Nudging with monthly feedback may help to reduce urinary catheter days and catheter-associated urinary tract infections

CAUTIs are the cause of 40% of all hospital-acquired infections and are – when evidence-based guideline recommendations are followed in up to 70% preventable. In this quality improvement project, we aimed to reduce CAUTI by using monthly feedback aimed at nudging health care professionals to increase awareness of CAUTI and guideline adherence. Non-randomized quality improvement project. We compared 12 months before and 12 months after the start of the nudging on the intervention wards to the wards without the nudging intervention. The nudging intervention was a monthly newsletter sent to physicians and nurses working on the wards that included feedback of the monthly number of patients with urinary catheters on the ward, information on evidence-based indications for urinary catheter, and urinary catheter management. On all wards, infectious diseases specialists conducted education on CAUTI prevention during the study period without differences between the wards. We compared the number of CAUTIs per month between wards with and without nudging. Additional outcomes were the incidence of patients with urinary catheter and the catheter days per 100 patient-days. Overall, 9 CAUTIs (0.18 CAUTI rate per 100 patients) were diagnosed during the 12 months of the pre-intervention period (5 for intervention ward, 4 for control wards. During the intervention period, no CAUTI was observed on the intervention wards, whereas two CAUTIs occurred on the control wards. Catheter days per 100 patient-days during the intervention period were 8.67 (SD 3.4) on the intervention wards and 11.33 (SD 3.0) on the control wards. There was some improvement in knowledge about the risk for CAUTI and the appropriate indications over time in residents receiving the nudging intervention. Nudging through monthly structured feedback to healthcare professionals was associated with fewer catheter days and no observed CAUTIs during the intervention period. These exploratory findings suggest that nudging strategies may support guideline adherence as part of a broader multimodal approach to reducing CAUTI risk.