Literature Review on Catheter Associated Urinary Tract Infections (CAUTI)

User Generated

xngancf0623

Writing

NUR3165 Research Nursing

Miami Dade College

Description

The purpose of this assignment is to retrieve a minimum of 5 nursing research publications based on an approved research problem. The goal is to be able to differentiate research from other types of publications, with a focus on recent, quantitative, nursing research. Copies of 5 retrieved full‐text publications are to be submitted with an accurately cited reference page formatted in APA style. At least one of the authors on each article must be a nurse.

GROUP LITERATURE REVIEW GRADING CRITERIA

1. Submission of 5 Nursing Research Publications 30%

a. Published articles are RESEARCH

b. Articles are from a quality peer‐reviewed nursing journal

c. At least one of the lead authors of each article is a nurse

d. Minimum of 2 studies that were published in the past 5 years

e. Maximum of 1 qualitative study permitted

f. No meta‐analyses or comprehensive reviews are permitted

g. Copy of full article is required, not just abstract

2. Literature Review Outline60%

a. Introduction provided that includes research question and databases used for search and concepts used for search. Major headings provided.

b. Summarize major findings of each study included under each major heading

c. At the end of each major heading, summarize similarities and differences.

2. Reference Page in APA format 10%

a. Running head

b. Page numbers

c. References heading

d. Correct spelling

e. Citations accurately referenced

f. One point deduction for each unique APA error

User generated content is uploaded by users for the purposes of learning and should be used following Studypool's honor code & terms of service.

Explanation & Answer

Attached.

Parker et al. BMC Health Services Research (2017) 17:314
DOI 10.1186/s12913-017-2268-2

STUDY PROTOCOL

Open Access

Avoiding inappropriate urinary catheter use
and catheter-associated urinary tract
infection (CAUTI): a pre-post control
intervention study
Vicki Parker1, Michelle Giles2*, Laura Graham2, Belinda Suthers3, Wendy Watts2, Tony O’Brien4 and Andrew Searles5

Abstract
Background: Urinary tract infection (UTI) as the most common healthcare-associated infection accounts for up to
36% of all healthcare-associated infections. Catheter-associated urinary tract infection (CAUTI) accounts for up to
80% of these. In many instances indwelling urinary catheter (IDC) insertions may be unjustified or inappropriate,
creating potentially avoidable and significant patient distress, embarrassment, discomfort, pain and activity
restrictions, together with substantial care burden, costs and hospitalisation. Multifaceted interventions combining
best practice guidelines with staff engagement, education and monitoring have been shown to be more effective
in bringing about practice change than those that focus on a single intervention. This study builds on a nurse-led
initiative that identified that significant benefits could be achieved through a systematic approach to
implementation of evidence-based practice.
Methods: The primary aim of the study is to reduce IDC usage rates by reducing inappropriate urinary
catheterisation and duration of catheterisation. The study will employ a multiple pre-post control intervention
design using a phased mixed method approach. A multifaceted intervention will be implemented and evaluated in
four acute care hospitals in NSW, Australia. The study design is novel and strengthened by a phased approach
across sites which allows for a built-in control mechanism and also reduces secular effects. Feedback of point
prevalence data will be utilised to engage staff and improve compliance. Ward-based champions will help to
steward the change and maintain focus.
Discussion: This study will improve patient safety through implementation and robust evaluation of clinical
practice and practice change. It is anticipated that it will contribute to a significant improvement in patient
experiences and health care outcomes. The provision of baseline data will provide a platform from which to ensure
ongoing improvement and normalisation of best practice. This study will add to the evidence base through
enhancing understanding of interventions to reduce CAUTI and provides a prototype for other studies focussed on
reduction of hospital acquired harms. Study findings will inform undergraduate and continuing education for
health professionals.
Trial registration: ACTRN12617000090314. Registered 17 January 2017. Retrospectively registered.
Keywords: Healthcare-associated infection, Catheter-associated urinary tract infection, Multifaceted intervention,
Evidence-based practice

* Correspondence: Michelle.giles@hnehealth.nsw.gov.au
2
Hunter New England Nursing and Midwifery Research Centre, James
Fletcher Campus, Gate Cottage, 72 Watt St, Newcastle, NSW, Australia2300
Full list of author information is available at the end of the article
© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Parker et al. BMC Health Services Research (2017) 17:314

