Optimising Interventions for Catheter-Associated Urinary Tract Infections (CAUTI) in Primary, Secondary and Care Home Settings
Abstract
:1. Introduction
- The Health and Social Care Act 2008 Code of Practice on the prevention and control of infections and related guidance (HSC Act 2008)—Guidelines for primary, secondary and community setting
- NICE QS90: Urinary Tract Infections in Adults (NICE QS90)—Guidelines for community setting
- NICE QS61: Infection prevention and control (NICE QS61)—Guidelines for primary, secondary and community setting
- NICE catheter audit tools—tools to help implementation of the clinical guidelines for primary and community setting
- Department of Health and Public Health England (2013): Prevention and control of infections in care homes: an informative resource (DH PHE 2013)—Guidelines for care homes
- Safety thermometer—a tool for HCP in primary, secondary, community and care homes setting
- Epic 3—guidelines for preventing healthcare-associated infections in acute settings
- High Impact Intervention for best practice insertion and care (High Impact)—intervention tools for community and secondary care setting
- Catheter Care: Royal College of Nursing Guidance for nurses (Catheter Care)—guidelines for nurses in primary, community, secondary and nursing homes setting
- HOUDINI Protocol (HOUDINI)—a nurse-led catheter removal protocol for secondary care
- Catheter Passport—document to be completed by both patients and HCPs to consistently manage and remove catheters for primary, community and nursing homes setting
- (1)
- Which interventions, targeting HCP behaviours, are effective at reducing incidence of CAUTI?
- (2)
- What is the content of interventions shown to be effective in research studies in comparison to national interventions?
- (3)
- To what extent are key influences on HCP behaviour addressed by effective interventions in comparison to national interventions?
- (4)
- How can we better address key influences on HCP behaviour?
2. Results
2.1. Rapid Review
2.2. Behavioural Analysis of Intervention Content
Intervention Content Matched against Key Influences on Behaviour
2.3. Stakeholder Feedback
2.4. Survey
3. Discussion
3.1. Implications for Existing CAUTI Interventions
3.2. Optimising National Interventions
3.3. Strengths and Limitations
4. Materials and Methods
4.1. Rapid Review to Identify Effective Research Interventions
4.2. Behavioural Analysis of Research Interventions in Comparison to National Interventions
4.3. Assessing the Behavioural Content of Research Interventions against Key Influences on Healthcare Professional Behaviours
4.4. Stakeholder Feedback Using a Focus Group and Survey
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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Intervention Function | National Interventions (n = 11) | Research Interventions (n = 37) |
Education | 11 | 37 |
Enablement | 7 | 31 |
Training | 4 | 22 |
Modelling | 2 | 3 |
Incentivisation | 1 | 5 |
Environmental restructuring | 0 | 25 |
Persuasion | 0 | 6 |
Coercion | 0 | 0 |
Restriction | 0 | 0 |
Policy Category | National Interventions (n = 11) | Research Interventions (n = 37) |
Guidelines | 9 | 17 |
Service provision | 1 | 36 |
Legislation | 1 | 0 |
Communication/marketing | 0 | 17 |
Regulation | 0 | 0 |
Fiscal measures | 0 | 0 |
Environmental/social planning | 0 | 0 |
National Interventions Top 10 BCTs (n = 11) | Frequency | Research Interventions Top 10 BCTs (n = 37) | Frequency |
---|---|---|---|
Instruction on how to perform a behavior * | 10 | Instruction on how to perform a behaviour | 36 |
Information about health consequences | 9 | Feedback on behaviour | 27 |
Self-monitoring of behaviour | 5 | Adding objects to the environment | 22 |
Social support practical | 4 | Prompts/cues | 15 |
Information about social environmental consequences | 4 | Behavioural practice/rehearsal | 14 |
Goal setting behaviour | 4 | Social support practical | 13 |
Monitoring of behaviour by others without feedback | 3 | Feedback on outcome of behaviour | 13 |
Feedback on behaviour | 3 | Action planning | 9 |
Feedback on outcome of behaviour | 3 | Behavioural substitution | 9 |
Self-monitoring of outcome of behaviour | 3 | Restructuring the social environment | 8 |
Intervention Component | Primary/ Community Care | Secondary Care | Care Homes |
