre RICAT-trial, a successful quality improvement project to reduce inappropriate use of intravenous and urinary catheters in seven hospitals in the Netherlands. Adult patients with a (central or peripheral) venous or urinary catheter admitted to internal medicine and non-surgical subspecialty wards were eligible for inclusion. Data were collected every other week during baseline (seven months) and intervention periods (seven months). The primary outcome was the proportion of urine cultures performed following a negative urinalysis, i.e. dipstick and/or microscopic analysis, within 24 h. ResultsBetween September 2016 and April 2018, we included 3748 patients, of which 3111 (83%) were admitted from the emergency department. Urinalysis and/or urine cultures were obtained in 2610 (70%) of 3748 patients. 626 (23.7%) of 2636 urine cultures and 1351 (55.8%) of 2419 microscopic analysis were unnecessary performed after a negative urinalysis. Cancelling urine testing orders after a negative dipstick would have saved almost € 19.500 during the study period in these seven hospitals. ConclusionUnnecessary urine testing is frequent in non-surgical patients in the Netherlands. We need to take action to reduce unnecessary urinalysis and cultures, and thereby probably reduce overtreatment of asymptomatic bacteriuria.

Effect of Physician Documentation on Catheter Associate Urinary Tract Infection Rates at a Community Hospital

<h3>Background</h3> Urinary tract infections (UTIs) account for more than 30% of healthcare-associated infections. Urinary catheters are often placed and continued for inappropriate indications. Urine cultures are also frequently obtained when not indicated. <h3>Methods</h3> Twenty-one catheter associated urinary tract infections (CAUTIs) were identified during the surveillance time-frame of October 2018 to March 2019. Chart review was done to identify provider order for urinary catheter insertion, documentation for appropriate indication of catheter and urine culture. <h3>Results</h3> Of the twenty-one CAUTIs, there was no provider order or documentation of appropriate indication for urinary catheter insertion in 48% of the charts that were reviewed. Sixty seven percent of these CAUTIs did not have daily documentation of urinary catheter necessity. Inappropriate continued urinary catheter use was identified in 57%. Urine culture was ordered when not clinically indicated in 48% of the patients. <h3>Conclusions</h3> Through this study, we identified opportunities to improve physician documentation for urinary catheter insertion, continued use and urine culture orders. Lack of diagnostic stewardship was noted, with half of the urine cultures obtained when not indicated. Efforts to improve physician awareness included education through presentation at grand rounds, medical staff orientation, communication in newsletters, emails and fliers in the physician's lounge. Urinary catheter order has been removed from all order sets with a few exceptions that are approved by the CAUTI committee (examples: preoperative, trauma, genital urinary). A request has been made to the Information Technology department to include the appropriate indications for urine catheter and urine culture to the respective orders and to have a hard stop option in the electronic medical record for provider documentation of daily catheter necessity. Our efforts have to date shown decreased Foley use. The house-wide utilization rate prior to these implementations was 0.22 compared to our current rate of 0.18. Critical care utilization rate decreased to 0.56 from 0.60.

Prevalence and risk factors of inappropriate use of intravenous and urinary catheters in surgical and medical patients

Previously, the RICAT (Reduction of Inappropriate use of intravenous and urinary CATheters) study had been conducted by ourselves to reduce inappropriate use of intravenous and urinary catheters in medical wards to prevent healthcare-associated infections. To compare surgical and medical wards, and to determine risk factors for inappropriate catheter use. A cross-sectional study was performed from October, 2017, to May, 2018, in surgical wards of two university hospitals in the Netherlands. Patients were prospectively observed every other week for seven months. Inappropriate use was compared with non-surgical wards in the RICAT study. In all, 409 surgical patients were included, and they were compared with 1781 medical patients. Inappropriate use occurred in 36 (8.5%) out of 425 peripheral intravenous catheters in 373 surgical patients, compared to 400 (22.9%) out of 1747 peripheral intravenous catheters in 1665 medical patients, a difference of 14.4% (95% confidence interval (CI): 11.1-17.8; P < 0.001). Inappropriate use of urinary catheters occurred in 14 (10.4%) out of 134 surgical patients, compared to 105 (32.4%) out of 324 medical patients, a difference of 22.0% (95% CI: 14.7-29.2; P < 0.001). Subgroup analysis in the two university hospitals confirmed these differences. The main risk factor for inappropriate use of peripheral intravenous catheters was admission in medical wards (odds ratio (OR): 3.50; 95% CI: 2.15-5.69), which was also one of the main risk factors for urinary catheters (OR: 2.75; 95% CI: 1.36-5.55). Inappropriate use of catheters is more common in medical wards compared to surgical wards. Prevention strategies to reduce healthcare-associated infections should primarily focus on sites with high prevalence of inappropriate use.

