The effect of a short educational intervention on the use of urinary catheters: a prospective cohort study.
OBJECTIVE
To assess the effectiveness of implementation of evidence-based recommendations to reduce catheter-associated urinary tract infections (CAUTIs).


METHODS
Prospective cohort study, conducted in 2010-12, with a before and after design.


METHODS
A major referral university hospital.


METHODS
Data were collected before (n = 244) and 1 year after (n = 255) the intervention for patients who received urinary catheters.


METHODS
The intervention comprised two elements: (i) aligning doctors' and nurses' knowledge of indications for the use of catheters and (ii) an educational effort consisting of three 30- to 45-minute sessions on evidence-based practice regarding catheter usage for nursing personnel on 17 medical and surgical wards.


METHODS
The main outcome measures were the proportion of (i) admitted patients receiving urinary catheters during hospitalization, (ii) catheters inserted without indication, (iii) inpatient days with catheter and (iv) the incidence of CAUTIs per 1000 catheter days. Secondary outcome measures were the proportion of (i) catheter days without appropriate indication and (ii) patients discharged with a catheter.


RESULTS
There was a reduction in the proportion of inpatient days with a catheter, from 44% to 41% (P = 0.006). There was also a reduction in the proportion of catheter days without appropriate indication (P < 0.001) and patients discharged with a catheter (P = 0.029). The majority of catheters were inserted outside the study wards.


CONCLUSIONS
A short educational intervention was feasible and resulted in significant practice improvements in catheter usage but no reduction of CAUTIs. Other measures than CAUTI may be more sensitive to detecting important practice changes.
Surgical Division, Landspitali - The National University Hospital of Iceland, 13A, 101 Reykjavik,  Iceland.|Faculty of Nursing, University of Iceland, Eiriksgotu 34, 101 Reykjavik, Iceland.
Katrin
K
Blondal
Surgical Division, Landspitali - The National University Hospital of Iceland, 13A, 101 Reykjavik,  Iceland.|Faculty of Nursing, University of Iceland, Eiriksgotu 34, 101 Reykjavik, Iceland.
Brynja
B
Ingadottir
Medical Division, Landspitali - The National University Hospital of Iceland, Eiriksgata 19, 101 Reykjavik, Iceland.
Hildur
H
Einarsdottir
Faculty of Nursing, University of Iceland, Eiriksgotu 34, 101 Reykjavik, Iceland.|Medical Division, Landspitali - The National University Hospital of Iceland,  Eiriksgata 19, 101 Reykjavik, Iceland.
Dorothea
D
Bergs
Department of Infection Control, Landspitali - The National University Hospital of Iceland, Eiríksgata 29, 101 Reykjavik, Iceland.
Ingunn
I
Steingrimsdottir
Department of Urology, Landspitali - The National University Hospital of Iceland, 11A, 101 Reykjavik, Iceland.
Sigrun
S
Steindorsdottir
Medical Division, Landspitali - The National University Hospital of Iceland, Eiriksgata 19, 101 Reykjavik, Iceland.
Gudbjorg
G
Gudmundsdottir
Department of Quality Improvement, Landspitali - The National University Hospital of Iceland, Eiríksgata 5, 101 Reykjavik, Iceland.
Elin
E
Hafsteinsdottir
D000368:Aged; D055499:Catheter-Related Infections / Q000517:prevention & control*; D002408:Catheters, Indwelling / Q000009:adverse effects; D015331:Cohort Studies; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007055:Iceland; D008297:Male; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000193:education*; D011446:Prospective Studies; D014546:Urinary Catheterization / Q000009:adverse effects / Q000451:nursing / Q000592:standards*; D062885:Urinary Catheters / Q000009:adverse effects
catheter-related infections; evidence-based practice; urinary tract infection