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      • Record: found
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      Reducing urinary catheter use: a protocol for a mixed methods evaluation of an electronic reminder system in hospitalised patients in Australia

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          Abstract

          Introduction

          Despite advances in infection prevention and control, catheter-associated urinary tract infections (CAUTIs) are common and remain problematic. Prolonged urinary catheterisation is the main risk factor for development of CAUTIs; hence, interventions that target early catheter removal warrant investigation. The study’s objectives are to examine the efficacy of an electronic reminder system, the CATH TAG, in reducing urinary catheter use (device utilisation ratio) and to determine the effect of the CATH TAG on nurses’ ability to deliver patient care.

          Methods and analysis

          This study uses a mixed methods approach in which both quantitative and qualitative data will be collected. A stepped wedge randomised controlled design in which wards provide before and after observations will be undertaken in one large Australian hospital over 24 weeks. The intervention is the use of the CATH TAG. Eligible hospital wards will receive the intervention and act as their own control, with analysis undertaken of the change within each ward using data collected in control and intervention periods. An online survey will be administered to nurses on study completion, and a focus group for nurses will be conducted 2 months after study completion. The primary outcomes are the urinary catheter device utilisation ratio and perceptions of nurses about ease of use of the CATH TAG. Secondary outcomes include a reduced number of cases of catheter-associated asymptomatic bacteriuria, a reduced number of urinary catheters inserted per 100 patient admissions, perceptions of nurses regarding effectiveness of the CATH TAG, changes in ownership/interest by patients in catheter management, as well as possible barriers to successful implementation of the CATH TAG.

          Ethics and dissemination

          Approval has been obtained from the Human Research Ethics Committees of Avondale College of Higher Education (2017:15) and Queensland Health (HREC17QTHS19). Results will be disseminated via peer-reviewed journals and conference presentations.

          Trial registration number

          ACTRN12617001191381 (Pre-results).

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          Most cited references25

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          Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs.

          Craig A Umscheid, Matthew D. Mitchell, Jalpa Doshi … (2011)
          To estimate the proportion of healthcare-associated infections (HAIs) in US hospitals that are "reasonably preventable," along with their related mortality and costs. To estimate preventability of catheter-associated bloodstream infections (CABSIs), catheter-associated urinary tract infections (CAUTIs), surgical site infections (SSIs), and ventilator-associated pneumonia (VAP), we used a federally sponsored systematic review of interventions to reduce HAIs. Ranges of preventability included the lowest and highest risk reductions reported by US studies of "moderate" to "good" quality published in the last 10 years. We used the most recently published national data to determine the annual incidence of HAIs and associated mortality. To estimate incremental cost of HAIs, we performed a systematic review, which included costs from studies in general US patient populations. To calculate ranges for the annual number of preventable infections and deaths and annual costs, we multiplied our infection, mortality, and cost figures with our ranges of preventability for each HAI. As many as 65%-70% of cases of CABSI and CAUTI and 55% of cases of VAP and SSI may be preventable with current evidence-based strategies. CAUTI may be the most preventable HAI. CABSI has the highest number of preventable deaths, followed by VAP. CABSI also has the highest cost impact; costs due to preventable cases of VAP, CAUTI, and SSI are likely less. Our findings suggest that 100% prevention of HAIs may not be attainable with current evidence-based prevention strategies; however, comprehensive implementation of such strategies could prevent hundreds of thousands of HAIs and save tens of thousands of lives and billions of dollars.
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            Systematic review of stepped wedge cluster randomized trials shows that design is particularly used to evaluate interventions during routine implementation.

            Noreen D Mdege, Mei-See Man, Celia A Taylor Nee Brown … (2011)
            To describe the application of the stepped wedge cluster randomized controlled trial (CRCT) design. Systematic review. We searched Medline, Embase, PsycINFO, HMIC, CINAHL, Cochrane Library, Web of Knowledge, and Current Controlled Trials Register for articles published up to January 2010. Stepped wedge CRCTs from all fields of research were included. Two authors independently reviewed and extracted data from the studies. Twenty-five studies were included in the review. Motivations for using the design included ethical, logistical, financial, social, and political acceptability and methodological reasons. Most studies were evaluating an intervention during routine implementation. For most of the included studies, there was also a belief or empirical evidence suggesting that the intervention would do more good than harm. There was variation in data analysis methods and insufficient quality of reporting. The stepped wedge CRCT design has been mainly used for evaluating interventions during routine implementation, particularly for interventions that have been shown to be effective in more controlled research settings, or where there is lack of evidence of effectiveness but there is a strong belief that they will do more good than harm. There is need for consistent data analysis and reporting. Copyright © 2011 Elsevier Inc. All rights reserved.
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              Guideline for prevention of catheter-associated urinary tract infections 2009.

              Carolyn Gould, Craig A Umscheid, Rajender K. Agarwal … (2010)
              Article 0 comments Cited 160 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMJ Open
                Journal ID (iso-abbrev): BMJ Open
                Journal ID (hwp): bmjopen
                Journal ID (publisher-id): bmjopen
                Title: BMJ Open
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 2044-6055
                Publication date Collection: 2018
                Publication date (Electronic): 9 May 2018
                Volume: 8
                Issue: 5
                Electronic Location Identifier: e020469
                Affiliations
                [1 ] departmentNursing Research Institute , Australian Catholic University and St Vincent’s Health Australia , Sydney, Australian Capital Territory, Australia
                [2 ] departmentLifestyle Research Centre , Avondale College of Higher Education , Cooranbong, New South Wales, Australia
                [3 ] departmentInfection Prevention and Healthcare Epidemiology Unit , Alfred Health , Melbourne, Victoria, Australia
                [4 ] departmentSchool of Public Health and Preventive Medicine , Monash University , Melbourne, Victoria, Australia
                [5 ] departmentSchool of Nursing and Midwifery , Deakin University , Melbourne, Victoria, Australia
                [6 ] departmentFaculty of Education, Business and Science , Avondale College of Higher Education , Cooranbong, New South Wales, Australia
                [7 ] departmentFaculty of Arts, Nursing and Theology , Avondale College of Higher Education , Wahroonga, New South Wales, Australia
                Author notes
                [Correspondence to ] Dr Oyebola Fasugba; oyebola.fasugba@ 123456acu.edu.au
                Article
                Publisher ID: bmjopen-2017-020469
                DOI: 10.1136/bmjopen-2017-020469
                PMC ID: 5942409
                PubMed ID: 29743326
                SO-VID: 99ad4f2d-afd7-4a65-a3d8-7adafb4fe099
                Copyright © © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
                License:

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                Date received : 06 November 2017
                Date revision received : 07 March 2018
                Date accepted : 04 April 2018
                Funding
                Funded by: Senver;
                Categories
                Subject: Nursing
                Subject: Protocol
                Subject: 1506
                Subject: 1715
                Custom metadata
                special-feature unlocked

                ScienceOpen disciplines: Medicine
                Keywords: healthcare-associated infection,catheter-associated urinary tract infection,cath tag,infection control
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: healthcare-associated infection, catheter-associated urinary tract infection, cath tag, infection control

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