Background: Catheter-associated urinary tract infection (CAUTI) is a common and clinically important hospital-associated infection throughout the world. A few data from Japan exist regarding the prevalence and appropriateness of urinary catheters in hospitalized patients but no interventions have been proven to decrease unnecessary urinary catheter use in Japan. Our aim of this study is to assess prevalence and appropriateness of urinary catheter use in inpatient ward and efficacy of a multimodal intervention to reduce its unnecessary use in Japan.
Methods: A multimodal intervention includes 1) educating nurses about the appropriate uses of urinary catheters using the 2009 guidelines from the Centers from Disease Control and Prevention and the 2015 Ann Arbor Criteria for Appropriate Urinary Catheter Use; 2) placing posters listing appropriate indications of urethral catheter use; and 3) assessing the indication of urethral catheters for each patient during patient rounds using a checklist. We conducted prospective pre-intervention/post-intervention study in one acute care unit of Japanese teaching hospital and collected data on catheter use and CAUTI rates during three phases pre-intervention (3 months), intervention (3 months) and post-intervention (3 months). Poisson regression model was used to analyze catheter use and CAUTI rates.
Results: During the pre-intervention period the urinary catheter point prevalence was 5.0% (41 catheter days out of 826 patient days assessed). The urinary catheters were considered appropriate for 22.0% of those catheter days (9 out of 41 catheter days). Additional 778 patient days had been assessed after the intervention was conducted. Urinary catheter point prevalence decreased by 1.7% (p<0.14) from 5.0% to 3.3% (26 catheter days out of 778 patient days post-intervention). The appropriateness of urinary catheter use increased by 35.7% (p<0.05) after the intervention: 22.0% before the intervention to 57.7% after the intervention. During the entire period no case of CAUTI were observed.
Conclusions: Our multimodal approach enhanced appropriate use of urinary catheters and it may reduce urinary catheters in Japan.