Schweiger, Alexander; Kuster, Stefan P; Maag, Judith; Züllig, Stephanie; Bertschy, Sonja; Bortolin, Emmanuelle; John, Gregor; Sax, Hugo; Limacher, Andreas; Atkinson, Andrew; Schwappach, David; Marschall, Jonas (2020). Impact of an evidence-based intervention on urinary catheter utilization, associated process indicators, and infectious and non-infectious outcomes. Journal of hospital infection, 106(2), pp. 364-371. Elsevier 10.1016/j.jhin.2020.07.002
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BACKGROUND
Multicentre intervention studies tackling urinary catheterization and its infections and non-infectious complications are lacking.
AIM
To decrease urinary catheterization and consequently catheter-associated urinary tract infections (CAUTI) and non-infectious complications.
METHODS
Before/after non-randomized multicenter intervention study in seven hospitals in Switzerland. Intervention bundle consisting of 1) a concise list of indications for urinary catheterization, 2) daily evaluation of the need for ongoing catheterization, and 3) education on proper insertion and maintenance of urinary catheters. The primary outcome was urinary catheter utilization. Secondary outcomes were CAUTI, non-infectious complications, and process indicators such as proportion of indicated catheters and frequency of catheter evaluation.
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
A straightforward bundle of three evidence-based measures reduced catheter utilization and non-infectious complications, whereas the proportion of indicated urinary catheters and daily evaluations increased. The CAUTI rate remained unchanged, albeit on a very low level.
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