JMIR Publications

ABSTRACT

Background:

Catheter-associated urinary tract infections (CAUTI) are the main cause of healthcare associated infections, leading to higher burden of disease, more antibiotic use and prolonged hospital stay. Inappropriate placement and unnecessary prolongation of use of a urinary catheter, lead to an elevated and preventable risk of infection. The smartphone application ‘Participatient’ is developed to involve patients in the communication and decision-making on urinary catheter use with the aim to overcome unnecessary (long-term) use of catheters to prevent CAUTI. Sustained behavior change in infection prevention could be promoted through patient empowerment through the smartphone app Participatient.

Objective:

In our multi-centered prospective interrupted time series, our primary aim is 15% reduction in inappropriate urinary catheter use. We will evaluate the efficacy of the app in this quality improvement project on clinical wards. To reduce CAUTI, increase patient satisfaction, involvement, and trust in their health care are secondary endpoints.

Methods:

We will conduct a multicenter, interrupted time series (ITS), to investigate the efficacy of the app in reducing inappropriate use of urinary catheters, consisting of a pre-, and post-intervention point-prevalence survey on the participating wards. After the app adjusted to the wards’ requirements, the patient-centered app with catheter indication checklist is implemented on clinical wards of four large hospitals in the Netherlands. The clinical data collection will be every 2 weeks during 6 months in both the pre- and post-intervention period. The impact of the app on patient satisfaction about their care and care providers and patient’s perceived involvement in care will be assessed in questionnaires. Barriers and facilitators of eHealth implementation are assessed through interviews with health-care workers.

Results:

Based on the objective of 15% reduction of the circa 40% inappropriate urinary catheters in use, we aim to collect 9-12 data points of 70-100 observations per moment per hospital. We will conduct an interrupted time series (ITS) analysis, which is considered a strong design when randomization is not feasible. We will present the difference in unadjusted and adjusted rate ratio (RR) with a 95% confidence interval (CI). Differences are considered to be statistically significant with a P < 0.05.

Conclusions:

This study aims to reduce the use of inappropriate urinary catheters, and the subsequent catheter-associated urinary tract infections. By providing patients with reliable information and daily checklists via an app, we aim to give patients a tool to be involved and increase the quality of care. Clinical Trial: Netherlands Trial Register NL7178