---|---|---|---|
Creating the rule that staff transferring catheterised patients to another setting, check/review the need for a catheter with the receiving team; could be prompted by a checklist for discharge/admission of patients to another setting Barriers: Transitions of care; Pre-emptively deciding to insert catheters; Cultural norms regarding standard catheterisation practice for specific patient groups | + | + | + |
Before inserting catheters, staff required to inform patients and relatives about pros and cons of catheters, risks associated with catheter use, including sepsis and antibiotic resistance and the importance of hydration (with or without written resources) and record that this has been explained to patients. Barriers: Requests from patients and their carers | + | + | + |
Ensure availability of setting and profession specific guidelines which are in agreement and which include examples of how to adapt to local contexts where possible. Barriers: CAUTI guidelines not perceived as relevant | + | + | |
Standardised nationwide computer-based documentation, accessible across healthcare sectors, requiring person initiating urinary catheterisation to insert detailed information such as date of catheter insertion, reason for catheterisation, an action plan for review and removal and details of difficult catheterisation (if relevant). Provided when transferring patients across settings. Barriers: inconsistent documentation and records; Transitions of care; No information regarding placement/ duration of catheters | + | + | |
Intervention to persuade staff of benefits of not using catheters for both patients (e.g., loss of mobility, bed sores, lower risk of infection) and staff (e.g., fewer patients developing infection, improved patient outcomes, lower costs). Reassure staff that not using catheters does not lead to suboptimal care and reframing severity of CAUTI as patient safety issue with a story of a patient who contracted CAUTI. Barriers: Convenience and ease of monitoring; Perceived severity of CAUTI; Lack of perceived benefits to CAUTI interventions; Lack of awareness of the risks related to catheters | + | ||
Introduction of “CAUTI Champions” (nurses and doctors). Champions role model how to manage patient/carer requests for catheter, lead on staff education and provide practical support for colleagues wanting to support patients to TWOC (trial without catheter) Barriers: Physicians dictate nurses’ practice; Lack of peer support and buy-in | + | ||
Provision of bladder scanners, accompanied by staff training on how to use scanners, to aid decisions in relation to problems with urinary retention. Barriers: Unavailability of medical alternatives to urinary catheterisation; Lack of knowledge of how to manage patients without catheters | + |
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Wanat, M.; Borek, A.J.; Atkins, L.; Sallis, A.; Ashiru-Oredope, D.; Beech, E.; Butler, C.C.; Chadborn, T.; Hopkins, S.; Jones, L.; et al. Optimising Interventions for Catheter-Associated Urinary Tract Infections (CAUTI) in Primary, Secondary and Care Home Settings. Antibiotics 2020, 9, 419. https://doi.org/10.3390/antibiotics9070419
Wanat M, Borek AJ, Atkins L, Sallis A, Ashiru-Oredope D, Beech E, Butler CC, Chadborn T, Hopkins S, Jones L, et al. Optimising Interventions for Catheter-Associated Urinary Tract Infections (CAUTI) in Primary, Secondary and Care Home Settings. Antibiotics. 2020; 9(7):419. https://doi.org/10.3390/antibiotics9070419
Chicago/Turabian StyleWanat, Marta, Aleksandra J. Borek, Lou Atkins, Anna Sallis, Diane Ashiru-Oredope, Elizabeth Beech, Christopher C. Butler, Tim Chadborn, Susan Hopkins, Leah Jones, and et al. 2020. "Optimising Interventions for Catheter-Associated Urinary Tract Infections (CAUTI) in Primary, Secondary and Care Home Settings" Antibiotics 9, no. 7: 419. https://doi.org/10.3390/antibiotics9070419
APA StyleWanat, M., Borek, A. J., Atkins, L., Sallis, A., Ashiru-Oredope, D., Beech, E., Butler, C. C., Chadborn, T., Hopkins, S., Jones, L., McNulty, C. A. M., Roberts, N., Shaw, K., Taborn, E., & Tonkin-Crine, S. (2020). Optimising Interventions for Catheter-Associated Urinary Tract Infections (CAUTI) in Primary, Secondary and Care Home Settings. Antibiotics, 9(7), 419. https://doi.org/10.3390/antibiotics9070419