[A quality improvement project on urinary catheter management in a medical ward of the Turin local health authority].

UNLABELLED: . A quality improvement project on urinary catheter management in a medical ward of the Turin local health authority.

INTRODUCTION

Appropriate use of urinary catheters (UC) is essential to prevent Catheter-Associated Urinary Tract Infections (CAUTI), which represent a substantial proportion of healthcare associated infections and are associated with increased morbidity, antibiotic use, and length of stay. In the Medical ward of the ASL Città di Torino, variability was observed in UC insertion, management, and reassessment practices, despite the availability of updated institutional recommendations.

AIM: To improve professionals' adherence to institutional recommendations on UC management and to evaluate the impact on care processes and clinical outcomes.

METHODS

A quality improvement project was conducted using two PDSA cycles, grounded in the COM-B and TDF frameworks. The multicomponent intervention included audit-feedback, multiprofessional briefings, training, electronic reminders, support materials, a project champion, a self assessment questionnaire, and structured brainstorming. Three measurement periods (baseline, post-PDSA1, post-PDSA2) monitored process indicators and clinical outcomes.

RESULTS

Fifty-six patients were assessed at baseline and forty-nine after PDSA2. Process indicators improved markedly: documentation of UC indication (59.2%→94.8%), daily reassessment (25%→89.6%), and documentation of catheter size (46.1%→98.3%). The number of catheterizations decreased (76→58), as did median catheter duration (8→6 days) and CAUTI incidence density (20→13.77 per 1,000 catheter-days), although without statistical significance.

CONCLUSIONS

Integrated, theory-driven interventions supported by a favourable organizational context can substantially improve UC-related care practices. Active professional engagement and decision support tools promote sustainable behavioural change. The model may be transferable to other clinical settings.