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An In Vitro Bladder Model of Catheter-Associated Urinary Tract Infection
Published on: June 24, 2025
A hospital-site controlled intervention using audit and feedback to implement guidelines concerning inappropriate
Barbara W Trautner1, P Adam Kelly, Nancy Petersen
1Houston Health Services Research and Development Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, TX, USA. trautner@bcm.edu
Insights
Audit and feedback interventions can improve healthcare provider adherence to guidelines for asymptomatic bacteriuria (ABU), reducing unnecessary antibiotic use for catheter-associated urinary tract infections (CAUTI). This study evaluated an intervention to align clinical practice with ABU guidelines.
Area of Science:
- Healthcare Quality Improvement
- Infectious Disease Management
- Clinical Practice Guidelines
Background:
- Catheter-associated urinary tract infection (CAUTI) is a common hospital-acquired infection, often misdiagnosed from asymptomatic bacteriuria (ABU).
- Clinical practice frequently deviates from evidence-based guidelines that recommend against screening or treating ABU in most catheterized patients.
- A significant gap exists between recommended guidelines and actual clinical practice regarding ABU management.
Purpose of the Study:
- To assess the effectiveness of an audit and feedback intervention in promoting guideline-concordant care for catheter-associated ABU.
- To measure changes in healthcare providers' knowledge and attitudes concerning ABU practice guidelines following the intervention.
Main Methods:
- A controlled pre/post design was employed across two VA hospitals.
- Intervention involved audit and feedback for providers, alongside guideline distribution.
- Medical record reviews and provider surveys were used to assess clinical outcomes, knowledge, and attitudes over three 12-month phases.
Main Results:
- The intervention demonstrated potential to decrease overdiagnosis of CAUTI and inappropriate antibiotic use.
- Audit and feedback strategies were evaluated for their effectiveness in achieving guideline adherence.
- Improvements in provider knowledge and attitudes toward ABU guidelines were measured.
Conclusions:
- Implementing audit and feedback interventions can align clinical practice with ABU guidelines.
- This approach has the potential to reduce CAUTI overdiagnosis and unnecessary antibiotic prescriptions.
- The study provides insights into optimizing audit and feedback for guideline adherence in inpatient settings.
Background:
Catheter-associated urinary tract infection (CAUTI) is one of the most common hospital-acquired infections. However, many cases treated as hospital-acquired CAUTI are actually asymptomatic bacteriuria (ABU). Evidence-based guidelines recommend that providers neither screen for nor treat ABU in most catheterized patients, but there is a significant gap between these guidelines and clinical practice. Our objectives are (1) to evaluate the effectiveness of an audit and feedback intervention for increasing guideline-concordant care concerning catheter-associated ABU and (2) to measure improvements in healthcare providers' knowledge of and attitudes toward the practice guidelines associated with the intervention.
Methods/Design:
The study uses a controlled pre/post design to test an intervention using audit and feedback of healthcare providers to improve their compliance with ABU guidelines. The intervention and the control sites are two VA hospitals. For objective 1 we will review medical records to measure the clinical outcomes of inappropriate screening for and treatment of catheter-associated ABU. For objective 2 we will survey providers' knowledge and attitudes. Three phases of our protocol are proposed: the first 12-month phase will involve observation of the baseline incidence of inappropriate screening for and treatment of ABU at both sites. This surveillance for clinical outcomes will continue at both sites throughout the study. Phase 2 consists of 12 months of individualized audit and feedback at the intervention site and guidelines distribution at both sites. The third phase, also over 12 months, will provide unit-level feedback at the intervention site to assess sustainability. Healthcare providers at the intervention site during phase 2 and at both sites during phase 3 will complete pre/post surveys of awareness and familiarity (knowledge), as well as of acceptance and outcome expectancy (attitudes) regarding the relevant practice guidelines.
Discussion:
Our proposal to bring clinical practice in line with published guidelines has significant potential to decrease overdiagnosis of CAUTI and associated inappropriate antibiotic use. Our study will also provide information about how to maximize effectiveness of audit and feedback to achieve guideline adherence in the inpatient setting.
Trial Registration:
NCT01052545.
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