Chen 2013.

Study characteristics
Methods	Study design: RCT Dates study conducted: April‐November 2008
Participants	Number of participants: 509 eligible; 278 randomised; 278 reported Setting: Taiwan Population: mixed Age (mean (SD): A 77 (12.7); B 78 (10.5) Inclusion criteria: all adult patients admitted to respiratory ICU Condition for hospitalisation: multiple. Most of the patients in the study had respiratory failure and were being treated with mechanical ventilation. Exclusion criteria: had not had IUC; did not stay in respiratory ICU for > 2 days Use of antibiotic prophylaxis: not used. Antibiotics were only given to symptomatic patients
Interventions	A: Intervention group – use of IUC removal reminder protocol (n = 147) Group 1 (n = 86): IUC removed ≤ 7 days Group 2 (n = 61): IUC removed > 7 days B: Control group i.e. no IUC removal reminder policy (n = 131) Group 1 (n = 48): IUC removed ≤ 7 days Group 2 (n = 83): IUC removed > 7 days Size and type of catheter used: not reported Study definition of short‐term catheterisation (days): not reported Intended duration of catheterisation for each group: A: intervention group – use of catheter removal reminder protocol Group 1 (catheter removed ≤ 7 days) Group 2 (catheter removed > 7days as clinically indicated) B: control group i.e. no catheter removal reminder policy Group 1 (catheter removed ≤ 7 days) Group 2 (catheter removed > 7days as clinically indicated)
Outcomes	Total CAUTIs Asymptomatic bacteriuria Symptomatic UTI Catheter‐associated asymptomatic bacteriuria Catheter‐associated symptomatic UTI Duration of catheterisation (mean, SD) Recatheterisation
Definition of CAUTI or bacteriuria	Determination of CAUTI was performed in accordance with criteria of the CDC and the National Healthcare Safety Network, including symptomatic UTI and asymptomatic bacteriuria. A CAUTI is a UTI that occurs in a patient who had an IUC in place within the 48 h before the onset of the UTI.
Sponsorship/funding	“This study was supported in part by a research grant from Taipei Veterans General Hospital (Taipei VGH‐V97A‐055)”
Ethical approval	The study was approved by the appropriate institutional review board before implementation.
Notes	Patients whose IUCs were removed later than planned were excluded from the per‐protocol analysis and were moved to a treatment‐contamination group. Protocol was not followed
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: “Computer‐generated random numbers were used …” Comment: adequate randomisation method
Allocation concealment (selection bias)	Unclear risk	Not reported
Blinding of participants and personnel (performance bias) All outcomes	Low risk	Quote: “These professionals had no knowledge of which group (control or intervention) a patient was assigned to ... most patients had respiratory failure and were being treated with mechanical ventilation.” Comment: adequate method of blinding. Unlikely participants knew due to being in ICU
Blinding of outcome assessment (detection bias) All outcomes	High risk	Quote: “The investigator responsible for the daily identification and assessment of all patients with indwelling urinary catheters, however, knew which group each patient was assigned to” Comment: outcome assessment was not blinded
Blinding of microbiological outcome (detection bias)	Low risk	Quote: “… all samples were sent to the laboratory…” Comment: unlikely laboratory staff knew which patients were in the trial
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Unclear. 278 patients were randomised but in table 3 there are 180 in group A and 181 in group B
Selective reporting (reporting bias)	Low risk	All outcomes are reported in both methods and results sections
Other bias	Low risk	Appears to be free from other sources of bias