De-implementation strategy to reduce inappropriate use of intravenous and urinary catheters (RICAT): a multicentre, prospective, interrupted time-series and before and after study

Catheter-associated bloodstream infections and urinary tract infections are frequently encountered health care-associated infections. We aimed to reduce inappropriate use of catheters to reduce health care-associated infections. In this multicentre, interrupted time-series and before and after study, we introduced a de-implementation strategy with multifaceted interventions in seven hospitals in the Netherlands. Adult patients admitted to internal medicine, gastroenterology, geriatic, oncology, or pulmonology wards, and non-surgical acute admission units, and who had a (central or peripheral) venous or urinary catheter were eligible for inclusion. One of the interventions was that nurses in the participating wards attended educational meetings on appropriate catheter use. Data on catheter use were collected every 2 weeks by the primary research physician during the baseline period (7 months) and intervention period (7 months), which were separated by a 5 month transition period. The primary outcomes were percentages of short peripheral intravenous catheters and urinary catheters used inappropriately on the days of data collection. Indications for catheter use were based on international guidelines. This study is registered with Netherlands Trial Register, NL5438. Between Sept 1, 2016, and April 1, 2018, we screened 6157 patients for inclusion, of whom 5696 were enrolled: 2650 patients in the baseline group, and 3046 in the intervention group. Inappropriate use of peripheral intravenous catheters occurred in 366 (22·0%, 95% CI 20·0 to 24·0) of 1665 patients in the baseline group and in 275 (14·4%, 12·8 to 16·0) of 1912 patients in the intervention group (incidence rate ratio [IRR] 0·65, 95% CI 0·56 to 0·77, p<0·0001). Time-series analyses showed an absolute reduction in inappropriate use of peripheral intravenous catheters from baseline to intervention periods of 6·65% (95% CI 2·47 to 10·82, p=0·011). Inappropriate use of urinary catheters occurred in 105 (32·4%, 95% CI 27·3 to 37·8) of 324 patients in the baseline group compared with 96 (24·1%, 20·0 to 28·6) of 398 patients in the intervention group (IRR 0·74, 95% CI 0·56 to 0·98, p=0·013). Time-series analyses showed an absolute reduction in inappropriate use of urinary catheters of 6·34% (95% CI -12·46 to 25·13, p=0·524). Our de-implementation strategy reduced inappropriate use of short peripheral intravenous catheters in patients who were not in the intensive care unit. The reduction of inappropriate use of urinary catheters was substantial, yet not statistically significant in time-series analysis due to a small sample size. The strategy appears well suited for broad-scale implementation to reduce health care-associated infections. Netherlands Organisation for Health Research and Development.

Transforming use of two catheters: from accessory to hazard

In The Lancet Infectious Diseases, Bart J Laan and colleagues 1 Laan BJ Maaskant JM Spijkerman IJ et al. De-implementation strategy to reduce inappropriate use of intravenous and urinary catheters (RICAT): a multicenter, prospective, interrupted time-series study. Lancet Infect Dis. 2020; (published online March 6.)https://doi.org/10.1016/S1473-3099(19)30709-1 Summary Full Text Full Text PDF PubMed Scopus (7) Google Scholar examined the effect of a tailored multifaceted intervention in medical wards in seven hospitals in the Netherlands that focused on reducing inappropriate use of two of the most commonly used medical technologies worldwide: short peripheral intravenous catheters and urinary catheters. These catheters are often inserted as part of routine, efficient evaluation and admission practices for patients presenting with common medical complaints and are frequently used until discharge. The use of these catheters has often required no order from physicians and no communication with patients regarding risks and benefits—in a way that is similar to attaching a hospital identification band to the wrist of a patient as a routine accessory. De-implementation strategy to reduce inappropriate use of intravenous and urinary catheters (RICAT): a multicentre, prospective, interrupted time-series and before and after studyOur de-implementation strategy reduced inappropriate use of short peripheral intravenous catheters in patients who were not in the intensive care unit. The reduction of inappropriate use of urinary catheters was substantial, yet not statistically significant in time-series analysis due to a small sample size. The strategy appears well suited for broad-scale implementation to reduce health care-associated infections. Full-Text PDF

Improving urinary catheterisation practices in a rural hospital in Ontario

IntroductionA urinary catheter constitutes a one-point patient restraint, can induce deconditioning and may lead to patient mortality. An audit performed at Winchester District Memorial Hospital revealed that 20% of patients...