Background
Urinary tract infection (UTI) is considered the most
common healthcare-associated infection (HAI) [1], accounting for up to 36% of all healthcare-associated
infections (HAIs) [2]. Catheter-associated urinary tract
infections (CAUTIs) represent the majority of UTIs
(up to 67% of UTIs in all hospital inpatients [3], and
up to 97% in ICUs [4]). Between 12 and 16% of hospitalised patients may receive a short term indwelling
urinary catheter (IDC) [5], and many of these IDC insertions have been identified as unjustified or inappropriate [6]. CAUTI risk increases considerably with
duration of catheterisation [7], and generates substantial
care burden and significant hospitalisation costs, patient
distress, embarrassment, discomfort, pain and activity restrictions [7–9]. A recent Australian study indicated that
1.7% of inpatients, hospitalised for > 48 h, contract a UTI,
adding additional days (mean = 4) to their length of stay
(LoS) [10].
CAUTI is possibly the most preventable HAI [11], with
significant potential cost savings. According to Mitchell et
al.’s (2016) [10] calculations, there are ~380,600 extra public hospital bed-days used each year in Australia due to
healthcare-associated urinary tract infections (the majority
being catheter-associated [3]). Umscheid et al. (2011) [11]
estimate that each CAUTI costs between $1200 and
$4700 USD. In the Australian setting, Jackson et al. (2011)
estimated that the costs associated with a patient diagnosed with CAUTI are twice as much as a patient not affected by CAUTI [12].
Preventing CAUTI

Worldwide, there has been renewed interest and research into reducing the incidence of CAUTI, especially
in the USA, with the introduction of non-payment for
‘reasonably preventable’ hospital-acquired complications
[13]. An integrative review by Meddings et al. (2014) [1]
evaluated interventions up to October 2012 to reduce
IDC usage and CAUTIs. Meddings et al. (2014) found
that interventions to reduce inappropriate IDC use, and
bundles of interventions focusing on reducing unnecessary catheter use and general infection control were successful in reducing catheter use [1]. A component
common to most urinary catheter bundles is timely
catheter removal [14–20]. Meddings et al. recognised
the importance of addressing socioadaptive factors in
successfully implementing interventions [1]. These
socioadaptive factors have since been addressed in the
USA with the Agency for Healthcare Research and Quality (AHRQ) Comprehensive Unit-based Safety Program
(CUSP). In a national US study, Saint et al. implemented
CUSP in 926 units, and found a significant reduction in
catheter use and CAUTI in non-ICUs [19]. Clinician
education about recommended practice is a key part of

Page 2 of 9

interventions to address catheter use and CAUTI; nine
studies since the Meddings et al. 2014 integrative review
implemented a hospital (or multi-hospital) intervention
to reduce CAUTI, and all included some form of education [14, 17, 19, 21–27]. Indeed, a systematic review of
interventions to reduce device-related infections found
that all interventions had some form of education as a
key component [28].
From evaluating the literature on hospital-wide and
multi-hospital interventions designed to reduce urinary
catheter use and CAUTI, a gap was identified in study
design; all identified studies used a pre-post design,
which does not account for secular trends.
Studies investigating use of IDCs and CAUTI have
been lacking in the Australian context [29, 30]. Extant
literature includes hospital-based rates of IDC usage
and/or rates of CAUTI, with some discussion of documentation, appropriate indications for IDC, and staff
knowledge. Wynne et al. (2014) [29] found a point
prevalence of 12.4% of patients with IDC in situ, in a tertiary teaching hospital in Melbourne. This included an
acute inpatient facility and a sub-acute aged care and rehabilitation service. Wynne et al.’s study did not report
on the days IDC in situ or prevalence of CAUTI, and a
differentiation between short-term and long-term IDC
usage was not made. So et al. (2014) conducted a chart
audit in a hospital in Sydney, finding catheter utilisation
of 11%. A study of staff and patient knowledge of IDC
usage in two general medical wards in a Melbourne
hospital found that the mean time an IDC was in situ
was 5.8 days, and that a physician’s awareness of IDC
presence was significantly associated with a shorter
time IDC in situ [31]. Giles et al. (2015), in a pilot
study, found the prevalence of IDCs in two wards in
an Australian hospital (urology ward = 25%; orthopaedic
ward = 31%), and rate of CAUTI = 2.2% [32]. Giles et al.
then went on to describe the development and pilot of a
bundled approach to target IDC utilization and CAUTI,
however results of the intervention were not reported. A
large point prevalence study in six Australian hospitals by
Gardner et al. (2014) found a CAUTI prevalence of 0.9%,
and urinary catheter prevalence of 26.3% (88.7% of these
being IDCs) [33].
The foregoing studies highlight a gap in knowledge in
the Australian healthcare context, in that there have
been no studies investigating the effects of an intervention on reducing IDC utilisation and CAUTI rates in an
acute care setting.
A multifaceted evidence-based intervention was
piloted in two wards in an acute care hospital in the
Hunter New England Local Health District, leading to
a 50% reduction in IDC insertions, significantly reduced IDC duration and number of patients treated
for CAUTI [34].

