Infection Control & Hospital Epidemiology (2019), 40, 427–431 doi:10.1017/ice.2019.31
Original Article
Reducing urinary catheter use using an electronic reminder systemin hospitalized patients: A randomized stepped-wedge trial Brett G. Mitchell PhD1,2
, Maria Northcote PhD3, Allen C. Cheng PhD4,5, Oyebola Fasugba PhD6,7, Philip L. Russo PhD7,8,9
and Hannah Rosebrock MPysch7 1Faculty of Arts, Nursing, and Theology, Avondale College of Higher Education, Wahroonga, New South Wales, Australia, 2School of Nursing and Midwifery, University of Newcastle, Newcastle, New South Wales, Australia, 3Faculty of Education, Business and Science, Avondale College of Higher Education, Cooranbong, New South Wales, Australia, 4Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Melbourne, Victoria, Australia, 5School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia, 6Nursing Research Institute, Australian Catholic University and St Vincent’s Health Australia, Sydney, Australian Capital Territory, Australia, 7Lifestyle Research Centre, Avondale College of Higher Education, Cooranbong, New South Wales, Australia, 8Centre for Nursing Research, Cabrini Institute, Malvern, Victoria, Australia and 9Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Victoria, Australia
Abstract Objective: To determine the effectiveness and ease of use of an electronic reminder device in reducing urinary catheterization duration.
Design: A randomized controlled trial with a cross-sectional anonymous online survey and focus group. Setting: Ten wards in an Australian hospital. Participants: All hospitalized patients with a urinary catheter. Intervention: An electronic reminder system, the CATH TAG, applied to urinary catheter bags to prompt removal of urinary catheters. Outcomes: Catheterization duration and perceptions of nurses about the ease of use.
Methods: A Cox proportional hazards model was used to assess the rate of removal of catheters. A phenomenological approach underpinned data collection and analysis methods associated with the focus group.
Results: In total, 1,167 patients with a urinary catheter were included. The mean durations in control and intervention phases were 5.51 days (95% confidence interval [CI], 4.9–6.2) and 5.08 days (95% CI, 4.6–5.6), respectively. For patients who had a CATH TAG applied, the hazard ratio (HR) was 1.02 (95% CI, 0.91–1.14; P=.75). A subgroup analysis excluded patients in an intensive care unit (ICU), and the use of the CATHTAGwas associated with a 23% decrease in the mean, from 5.00 days (95% CI, 4.44–5.56) to 3.84 days (95% CI, 3.47–4.21). Overall, 82 nurses completed a survey and 5 nurses participated in a focus group. Responses regarding the device were largely positive, and benefits for patient care were identified.
Conclusion: TheCATHTAGdid not reduce the duration of catheterization, but potential benefits in patients outside the ICU were identified. Electronic reminders may be useful to aid prompt removal of urinary catheters in the non-ICU hospital setting.
(Received 10 October 2018; accepted 24 January 2019)
The main risk factor for catheter-associated urinary tract infections (CAUTIs) appears to be prolonged catheterization.1 Previous research has shown promising results using reminder interven- tions to reduce urinary catheter use.1,2 However, we have been unable to identify any studies evaluating electronic reminders at the point of care for urinary catheters or studies that have included randomization in their design. A reminder intervention is a mechanism that prompts the nurse or physician to review the ongoing need for catheterization. Catheter reminder interventions
Author for correspondence: Brett G. Mitchell, Email:
brett.mitchell@
avondale.edu.au Cite this article: Mitchell BG, et al. (2019). Reducing urinary catheter use using an
electronic reminder system in hospitalized patients: A randomized stepped-wedge trial. Infection Control& Hospital Epidemiology, 40: 427–431,
https://doi.org/10.1017/ice.2019.31
evaluated in previous research included verbal or written remind- ers, a sticker on the catheter bag or patient’s chart, computer-gen- erated reminders, or stop orders.1,2 The 2 main objectives of the our study were (1) to examine the efficacy of an electronic reminder system, the CATH TAG, in reducing the duration of catheteriza- tion in hospitalized patients and (2) to explore the effects of the CATH TAG on nurses’ ability to deliver patient care.
Methods Study design and setting
Astepped-wedge, randomized, controlled design was performed in 10 wards of a large, principal referral, Australian hospital over a
© The Society for Healthcare Epidemiology of America 2019. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://
creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
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