title: Systematic review and meta-analysis: reminder systems to reduce catheter-associated urinary tract infections and urinary catheter use in hospitalized patients.
abstract: BACKGROUND
  Prolonged catheterization is the primary risk factor for catheter-associated urinary tract infection (CAUTI). Reminder systems are interventions used to prompt the removal of unnecessary urinary catheters. To summarize the effect of urinary catheter reminder systems on the rate of CAUTI, urinary catheter use, and the need for recatheterization, we performed a systematic review and meta-analysis.
  
  
  METHODS
  Studies were identified in MEDLINE, the Cochrane Library, Biosis, the Web of Science, EMBASE, and CINAHL through August 2008. Only interventional studies that used reminders to physicians or nurses that a urinary catheter was in use or stop orders to prompt catheter removal in hospitalized adults were included. A total of 6679 citations were identified; 118 articles were reviewed, and 14 articles met the selection criteria.
  
  
  RESULTS
  The rate of CAUTI (episodes per 1000 catheter-days) was reduced by 52% (P < .001) with use of a reminder or stop order. The mean duration of catheterization decreased by 37%, resulting in 2.61 fewer days of catheterization per patient in the intervention versus control groups; the pooled standardized mean difference (SMD) in the duration of catheterization was -1.11 overall (P = 070), including a statistically significant decrease in studies that used a stop order (SMD, -0.30; P = .001) but not in those that used a reminder (SMD, -1.54; P = .071). Recatheterization rates were similar in control and intervention groups.
  
  
  CONCLUSIONS
  Urinary catheter reminders and stop orders appear to reduce the rate of CAUTI and should be strongly considered to enhance the safety of hospitalized patients.
authors.affiliation: Department of Internal Medicine, University of Michigan, and 3Ann Arbor VA Medical Center, Ann Arbor, Michigan 48109-0429, USA. meddings@umich.edu
authors.forename: Jennifer
authors.initials: J
authors.lastname: Meddings
authors.forename: Mary A M
authors.initials: MA
authors.lastname: Rogers
authors.forename: Michelle
authors.initials: M
authors.lastname: Macy
authors.forename: Sanjay
authors.initials: S
authors.lastname: Saint
mesh_terms: D055499:Catheter-Related Infections / Q000517:prevention & control*; D020878:Device Removal / Q000592:standards; D006760:Hospitalization; D006801:Humans; D013997:Time Factors; D014546:Urinary Catheterization / Q000009:adverse effects* / Q000295:instrumentation; D014552:Urinary Tract Infections / Q000209:etiology* / Q000517:prevention & control*