Table 1.
Summary of included studies
| Reference | Country | Disease | Participants | Behaviour | Measurement of behaviour |
|---|---|---|---|---|---|
| Community care | |||||
| Getliffe & Newton [20] | UK | Not specified | District nurses (101/129 total sample; 18 community hospital and 10 nursing home care staff) | Record keeping relating to catheter care and CAUTI | Self-report questionnaire |
| Nursing home | |||||
| Krein et al. [21]. | USA | Not specified | Organizational and facility leaders | Implementing ‘The Agency for Healthcare Research and Quality (AHRQ) Safety Program for Long-term Care: Health Care-Associated Infections/Catheter-Associated Urinary Tract Infection' | Semi-structured telephone interviews |
| Secondary care | |||||
|
Krein et al. [22] Harrod et al. [23] |
USA | Not specified | Infection control nurse (42), nurse/nurse manager (25), other, e.g. quality manager (2), hospital epidemiologist or infectious diseases physician (1); prevention specialists | Implementing the ‘Bladder Bundle’ care package | Semi-structured interview |
| Alexaitis & Broome [24] | USA | Neuroscience intensive care unit: common diagnoses include aneurysms, arteriovenous malformations, central nervous system neoplasms, traumatic brain injuries, spinal cord injuries, hemorrhagic and ischemic strokes, and status epilepticus. | Patients (183), nurses (107) | Discontinuation of indwelling catheters and use of bladder ultrasonography in conjunction with intermittent catheterizations | Pre-post study: catheter utilization, CAUTI rates, number of CAUTIs per month, LOS (length of stay, and cost associated with treating CAUTIs |
| Andreessen et al. [25] | USA | Not specified | Male in-patients with acute indwelling urinary catheters; staff of the medical centre | Implementing evidence-based guidelines and a urinary catheter bundle (Adult Catheter Bundle) focusing on optimizing the use of urinary catheters through continual assessment and prompt catheter removal. | Pre-post study: catheter device days, compliance with urinary catheter orders, and computer documentation of continued catheter indications. |
| Apisarnthanarak et al. [26] | Thailand | Not specified | Survey: general personnel; interview: lead infection preventionist | Prevention practices for CAUTI, CLABSI and VAP | Survey; interview assessing prevention practices |
| Bursle et al. [27] | Australia | Not specified | Patients with urinary source bloodstream infection associated with an indwelling urinary catheter | Insertion of urinary catheter. | Case-control study: assessing risk factors for urinary catheter associated bloodstream infection |
|
Carter et al. [28] Carter et al. [29] |
USA | Not specified | Staff at emergency department | Implementing a CAUTI prevention program among Emergency Departments | Qualitative comparative case study |
| Hu et al. [30] | Taiwan | Not specified | 65 years or older | Insertion of urinary catheter | Prospective study: risk factors and outcomes for inappropriate use of urinary catheters |
| Conner et al. [31] | USA | Not specified | Nurses | Nurse driven early catheter discontinuation; assessing a patient’s need for indwelling urinary catheterization beyond 48 h | Pre-post study: factors associated with nurses’ adoption of an evidence-based practice to reduce the duration of catheterization |
| Conway et al. [32] | USA | Not specified | IPC (infection prevention control) department managers or directors | Adherence to CAUTI prevention policies | Cross-sectional survey on presence of CAUTI prevention policies, adherence to policies, CAUTI incidence rates |
| Crouzet et al. [33] | France | Not specified | Five hospital departments (not specified further) | Reducing the duration of the catheterisation | Non-random intervention study: duration of catheterisation, late CAUTI frequency |
| Dugyon-Escalante et al. [34] | USA | Not specified | Patients in intensive care units | Managing catheter use by multidisciplinary teams | Number of CAUTI cases and infection rates: pre-post |
| Fakih et al. [35] | USA | Not specified | Patients in medical-surgical units | Unnecessary use of urinary catheters | Quasi-experimental study with a control group: reduction in the rate of UC utilization |