Parker et al. BMC Health Services Research (2017) 17:314

Building from the positive results from the aforementioned pilot, the present study aims to implement and
evaluate an intervention across four acute care hospitals
in NSW, Australia. To control for secular trends, implementation of the intervention will be phased across the
hospitals.

Methods/Design
Aims

The primary aim of the study is to reduce IDC usage
rates by reducing inappropriate urinary catheterisation
and duration of catheterisation.
The secondary aims of the study are to identify:
1. The current inpatient indwelling urinary catheter
usage rate and incidence of CAUTI;
2. If the implementation and adherence to bundled
catheter care (BCC) reduces IDC use and CAUTI;
3. How effective BCC is in improving IDC-related
outcomes;
4. The barriers and enablers to successful
implementation of BCC; and
5. The cost benefits of implementation.

Page 3 of 9

A mixed method design provides a platform to explore
in-depth existing barriers and enablers related to implementing practice change. The sequential phased nature
of the study ensures that the necessary evidence is available to inform the subsequent implementation phase of
the study. The focus groups will identify barriers and enablers to implementation and uptake and will inform
strategies to embed the intervention into normal practice. Questions in the focus groups will be informed by
results from the point prevalence and clinician surveys.
The control will be usual urinary catheterisation practice, i.e., no intervention or implementation strategies.
NSW Health evidence-based practice guidelines for
“Adult Urethral Catheterisation for Acute Care Settings”
[35], and local clinical practice guidelines for urinary
catheterisation for each Health District are available for
all clinicians, and can be accessed online.
The Clinical Excellence Commission (CEC), a corporation addressing patient safety and clinical quality in the
NSW Health context, established a CAUTI project in
2014 to “help healthcare professionals in reducing the
incidence of CAUTIs in acute care settings” [36]. A urinary catheterisation course on an online NSW Health
learning platform also exists [37].

Design

The study will employ a multiple pre-post control intervention design using a phased mixed method approach
(Fig. 1).
Implementation of the intervention across four acute
care hospitals will be staged, with multiple clusters in
each of two implementation stages. Pre and post point
prevalence data comparison will occur within all hospitals pre and post intervention, as well as between the
two Health Districts as detailed in Fig. 1.
The staged implementation of the intervention allows
for a control between the two Health Districts.

Setting

The intervention sites are four acute care hospitals from
two Health Districts in NSW, Australia. Hospitals have
been purposively selected, matched on total bed numbers, activity type and activity levels (See Table 1).
A key difference between the two health districts is
the system used for medical health records: Health District 1 uses paper-based medical records, whereas Health
District 2 uses electronic medical records. Data collection methods and training have been individualised to
accommodate these differences.

Fig. 1 Study Design. Data collection points are indicated with diamonds on timeline

Parker et al. BMC Health Services Research (2017) 17:314

Page 4 of 9

Table 1 Setting
Health District

Facility

1

Hospital A

Beds
360

Hospital B

260

a firewall protected online survey tool. Survey data will
then be exported and merged with other electronically
extracted demographic patient data into statistical package STATA [38] for analysis.

Total beds Health District 1 = 620
2

Hospital C

549

Exclusion and inclusion criteria

Hospital D

318

Point prevalence data will be collected from all adult inpatient wards across four hospitals in two Health Districts (excluding emergency departments, operating
theatres and day only wards).

