Summary of best evidence for CAUTI evidence-based nursing measures and localized quality improvement innovations

To retrieve and summarize the best evidence for the prevention and control of catheter-associated urinary tract infections (CAUTI) and validate its clinical effectiveness through localized quality improvement, providing an evidence-based foundation for standardized clinical management.

Based on the Joanna Briggs Institute (JBI) evidence translation framework, a baseline review was conducted first. A systematic search was then performed on relevant domestic and international websites. Evidence-based databases included BMJ Best Practice, the Cochrane Library, and the OVID-JBI Library. Comprehensive databases included PubMed, Embase, CINAHL, Web of Science, CNKI, Wanfang Database, China Biomedical Literature Database, and Medlive. English databases included PubMed, Sinomed, Web of Science, etc. The search timeframe ranged from database inception to April 30, 2024. At the screening phase, only literature published from 2019 to 2024 (the last 5 years) was included. Two researchers independently evaluated literature quality and extracted data to summarize evidence. A localized plan was developed, revised through two rounds of the Delphi method, implemented clinically, and evaluated for effectiveness.

A total of 11 articles met the evidence requirements, including 6 randomized controlled trials (RCTs) and 5 quasi-experimental studies. The final evidence summary comprised 4 dimensions (pre-insertion, training management, maintenance measures, and quality control with continuous improvement) and 11 best evidence items. Based on the best evidence, the sample healthcare institution summarized 11 pieces of evidence-based recommendations and formulated six localized CAUTI-prevention nursing measures, and optimized relevant training schemes and supplementary training content, developed checklists based on nursing and hospital-acquired infection (HAI) CAUTI prevention indicator systems, and added high-risk infection factor alerts in the information system. Process-related indicators-including hand hygiene compliance, daily assessment execution rate, and catheter utilization rate-showed statistically significant improvements (all p < 0.05). The CAUTI incidence per 1,000 catheter-days decreased from 2.16‰ (28/12943) to 1.82‰ (17/9325). Poisson regression analysis showed a rate ratio (IRR) of 0.84 (95% CI: 0.46-1.54, p = 0.58), indicating that this reduction did not reach statistical significance.

This study, based on evidence-based medicine principles, summarized the best evidence for CAUTI prevention and control. Subsequently, it conducted clinical validation of this evidence, which firmly attested to the scientific rigor and reliability of the evidence summary. The findings of this study offer highly valuable perspectives and guidance for the effective prevention and control of CAUTI.