Reducing inappropriate catheterisation to prevent catheter-associated urinary tract infection (CAUTI) through a hospital-wide, bundled catheter care (BCC) approach: a non-randomised, controlled intervention study

The intervention period is 6 months at each hospital. The key component of the intervention is the evidence-based “No CAUTI” bundle: N - NEED for catheter assessed – refer to indications, scan bladder, consider alternative, document reason. O - OBTAIN patient consent, OFFER patient education including hygiene. C - COMPETENCY – clinicians who insert catheters must have documented competency. A - ASEPSIS – maintain asepsis & hand hygiene during insertion and while catheter is in place. U - UNOBSTRUCTED flow - No kinks or loops, catheter secured, bag below bladder level and off the floor. T - TIMELY catheter removal and documentation – May be nurse initiated. I - INFECTION RISK – daily periurethral hygiene. Collect urine specimen only when clinically indicated. The No CAUTI bundle will be displayed on posters within the hospitals. 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 - Educational resources and compliance auditing tools The distribution and standardised use of a cost-effective, generic IDC insertion pack forms part of the intervention. The insertion pack includes all equipment required for catheterisation, documentation stickers, and securing devices. Routine assessment of clinician competency in urinary catheter insertion will be introduced as part of the multifaceted intervention. Implementation strategies include: - Education (train-the-trainer workshops and ward inservices) - Monitoring and feedback (compliance audits and feedback, and feedback of point prevalence of IDC usage and CAUTI) - Resources (No CAUTI bundle posters and badges, and catheter insertion DVDs) - Facilitation (competency assessments and champions) Implementation strategies are detailed below: All intervention components will be delivered in participating facilities. The intervention will be delivered in all adult inpatient wards, emergency departments, and operating theatres in all four hospitals. Train-the-trainer workshops: Train-the-trainer workshops will prepare nurse educators to present the “No CAUTI” bundle to ward-based staff, and to train educators to complete urinary catheterisation competency assessments. Mode-of delivery will be face-to-face (group), and workshops will be delivered by clinical nurse consultant – urology. 1x 2-3 hour workshop will be delivered at each hospital at the start of the intervention. Ward in-services will be delivered to familiarise staff with the “No CAUTI” bundle and nurse-initiated removal flowchart, and to identify champions on each ward. In-services will be delivered face-to-face (group) by nurse educators, to an audience of nurses and medical officers from adult inpatient wards, operating theatres, and emergency departments. A minimum of 1x 20 minute in-service in each ward at the start of the intervention will be delivered. Compliance audits and feedback will take place to monitor compliance with “No CAUTI” bundle and provide strategies to support implementation of the intervention. Mode of delivery will be individual patient audit, and face-to-face (group) feedback to clinicians. Champions (clinicians previously identified in in-services) will deliver this component in all inpatient wards. Compliance audits will be conducted for the first two months of the intervention and then monthly for the remaining four months of the intervention period. Feedback of point prevalence indwelling urinary catheter usage and CAUTI: Face-to-face (group) and email feedback will be provided by research project staff to all clinicians at a ward, facility and district level. This will take place at baseline, 4 months, and 9 months. Resources: “No CAUTI” bundle badges and posters will be disseminated throughout participating hospitals to prompt awareness of the intervention. Badges will also help to identify ward champions. Posters will be displayed in all participating wards, and badges will be worn by clinicians and champions. This is a passive intervention component. Ongoing throughout intervention period. Resource – catheter insertion DVDs: DVDs to educate nurses about the correct catheterisation process will be made available on the intranet throughout the intervention period. This is a passive intervention component. Competency assessments: competency assessments will increase the proportion of clinicians that are competent in urinary catheterisation. This component will be delivered by nurse educators to nurses on an individual face-to-face basis. These are an ongoing component of the intervention. Champions: Champions will act as a resource for clinicians and promote the No CAUTI bundle to clinicians, and will also support implementation of the intervention. Nurses will act as champions, and will be an ongoing component of the intervention.