title: De-implementation strategy to Reduce the Inappropriate use of urinary and intravenous CATheters: study protocol for the RICAT-study.
abstract: Urinary and (peripheral and central) intravenous catheters are widely used in hospitalized patients. However, up to 56% of the catheters do not have an appropriate indication and some serious complications with the use of these catheters can occur. The main objective of our quality improvement project is to reduce the use of catheters without an appropriate indication by 25-50%, and to evaluate the affecting factors of our de-implementation strategy.
  
  
  
  In a multicenter, prospective interrupted time series analysis, several interventions to avoid inappropriate use of catheters will be conducted in seven hospitals in the Netherlands. Firstly, we will define a list of appropriate indications for urinary and (peripheral and central) intravenous catheters, which will restrict the use of catheters and urge catheter removal when the indication is no longer appropriate. Secondly, after the baseline measurements, the intervention will take place, which consists of a kick-off meeting, including a competitive feedback report of the baseline measurements, and education of healthcare workers and patients. Additional strategies based on the baseline data and local conditions are optional. The primary endpoint is the percentage of catheters with an inappropriate indication on the day of data collection before and after the de-implementation strategy. Secondary endpoints are catheter-related infections or other complications, catheter re-insertion rate, length of hospital (and ICU) stay and mortality. In addition, the cost-effectiveness of the de-implementation strategy will be calculated.
  
  
  
  This study aims to reduce the use of urinary and intravenous catheters with an inappropriate indication, and as a result reduce the catheter-related complications. If (cost-) effective it provides a tool for a nationwide approach to reduce catheter-related infections and other complications.
  
  
  
  Dutch trial registry: NTR6015 . Registered 9 August 2016.
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. b.j.laan@amc.uva.nl.
authors.forename: Bart J
authors.initials: BJ
authors.lastname: Laan
authors.affiliation: Department of Medical Microbiology, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: Ingrid J B
authors.initials: IJ
authors.lastname: Spijkerman
authors.affiliation: Department of Internal Medicine, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: Mieke H
authors.initials: MH
authors.lastname: Godfried
authors.affiliation: Department of Internal Medicine, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: Berend C
authors.initials: BC
authors.lastname: Pasmooij
authors.affiliation: Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Medical Faculty, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: Jolanda M
authors.initials: JM
authors.lastname: Maaskant
authors.affiliation: Department of Internal Medicine, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: Marjon J
authors.initials: MJ
authors.lastname: Borgert
authors.affiliation: Clinical Research Unit, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: Brent C
authors.initials: BC
authors.lastname: Opmeer
authors.affiliation: Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
authors.forename: Margreet C
authors.initials: MC
authors.lastname: Vos
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. s.e.geerlings@amc.uva.nl.
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Geerlings
mesh_terms: D016470:Bacteremia / Q000191:economics / Q000209:etiology / Q000517:prevention & control*; D055499:Catheter-Related Infections / Q000191:economics / Q000209:etiology / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000706:statistics & numerical data*; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000706:statistics & numerical data*; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000706:statistics & numerical data*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D065186:Interrupted Time Series Analysis; D008297:Male; D009426:Netherlands; D011446:Prospective Studies; D058996:Quality Improvement; D019564:Unnecessary Procedures; D014546:Urinary Catheterization / Q000009:adverse effects / Q000706:statistics & numerical data*; D062885:Urinary Catheters / Q000009:adverse effects / Q000821:virology*; D014552:Urinary Tract Infections / Q000191:economics / Q000209:etiology / Q000517:prevention & control*
keywords: Adult; Catheter-Related Infections/prevention & control; Healthcare quality improvement; Implementation; Interrupted time series; Research Design; Urinary Tract Infections/prevention & control