Patient engagement to counter catheter-associated urinary tract infections with an app (PECCA): a multicentre, prospective, interrupted time-series and before-and-after study

J Hosp Infect. 2024 May:147:98-106. doi: 10.1016/j.jhin.2023.11.005. Epub 2023 Nov 29.

Abstract

Background: The risk of urinary tract infections (UTIs) is increased by unnecessary placement and prolonged use of urinary catheters.

Aim: To assess whether inappropriate use of catheters and catheter-associated UTI were reduced through patient participation.

Methods: In this multicentre, interrupted time-series and before-and-after study, we implemented a patient-centred app which provides catheter advice for patients, together with clinical lessons, feedback via e-mails and support rounds for staff members. Data on catheter use and infections were collected during a six-month baseline and a six-month intervention period on 13 wards in four hospitals in the Netherlands. Dutch Trial Register: NL7178.

Findings: Between June 25th, 2018 and August 1st, 2019, 6556 patients were included in 24 point-prevalence surveys, 3285 (50%) at baseline and 3271 (50%) during the intervention. During the intervention 249 app users and a median of seven new app users per week were registered (interquartile range: 5.5-13.0). At baseline, inappropriate catheter use was registered for 175 (21.9%) out of 798 catheters, compared to 55 (7.0%) out of 786 during the intervention. Time-series analysis showed a non-significant decrease of inappropriate use of 5.8% (95% confidence interval: -3.76 to 15.45; P = 0.219), with an odds ratio of 0.27 (0.19-0.37; P < 0.001). Catheter-associated UTI decreased by 3.0% (1.3-4.6; P = 0.001), with odds ratio 0.541 (0.408-0.716; P < 0.001).

Conclusion: Although UTI significantly decreased after the implementation, patient participation did not significantly reduce the prevalence of inappropriate urinary catheter use. However, the inappropriate catheter reduction of 5.8% and an odds ratio of 0.27 suggest a positive trend. Patient participation appears to reduce CAUTI and could reduce other healthcare-associated infections.

Keywords: Catheter-associated urinary tract infections; Infection control; Patient engagement; Patient participation; Urinary catheter; eHealth.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Catheter-Related Infections* / epidemiology
  • Catheter-Related Infections* / prevention & control
  • Cross Infection / epidemiology
  • Cross Infection / prevention & control
  • Female
  • Humans
  • Interrupted Time Series Analysis*
  • Male
  • Middle Aged
  • Mobile Applications*
  • Netherlands / epidemiology
  • Patient Participation* / statistics & numerical data
  • Prospective Studies
  • Urinary Catheterization / adverse effects
  • Urinary Tract Infections* / epidemiology
  • Urinary Tract Infections* / etiology
  • Urinary Tract Infections* / prevention & control
  • Young Adult