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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

ReferenceCountryDiseaseParticipantsBehaviourMeasurement of behaviour
Community care
Getliffe & Newton [20]UKNot specifiedDistrict nurses (101/129 total sample; 18 community hospital and 10 nursing home care staff)Record keeping relating to catheter care and CAUTISelf-report questionnaire
Nursing home
Krein et al. [21].USANot specifiedOrganizational and facility leadersImplementing ‘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]
USANot specifiedInfection control nurse (42), nurse/nurse manager (25), other, e.g. quality manager (2), hospital epidemiologist or infectious diseases physician (1); prevention specialistsImplementing the ‘Bladder Bundle’ care packageSemi-structured interview
Alexaitis & Broome [24]USANeuroscience 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 catheterizationsPre-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]USANot specifiedMale in-patients with acute indwelling urinary catheters; staff of the medical centreImplementing 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]ThailandNot specifiedSurvey: general personnel; interview: lead infection preventionistPrevention practices for CAUTI, CLABSI and VAPSurvey; interview assessing prevention practices
Bursle et al. [27]AustraliaNot specifiedPatients with urinary source bloodstream infection associated with an indwelling urinary catheterInsertion of urinary catheter.Case-control study: assessing risk factors for urinary catheter associated bloodstream infection
Carter et al. [28]
Carter et al. [29]
USANot specifiedStaff at emergency departmentImplementing a CAUTI prevention program among Emergency DepartmentsQualitative comparative case study
Hu et al. [30]TaiwanNot specified65 years or olderInsertion of urinary catheterProspective study: risk factors and outcomes for inappropriate use of urinary catheters
Conner et al. [31]USANot specifiedNursesNurse driven early catheter discontinuation; assessing a patient’s need for indwelling urinary catheterization beyond 48 hPre-post study: factors associated with nurses’ adoption of an evidence-based practice to reduce the duration of catheterization
Conway et al. [32]USANot specifiedIPC (infection prevention control) department managers or directorsAdherence to CAUTI prevention policiesCross-sectional survey on presence of CAUTI prevention policies, adherence to policies, CAUTI incidence rates
Crouzet et al. [33]FranceNot specifiedFive hospital departments (not specified further)Reducing the duration of the catheterisationNon-random intervention study: duration of catheterisation, late CAUTI frequency
Dugyon-Escalante et al. [34]USANot specifiedPatients in intensive care unitsManaging catheter use by multidisciplinary teamsNumber of CAUTI cases and infection rates: pre-post
Fakih et al. [35]USANot specifiedPatients in medical-surgical unitsUnnecessary use of urinary cathetersQuasi-experimental study with a control group: reduction in the rate of UC utilization
Fakih et al. [36]USANot specifiedNurse 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]USANot specified (ICU patients)MICU medical director, MICU fellows, nurse managers and an infection control nurse1. 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 futureIUC 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]CanadaNot specified (intensive care units and rehabilitation unit)Intensive care and rehabilitation unit nursesCompliance 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]UKNot 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 interviewDecision making regarding IUC placement30 RTA interviews and 20 semi-structured interviews
Patrizzi et al. [40]USANot specified (ED and inpatient units)ED nursesImplementing 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]USANot specifiedBurn ICU nursesInsertion, maintenance and removal of urinary catheters.CAUTI rates and catheter utilization rates
Tertiary care
Fakih et al. [42]USANot specifiedEPs and resident staff in EDAdherence to guidelines for urinary catheter placementData 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]USANot specified169 physiciansManagement of catheter-associated urine culturesSelf-report questionnaire
Kolonoski et al. [44]USANot specified (post-acute units patients)Physicians and nursesImplementation of quality improvement programme to reduce CAUTIInterview and point prevalence survey of Foley catheter use