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Table 1 Summary of included studies

From: Reducing catheter-associated urinary tract infections: a systematic review of barriers and facilitators and strategic behavioural analysis of interventions

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