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Urinary, and peripheral and central intravenous catheters are widely used in hospitalized patients. However, up to 56 percent 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 the quality improvement project by Bart, et al. (2017) is to reduce the use of catheters without an appropriate indication by 25 percent to 50 percent, and to evaluate the affecting factors of a 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, the researchers 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.
In their study protocol report, the researchers say that 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.
Source: Reference: Bart J. Laan BJ, et al. De-implementation strategy to Reduce the Inappropriate use of urinary and intravenous CATheters: study protocol for the RICAT-study. BMC Infectious Diseases. 2017;17:53