Total beds Health District 2 = 867

Data collection

Three main types of data will be collected:
– Pre and post implementation point prevalence and
patient demographics (quantitative)
– Pre and post implementation clinician knowledge
and competence (quantitative)
– Post implementation perceived barriers and
enablers to implementation (qualitative)
Data collection types and details are outlined in
Table 2, and the data collection timepoints are displayed
in Fig. 1.
The point prevalence data will be collected by project
staff (clinical nurse consultants, research assistant),
nurse and midwife clinicians and clinical nurse educators from each hospital. Training will be administered to
all clinicians involved on data collection techniques and
definitions prior to collection, and they will be paired
where possible with members of the research team. Data
collection staff will go to every inpatient bed on every
adult inpatient ward in the hospital and input data into

Multifaceted intervention

The intervention will be delivered in all adult inpatient
wards, emergency departments, and operating theatres
in all four hospitals. The key component of the intervention is the evidence-based “No CAUTI” bundle (Table 3).
To support implementation of the No CAUTI bundle,
the following resources were developed as part of the
intervention:





IDC insertion criteria guidelines
Indications for IDC specimen collection
Nurse-led IDC removal guidelines (Additional file 1)
Educational resources and compliance auditing tools

The distribution and standardised use of a costeffective, generic IDC insertion pack forms part of the
intervention. The insertion pack includes all equipment
required for catheterisation, documentation stickers, and
securing devices.

Table 2 Data collection sources and methods
Data

Data collection method

Data source(s)

Data collected

Data collection
timepoint(s)

IDC usage rate
Online data collection tool
and incidence of
CAUTI

- Patient medical records – facility-wide
across all four hospitals
- Bedside observation
- Infection control database

- Urinary catheter presence
- Days catheter in situ
- CAUTI rate

- Baseline
- 4 months postimplementation
commencement
- 9 months postimplementation
commencement

Patient profile

Data extraction and then
merge with data from
point prevalence

- Electronic patient management
systems

- Patient demographics including
age, gender, weight, diagnosis,
type of admission

- Baseline
- 4 months postimplementation
commencement
- 9 months postimplementation
commencement

Clinician
knowledge and
competency

Online survey

- Clinicians (all nurses and medical
officers invited from participating
hospitals)

- Clinician competency
- Clinician knowledge of CAUTI
prevention
- Perception of unit-based culture

- Baseline
- 6 months postimplementation
commencement

Barriers and
enablers to
implementation

Focus group

- Clinicians (6–8 per facility) (all nurses
and medical officers invited from
participating hospitals)

- Perceived barriers and enablers to - 6 months postimplementation
implementation
commencement

Parker et al. BMC Health Services Research (2017) 17:314

Page 5 of 9

Table 3 Evidence base for No CAUTI Bundle
N

NEED for catheter assessed – refer to indications, scan bladder, consider alternative, document indication.
- Need for IUC is assessed - appropriate indications for insertion [7, 47, 48].
- Scan the bladder to determine bladder volume [7]
- Consider alternatives such as external sheath (males),intermittent catheterisation by staff/patient, SPC, double voiding, commode,
timed toileting [7, 47, 48]

O

OBTAIN patient consent, OFFER patient education including hygiene.
- Obtain patient consent and importance of accurate complete documentation.
- Provide written and verbal information to patient/carer [49]
- Ensure daily meatal hygiene is performed as part of personal hygiene, soap and water is all that is required [7, 47, 48]

C

COMPETENCY – clinicians who insert catheters must have documented competency
- Competent and trained staff should insert catheters [7, 48]

A

ASEPSIS – maintain asepsis & hand hygiene during insertion and while catheter is in place.
- Aseptic technique and sterile equipment must be used for IUC insertion. Hand hygiene “Moment 2” and non-sterile gloves is
recommended when manipulation of the IUC or drainage system is required.
- Empty the bag when ¾ full and use a clean container for each patient; avoid contact between outlet and container.
- Maintain a sterile closed system of drainage [7, 48]

U

UNOBSTRUCTED flow – no kinks or loops, catheter secured, bag below bladder level and off the floor.
- Unobstructed continuous urine flow with no kinks or loops, bag below the bladder and not in touch with any surface. Secure the
catheter to the patient to minimise movement and trauma and improve patient comfort [7, 48]