| Fakih et al. [36] | USA | Not specified | Nurse and physician champions. Nurses caring for the patients. Other healthcare workers (e.g. infection preventionist, quality manager, safety officer, utilization manager) | Urinary catheter use and appropriateness of the indication for use (accountability at the unit level). | Symptomatic National Healthcare Safety Network (NHSN) CAUTI rate and population-based CAUTI rate. AHRQ's Hospital Survey on Patient Safety Culture administered both at baseline and 15 months later to evaluate changes in patient safety culture over time. Readiness assessment per unit at the beginning of the project and team check-up tool quarterly to report on progress with the implementation of CUSP principles and barriers |
| Gupta et al. [37] | USA | Not specified (ICU patients) | MICU medical director, MICU fellows, nurse managers and an infection control nurse | 1. Restricting IUC use to a limited list of predetermined indications. 2. Physicians and nurses were required to discontinue urinary catheters in all patients on admission unless warranted. 3. Narrowing down the criteria for urinary catheter utilization to urinary retention and genitourinary procedures only. 4. Use of sonographic bladder scanning to identify high-risk patients who may need indwelling catheters in the near future | IUC utilization ratio (number of urinary catheter days/patient days) and catheter-associated urinary tract infection (CAUTI) rates (number of CAUTI infections in a particular location or number of urinary catheter days in a particular location × 1000) |
| Mann et al. [38] | Canada | Not specified (intensive care units and rehabilitation unit) | Intensive care and rehabilitation unit nurses | Compliance with CAUTI prevention measures (Foley maintenance) | Compliance with the following evidence-based practices: catheter securement, tamper evident seal (TES) intact, absence of dependent loop, catheter below bladder level, drainage bag not touching floor and drainage bag not overfilled |
| Murphy et al. [39] | UK | Not specified (ED, medical assessment unit, cardiology wards, and older people’s acute medicine wards) | 8 nurses and 22 physicians in retrospective think aloud - RTA interviews. 20 of these (not specified how many nurses/physicians) also took part in a semi-structured interview | Decision making regarding IUC placement | 30 RTA interviews and 20 semi-structured interviews |
| Patrizzi et al. [40] | USA | Not specified (ED and inpatient units) | ED nurses |
Implementing a nurse-driven protocol to reduce CAUTI: Emergency department behaviours: 1. Removing direct access to catheters by placing them centrally in a supply closet instead of in each bedside supply cart. 2. Only storing 14F catheters (and no larger ones) in the supply closet as risk of infection increases with size. 3. Adding intermittent urinary catheterization kits to the supply closet as an alternative. 4. Education (e.g., The PPMC ‘UTI Bundle’ mandatory education day). 5. Availability of a bladder scanner. 6. New order set for indwelling urinary catheterization that lists 5 different indications to justify catheter placement (following hospital policy) instead of the previous ‘Foley catheter insertion’ order. 7. Collaboratively discussion between physician and nurse if the latter feels the insertion does not meet the established criteria. Inpatient unit behaviours: 1. Monitoring sheet placed on each patient’s medical record. 2. Daily assessment of a. necessity and b. standards for managing the catheter are being kept (e.g. bag below level of bladder) |
Percentage of patients admitted from ER with indwelling urinary catheters |
| Smith L et al. [41] | USA | Not specified | Burn ICU nurses | Insertion, maintenance and removal of urinary catheters. | CAUTI rates and catheter utilization rates |
| Tertiary care | |||||
| Fakih et al. [42] | USA | Not specified | EPs and resident staff in ED | Adherence to guidelines for urinary catheter placement | Data on urinary catheter presence on emergency department arrival, placement of a urinary catheter in the emergency department, documentation of a physician order for urinary catheter placement, reasons for placement, and compliance with the indications were collected retrospectively reviewing the emergency department records |
| Trautner et al. [43] | USA | Not specified | 169 physicians | Management of catheter-associated urine cultures | Self-report questionnaire |
| Kolonoski et al. [44] | USA | Not specified (post-acute units patients) | Physicians and nurses | Implementation of quality improvement programme to reduce CAUTI | Interview and point prevalence survey of Foley catheter use |