title: Novel low-resource intervention reduces urinary catheter use and associated urinary tract infections: role of outcome measure bias?
abstract: BACKGROUND
  Previous interventions targeting nosocomial urinary tract infections have reduced catheterization and infections, but they require significant resources and may be susceptible to misclassification and surveillance bias. We sought to determine the effectiveness of a novel intervention at reducing catheterization and infections while exploring the potential for bias.
  
  
  METHODS
  We conducted a prospective study of a brief monthly in-person educational intervention focusing on appropriate urinary catheter use.
  
  
  RESULTS
  We studied 1,335 patients (13,753 patient days) on 1 control and 1 intervention ward. After the intervention, the device utilization rate was significantly reduced, with a relative risk of 0.49 (95% confidence interval [CI], 0.32-0.76; P = .001) versus 1.02 (95% CI, 0.58-1.82; P = .93) for controls. Both wards demonstrated a reduction in catheter-associated infections after intervention, with an intervention relative risk of 0.42 (95% CI, 0.16-1.08; P = .07) and 0.51 (95% CI, 0.22-1.20; P = .12) for controls. There was no change in the rate of all nosocomial urine infections, with an intervention relative risk of 0.79 (95% CI, 0.38-1.65; P = .53) and 0.89 (95% CI, 0.48-1.67; P = .72) for controls.
  
  
  CONCLUSIONS
  Our study demonstrates that our novel educational intervention significantly reduces urinary catheter use in hospitalized patients. The trend towards reduced catheter-associated infections after intervention, coupled with the absence of an improvement in all nosocomial infections supports a potential role of misclassification bias. We suggest that future prospective investigations explore this phenomenon using more robust outcome measures.
authors: Division of General Internal Medicine, Department of Medicine, McGill University, Montreal, QC, Canada. Electronic address: Blair.schwartz@mcgill.ca.
authors: Blair Carl
authors: BC
authors: Schwartz
authors: Division of Infectious Diseases, Infection Prevention and Control Service, Department of Medicine, McGill University Health Center, Montreal, QC, Canada.
authors: Charles
authors: C
authors: Frenette
authors: Division of General Internal Medicine, Department of Medicine, McGill University, Montreal, QC, Canada; Division of Infectious Diseases, Department of Medicine, McGill University, Montreal, QC, Canada.
authors: Todd C
authors: TC
authors: Lee
authors: Division of General Internal Medicine, Department of Medicine, McGill University, Montreal, QC, Canada.
authors: Laurence
authors: L
authors: Green
authors: Division of General Internal Medicine, Department of Medicine, McGill University, Montreal, QC, Canada.
authors: Dev
authors: D
authors: Jayaraman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents; D055499:Catheter-Related Infections / Q000209:etiology / Q000517:prevention & control*; D003428:Cross Infection / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006760:Hospitalization; D006801:Humans; D017053:Infection Control / Q000379:methods; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D062885:Urinary Catheters / Q000009:adverse effects*; D014552:Urinary Tract Infections / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Device-related infection; Nosocomial; Quality improvement; Urinary tract infection