title: Barriers to reducing urinary catheter use: a qualitative assessment of a statewide initiative.
abstract: OBJECTIVE
  Preventing catheter-associated urinary tract infection (CAUTI), a common health care-associated infection, is important for improving the care of hospitalized patients and in meeting the goals for reduction of health care-associated infections set by the US Department of Health and Human Services.
  
  
  OBJECTIVE
  To identify ways to enhance CAUTI prevention efforts based on the experiences of hospitals participating in the Michigan Health and Hospital Association Keystone Center for Patient Safety statewide program to reduce unnecessary use of urinary catheters (the Bladder Bundle).
  
  
  METHODS
  Qualitative assessment of data collected through semistructured telephone interviews with key informants at 12 hospitals and in-person interviews and site visits at 3 of the 12 hospitals. The analysis focused on perceptions and key issues identified by hospitals as influencing implementation of CAUTI prevention practices as recommended by the Bladder Bundle initiative.
  
  
  METHODS
  Twelve purposefully sampled hospitals in Michigan.
  
  
  METHODS
  Key informants including infection preventionists, clinical personnel, and senior executives.
  
  
  RESULTS
  Common barriers to Bladder Bundle implementation and appropriate urinary catheter use included (1) difficulty with nurse and physician engagement, (2) patient and family request for indwelling catheters, and (3) catheter insertion practices and customs in the emergency department. Strategies to address these barriers were also identified by several of the participating hospitals, including (1) incorporating urinary management (eg, planned toileting) as part of other patient safety programs, such as a fall reduction program, (2) explicitly discussing the risks of indwelling urinary catheters with patients and families, and (3) engaging with emergency department nurses and physicians to implement a process that ensures that appropriate indications for catheter use are followed.
  
  
  CONCLUSIONS
  The Bladder Bundle program provides a model for implementing strategies to reduce CAUTI. These findings provide actionable information to inform CAUTI prevention-related activities in hospitals throughout the country.
authors.affiliation: Center for Clinical Management Research, Veterans Affairs Health Services Research & Development (Stop Code 152), Veterans Affairs Ann Arbor Healthcare System, PO Box 130170, Ann Arbor, MI 48113, USA. sarah.krein@va.gov
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Krein
authors.forename: Christine P
authors.initials: CP
authors.lastname: Kowalski
authors.forename: Molly
authors.initials: M
authors.lastname: Harrod
authors.forename: Jane
authors.initials: J
authors.lastname: Forman
authors.forename: Sanjay
authors.initials: S
authors.lastname: Saint
mesh_terms: D055499:Catheter-Related Infections / Q000453:epidemiology / Q000517:prevention & control*; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000706:statistics & numerical data*; D015986:Confounding Factors, Epidemiologic; D005190:Family; D019538:Health Care Surveys; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D017053:Infection Control / Q000379:methods / Q000458:organization & administration; D008824:Michigan / Q000453:epidemiology; D010353:Patient Education as Topic; D015397:Program Evaluation; D036301:Qualitative Research; D014481:United States; D014546:Urinary Catheterization / Q000009:adverse effects / Q000379:methods / Q000592:standards; D062885:Urinary Catheters / Q000009:adverse effects / Q000706:statistics & numerical data*; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*