T

TIMELY catheter removal and documentation – may be nurse initiated.
- Timely removal of the IUC - daily review. Nurse initiated removal guidelines followed if there is no medical documentation for
continued use [7, 48]

I

INFECTION risk – daily periurethral hygiene. Collect urine specimen only when clinically indicated.
- Infection and catheter specimen urine (CSU) collection: must be collected using aseptic technique, from a newly inserted catheter
and before the commencement of antimicrobials
- CSU should only be collected if clinically indicated [7, 47, 48]

Routine assessment of clinician competency in urinary
catheter insertion will be introduced as part of the
multifaceted intervention.
No CAUTI Bundle

The “bundled intervention” framework used in this
project is defined as a collection of a number of evidence based practices or steps, vital to achieving improvement in clinical outcomes [39]. The “No
CAUTI” bundle was developed during the pilot project, and is based on evidence-based recommendations. The evidence for the bundled intervention is
presented in Table 3.

Whilst there are key implementation strategies that
will be common to all intervention hospitals, there
will be a degree of flexibility between the two Health
Districts, and their hospitals. Both active (e.g. workshops, audit and feedback) and passive strategies (e.g.
distribution and display of posters, equipment) will be
used [28].
Previous studies have identified champions as playing
a significant role in reinforcing practice change [42]. The
need for multiple champions when implementing a large
degree of practice change is recommended [43]; the
current study will have a champion in each ward, and
champions will meet regularly. Nursing staff are critical
to the success of bundled interventions aimed at reducing IDC use [27].

Implementation strategies

A number of implementation strategies will be used in
the project: education, monitoring and feedback, resources, and facilitation. The timing of implementation
is displayed in Fig. 2. The Template for Intervention Description and Replication (TIDieR) was developed to improve the quality of descriptions of interventions [40],
and can be used to report content of behavior change
interventions, including what is delivered, who the intervention is delivered to, and what materials are used.
TIDieR has previously been used to describe care bundle
interventions [41]. The TIDieR framework has been used
to outline the current implementation strategies in
Table 4.

Power and sample size calculation

A sample size calculation has indicated that 500 patients
per Health District would be sufficient to detect a 40%
fall (15 to 9%) in relative IDC insertion rates with a
power of 0.8 and alpha 0.05. This is based on a 50%
(39.5 to 14.6%) reduction observed in the pilot study
[34]. Estimated bed numbers of 860 in Health District 2
and 610 in Health District 1 should thus be more than
adequate to provide sufficient power to detect a significant change. Further power will be obtained through
having baseline control data and from stratifying the
analysis by hospital wards.

Parker et al. BMC Health Services Research (2017) 17:314

Page 6 of 9

Fig. 2 Timeline of implementation components. The intervention commences with four weeks of intensive education. For the first two months,
compliance audits are completed on a weekly basis, and then continue on a monthly basis for the remainder of the 6-month intervention period.
Champion meetings will be held on a monthly basis throughout the intervention period

Statistical analysis – point prevalence data

Economic evaluation

identified using a short data collection instrument. Cost
related data collected from usual care and intervention
arms will include: materials used for catheterisation, proportion of patients receiving IDC, CAUTI rates, LoS for
patients diagnosed with CAUTI, and CAUTI treatment
expenses (e.g. antibiotics).
The measure of effect will be based on the change in
the rate of CAUTI between the usual care and intervention groups. If the expected intervention benefit is demonstrated in the trial, the measure of effect will be the
cases of CAUTI avoided due to the intervention. The
economic analysis will identify the cost to avoid an additional case of CAUTI. The reportable outcomes will be
average cost-effectiveness and incremental costeffectiveness ratios. A sensitivity analysis will be conducted to explore the robustness of the results to the
uncertainty around parameters used in the model. The
results will be interpreted in a broader decision making
framework that includes acceptability and sustainability
of the intervention. The economic sustainability of the
intervention will be based on the cost and effect of delivering the intervention in a wider setting. The analysis
will also report the resources required to implement the
intervention in other localities. This information is relevant to policy makers because it reflects the resources
required by other Health Districts to implement the
intervention.

