A tiered approach to reducing infectious and non-infectious urinary catheter-related complications in hospitalised older patients: an interrupted time-series study.

BACKGROUND

Inappropriate urinary catheter use is common among older inpatients, causing infectious and non-infectious complications. Although a tiered approach has been recommended, its comprehensive application remains underexplored.

AIM: To evaluate the effect of a tiered-approach intervention on catheter-associated urinary tract infections (CAUTIs) and non-infectious complications in hospitalised older patients.

METHODS

This quasi-experimental interrupted time-series study, conducted in a Taiwanese tertiary centre from October 2020 to June 2023, enrolled patients aged 65 years and older with urinary catheters inserted within 24 h of hospital admission. We used medical records and interviews to compare CAUTIs and catheter appropriateness between the 12-month pre-intervention and 18-month intervention periods.

RESULTS

Of 427 patients, 185 were included in the baseline group and 242 in the intervention group. CAUTIs increased significantly during the pre-intervention period (coefficient = 1.93; P = 0.025) but declined significantly after intervention (coefficient = -2.53; P = 0.012). Non-infectious complications showed a non-significant increase before intervention (coefficient = 1.57; P = 0.121) followed by a significant decline after intervention (coefficient = -2.60; P = 0.029), although no immediate effect was observed (coefficient = -7.32; P = 0.472). Documentation of catheter insertion initially increased, declined during implementation, and then stabilised. Trends in initially inappropriate catheter insertion, catheter utilisation ratios, inappropriate catheter-days, and reinsertion fluctuated, with inappropriate reinsertion demonstrating a sustained decline after intervention.

CONCLUSIONS AND IMPLICATIONS: Implementation of a tiered approach reduced CAUTIs and non-infectious catheter-related complications. Long-term success requires co-ordinated system- and process-level strategies that integrate institutional protocols, professional practice, patient perspectives, and ward culture to optimise outcomes.