1530. De-implementation Strategy to Reduce the Inappropriate Use of Urinary and Intravenous CATheters: the RICAT Study

BackgroundCatheter-associated urinary tract infection (UTI) and catheter-associated bloodstream infection (BSI) are common healthcare-associated infections (HAI). Therefore, catheters should only be used if indicated. However, based on the literature up to 65% of the urinary catheters and 56% of the peripheral intravenous catheters have an inappropriate indication. So, an efficient way to reduce HAIs is to avoid unnecessary use of catheters. Our quality improvement project aims to reduce unnecessary use of catheters.MethodsIn a multicenter, interrupted time series study, several interventions to avoid inappropriate use of catheters were carried out in internal medicine and nonsurgical subspecialty wards in seven hospitals in the Netherlands. The indications for catheter use were based on (inter)national guidelines. The primary endpoint is the percentage of inappropriate indications on the day of data collection. Secondary endpoints are catheter-associated infections, length of hospital stay and mortality. Data were collected once per 2 weeks during baseline (7 months) and post-intervention (7 months). Preliminary analyses compared incidence rates before and after the intervention.ResultsData were obtained from 5,691 observed patients. The rate of inappropriate use of urinary catheters decreased from 32.1 to 23.7% (incidence rate ratio 0.74, 95% CI 0.58–0.94, P = 0.013), and inappropriate use of peripheral intravenous catheters decreased from 22.0 to 15.2% (incidence rate ratio 0.69, 95% CI 0.60–0.80, P < 0.001). The overall urinary and intravenous catheter use was stable, resp. 12.2% (n = 324) to 12.5% (n = 380) and 62.8% (n = 1,665) to 62.1% (n = 1,887). Most inappropriate indications were due to prolonged catheter use. The indications which expire frequently are”Accurate measurements of urinary output in critically ill patients’ for urinary and”IV fluids and antibiotic therapy’ for intravenous catheters. Subsequent analyses will take into account the interrupted time series design, and evaluate catheter-associated UTI and BSI rates. ConclusionOur de-implementation strategy reduces unnecessary use of urinary and intravenous catheters in non-ICUs. It is important to increase awareness for inappropriate use of catheters.Disclosures S. E. Geerlings, Nordic Pharma: Consultant and Fosfomycin iv, consulting fee.

Dynamic changes in the appropriateness of urinary catheter use among hospitalized older patients in the emergency department.

ObjectivesTo investigate incidence, rationales, related factors and outcomes for changing from appropriate catheter placement to inappropriate use among hospitalized older patients in the emergency department.MethodsA secondary analysis was adopted from a longitudinal study that was designed to follow the lifecycle of the urinary catheter among hospitalized older patients. Patients aged 65 and older with a urinary catheter that had been placed in the emergency department were included. Demographic factors, present health conditions, conditional factors of catheter placement, and rationales for daily urinary catheter use were collected from the original data. Inappropriate urinary catheter days were evaluated as an outcome.ResultsAppropriate urinary catheters were placed in the emergency department in 117 of the 156 patients (75%). Of these patients, 77 patients (65.8%) experienced a change from appropriate placement to inappropriate use, with a mean duration of 2.88±1.56 days. The common rationales were post-operation for hip fracture (36.3%) and no longer needing to monitor urine output (27.2%). A hierarchical regression model shows that a change from appropriate catheter placement to inappropriate use was associated with a diagnosis of urinary tract infection (OR = 0.15; 95% CI = 0.03–0.77; p = 0.02) and no record of the indication for catheter placement (OR = 4.76; 95% CI = 1.20–18.90; p = 0.02), and all variables together explained 35.9% of the variance. In addition, a change from appropriate placement to inappropriate use was further associated with prolonging inappropriate catheter-days (β = 5.34; 95% CI: 3.72–6.97; p <0.001).ConclusionsThe study highlights a considerable percentage of change from appropriate placement to inappropriate use. Efforts to construct reminder intervention, to improve the record of catheter placement and continued attention to catheter use are necessary to reduce inappropriate urinary catheter use.

Gender differences in inappropriate use of urinary catheters among hospitalized older patients

ABSTRACTThis study investigated the incidence, rationales, and associated factors of inappropriate urinary catheter use among hospitalized older patients by gender. A longitudinal study of 321 patients with urinary catheter was conducted. Demographic factors, present health factors, urinary catheter factors, and indications of catheter use were collected. A total of 53.7% of urinary catheter-days were inappropriate. For both men and women, there was no significant difference in the incidence and common rationales of inappropriate use. Women, however, have another associated factor with inappropriate use. More tailored alternatives are needed for women to increase comfort to avoid inappropriate catheter use.