The economic evaluation will be based on a costeffectiveness analysis to determine whether the multifaceted care intervention is more cost-effective than usual
care in reducing CAUTI amongst hospital inpatients. A
healthcare provider perspective will be adopted. International guidelines for conducting economic evaluations,
as recommended by Drummond et al.[45], and Husereau
et al. [46] will be followed. Resource use will be

Discussion
A review of the literature highlighted a lack of interventional studies aiming to reduce IDC use or CAUTI rates
in the Australian context. Internationally, there is a
sparsity of studies using a control design in CAUTI
intervention evaluations.

Statistical analysis will be undertaken to determine differences in the prevalence of IDCs between Health District 1 (post) and Health District 2 (no intervention). A
mixed methods analysis will compare pre and post data
within the groups, across the time frame. Within group
data will be stratified according to wards to allow for
variation in the case mix of patients between wards. If
differences in patient demographics are detected at baseline these will be controlled for in the between group
analyses. Data linkage will be used to determine LoS and
CAUTI rates for patients at each time point.
Qualitative analysis

All focus group interviews will be digitally audio-recorded
and later transcribed verbatim by a professional transcriber/research assistant. Data will be analysed, coded
and themed to low-level themes [44]. Cross-checking of
coding will occur within the research team, and emerging
themes will be shared within the whole research team as a
check on credibility.
Using a mixed methods approach, the quantitative
data from the point prevalence survey and the clinician
survey will be analysed to inform the questions for the
focus groups.

To focus clinicians on targets and
progress

Feedback of point prevalence of
IDC usage and CAUTI

Prompt awareness of intervention
and identify ward champions

Educate nurses about correct
catheterisation processes

“No CAUTI” bundle badges

Catheter insertion DVDs

Act as a resource for clinicians
and promote the No CAUTI bundle
to clinicians; support implementation

Champions

Face-to-face (individual
and group)

Increase proportion of clinicians that
Face-to-face (individual)
are competent in urinary catheterisation

Available on intranet

Worn by clinicians and
champions

Documents displayed in
wards

Face-to-face (group) and
email

Competency assessments

Facilitation

Prompt awareness and better
documentation

“No CAUTI” bundle posters

Resources

To monitor compliance with
“No CAUTI” bundle and provide
strategies to support implementation

Compliance audits and feedback

Nurse educators

Clinical nurse
consultant – urology

Delivered by

Nurses

Nurse educators

N/A (passive
component)

N/A (passive
component)

N/A (passive
component)

Research project staff

1x 2-3 h workshop at each
facility at start of intervention

When/how often

Nurses and medical officers

Nurses

Nurses

Nurses and medical officers

Nurses and medical officers

All clinicians at a ward,
facility, and district level

Ongoing

Ongoing

Ongoing

Ongoing

Ongoing

Baseline, 4 months, and 9 months

Weekly for first two months and
then monthly for remaining
4 months of intervention period.

Nurses and medical officers
Minimum 1x 20 min in-service
from all adult inpatient wards, in each ward at start of intervention
OTs, and EDs

Nurse educators from
across hospital

Delivered to and where

Individual patient audit,
Champions (clinicians All inpatient wards
and feedback face-to-face previously identified in
(group) to clinicians
in-services)

Face-to-face (group)

To familiarise staff with “No CAUTI”
bundle and nurse-initiated removal
flowchart
To identify champions in each ward

Ward in-services

Monitoring and feedback

Face-to-face (group)

Mode of delivery

To prepare educators to present the
“No CAUTI” bundle to ward-based
staff, and to train educators to
complete urinary catheterisation
competency assessments

Rationale

Train-the-trainer workshops

Education

Implementation Strategy

Table 4 “No CAUTI” Implementation strategies summary based on TIDieR

Parker et al. BMC Health Services Research (2017) 17:314
Page 7 of 9

Parker et al. BMC Health Services Research (2017) 17:314

This study will add to the evidence-base through enhancing understanding of interventions to reduce
CAUTI, using a control design to reduce secular effects.
Using the TIDieR framework, implementation strategies have been explicitly outlined, enabling easier replication of the intervention and implementation strategies.
The use of a mixed methods approach will provide a
platform to explore in-depth the existing barriers and
enablers related to implementing practice change.
Ultimately, this study will improve patient safety
through implementation and a robust evaluation of clinical practice and practice change.

Additional file
Additional file 1: Nurse-initiated IDC assessment and removal decision
flowchart. (DOCX 152 kb)
Abbreviations
AHRQ: Agency for Healthcare Research and Quality; CAUTI: Catheterassociated urinary tract infection; CEC: Clinical Excellence Commission;
CUSP: Comprehensive Unit-based Safety Program; HAI: Healthcare-associated
infection; IDC: Indwelling urinary catheter; LoS: Length of stay;
TIDieR: Template for Intervention Description and Replication; UTI: Urinary
tract infection.
Acknowledgements
Not applicable.
Funding
Funding for the project has been granted through the NSW Ministry of
Health Translational Research Grants.
Availability of data and materials
Not applicable.
Authors’ contributions
VP and MG contributed to the development of research conception, design
and methods and have significantly critically revised and contributed to the
content in this manuscript. LG contributed to the initial drafting of this
manuscript. BS contributed significantly to the development of the design
and power and sample size calculation. WW contributed to the
development of research conception, design and methods. TO contributed
to the development of research conception, design and methods, and
critically revised the content in this manuscript. AS contributed to the
economic evaluation. All authors have read and approved the final
manuscript.
Competing interests
The authors declare that they have no competing interests.
Consent for publication
Not applicable.
Ethics approval and consent to participate
Ethical approval has been granted through Hunter New England Local
Health District’s and Central Coast Local Health District’s Human Research
Ethics Committees (Ref 16/10/19/5.09 and 1016-097C respectively).
Data will be stored on a secure network, protected by password and only
accessible to members of the research team. A formal data monitoring
committee was not warranted as there are known minimal risks. The
collection and management of data is overseen by the research team.
Patients will be receiving routine care in alignment with best practice
principles in relation to IDC usage so consent is not required from patients.
Healthcare professional participants will give informed consent to participate

Page 8 of 9

in focus groups and consent will be implied when they undertake the
survey.
The conduct of the research is being overseen by a steering committee
made up of experienced researchers and clinicians.
There will be a report to the NSW Health funding agency and the
participating health districts, journal publications and conference
presentations. Evaluation and outcomes will be disseminated to colleagues
within and outside the participating health districts to inform sustainability
of best practice related to urinary catheterisation and CAUTI prevention.

Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in
published maps and institutional affiliations.
Author details
1
School of Nursing, University of New England, Armidale, NSW, Australia2351.
2
Hunter New England Nursing and Midwifery Research Centre, James
Fletcher Campus, Gate Cottage, 72 Watt St, Newcastle, NSW, Australia2300.
3
Respiratory and General Medicine, John Hunter Hospital, Locked Bag 1
HRMC, New Lambton Heights, NSW, Australia2310. 4School of Nursing and
Midwifery, University of Newcastle, Callaghan, NSW, Australia2308. 5Hunter
Medical Research Institute (HMRI), New Lambton Heights, NSW,
Australia2305.
Received: 2 February 2017 Accepted: 26 April 2017

References
1. Meddings J, Rogers M, Krein S, Fakih M, Olmsted R, Saint S. Reducing
unnecessary urinary catheter use and other strategies to prevent catheterassociated urinary tract infection: An integrative review. BMJ Qual Saf. 2014;
23:277–89.
2. Allegranzi B, Bagheri Nejad S, Garcia Castillejos G, Kilpatrick C, Kelley E,
Mathai E. Report on the burden of endemic health care-associated infection
worldwide: A systematic review of the literature. World Health Organization.
2011. http://apps.who.int/iris/bitstream/10665/80135/1/9789241501507_eng.
pdf. Accessed 25 Oct 2016.
3. Magill SS, Edwards JR, Bamberg W, Beldavs ZG, Dumyati G, Kainer MA,
Lynfield R, Maloney M, McAllister-Hollod L, Nadle J, Ray S, Thompson D,
Wilson L, Fridkin S. Multistate Point-Prevalence Survey of Health Care–
Associated Infections. N Engl J Med. 2014;370(13):1198–208.
4. Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in
combined medical-surgical intensive care units in the United States. Infect
Control Hosp Epidemiol. 2000;21(8):510–5.
5. Association for Professionals in Infection Control and Epidemiology (APIC).
Guide to preventing catheter-associated urinary tract infections. 2014.
http://apic.org/Resource_/EliminationGuideForm/0ff6ae59-0a...


Anonymous
Nice! Really impressed with the quality.

Studypool
4.7
Trustpilot
4.5
Sitejabber
4.4

Related Tags