Avoiding inappropriate urinary catheter use and catheter-associated urinary tract infection (CAUTI): a pre-post control intervention study

BackgroundUrinary tract infection (UTI) as the most common healthcare-associated infection accounts for up to 36% of all healthcare-associated infections. Catheter-associated urinary tract infection (CAUTI) accounts for up to 80% of these. In many instances indwelling urinary catheter (IDC) insertions may be unjustified or inappropriate, creating potentially avoidable and significant patient distress, embarrassment, discomfort, pain and activity restrictions, together with substantial care burden, costs and hospitalisation. Multifaceted interventions combining best practice guidelines with staff engagement, education and monitoring have been shown to be more effective in bringing about practice change than those that focus on a single intervention. This study builds on a nurse-led initiative that identified that significant benefits could be achieved through a systematic approach to implementation of evidence-based practice.MethodsThe primary aim of the study is to reduce IDC usage rates by reducing inappropriate urinary catheterisation and duration of catheterisation. The study will employ a multiple pre-post control intervention design using a phased mixed method approach. A multifaceted intervention will be implemented and evaluated in four acute care hospitals in NSW, Australia. The study design is novel and strengthened by a phased approach across sites which allows for a built-in control mechanism and also reduces secular effects. Feedback of point prevalence data will be utilised to engage staff and improve compliance. Ward-based champions will help to steward the change and maintain focus.DiscussionThis study will improve patient safety through implementation and robust evaluation of clinical practice and practice change. It is anticipated that it will contribute to a significant improvement in patient experiences and health care outcomes. The provision of baseline data will provide a platform from which to ensure ongoing improvement and normalisation of best practice. This study will add to the evidence base through enhancing understanding of interventions to reduce CAUTI and provides a prototype for other studies focussed on reduction of hospital acquired harms. Study findings will inform undergraduate and continuing education for health professionals.Trial registrationACTRN12617000090314. Registered 17 January 2017. Retrospectively registered.

Prevalence and Appropriateness of Urinary Catheters in Japanese Intensive Care Units: Results From a Multicenter Point Prevalence Study.

Catheter-associated urinary tract infection is a common and costly problem throughout the world. As limited data from Asia exist regarding the prevalence and appropriateness of urinary catheters in critically ill patients, we sought to assess both prevalence and appropriateness of urinary catheters in Japan. Using independent observers, we evaluated the prevalence and clinical necessity of indwelling urinary catheters in 7 Japanese intensive care units. Data were collected on 1289 catheter-days and 1706 patient days in the 7 participating intensive care units between August 2015 and May 2016. Urinary catheter prevalence was 76% (range, 49%-94%). The observers deemed that only 54% of the catheters met an appropriate indication for use (range, 40%-74%). The most common appropriate indications for urinary catheter use were (1) the need for accurate input and output monitoring in critically ill patients; (2) perioperative use; and (3) prolonged immobilization. The use of monitoring accurate input and output in critically ill patients, however, may be overused as bedside nurses used this indication in 27% more patients than the objective observer deemed necessary. Urinary catheters were frequently used in the 7 participating Japanese intensive care units and almost half did not meet an appropriate indication for use. Overusing catheters for monitoring accurate input and output was especially notable. Multimodal interventions may be needed to limit inappropriate urinary catheter use.

De-implementation strategy to Reduce the Inappropriate use of urinary and intravenous CATheters: study protocol for the RICAT-study

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.

Physician-initiated daily verbal reminders decrease the duration of indwelling urinary catheter use compared with nurse-initiated reminders

We compared the effectiveness of physician-initiated daily verbal reminders to primary care providers with nurse-initiated daily verbal reminders in decreasing the duration of inappropriate indwelling urinary catheter use in hospitalized patients. Catheter use duration was significantly decreased in the physician-initiated intervention group compared with the nurse-initiated intervention group (0.5 ± 0.8 vs 1.7 ± 2.7 days, respectively; P = .03).

Reducing inappropriate urinary catheter use: quality care initiatives.

Healthcare-acquired urinary infection presents a substantial burden for patients and the healthcare system. Urinary tract infections have not gained the same level of media attention as other healthcare-associated infections, yet interventions to reduce urinary catheter use are one of the top ten recommended patient safety strategies. To improve practice around urinary catheter placement and removal requires interventions to change the expectations and habits of nurses, medical teams and patients regarding the need for a urinary catheter. In the authors' trust, a redesign of the existing urinary catheter device record was undertaken to help avoid unnecessary placement of catheters, and resulted in a reduction of urinary catheters in situ longer than 48 hours. Other strategies included implementation of catheter rounds in a high-usage area, and credit-card-sized education cards. A catheter 'passport' was introduced for patients discharged with a catheter to ensure information for insertion and ongoing use were effectively communicated.