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Using Agile Science to implement alternatives to indwelling urinary catheters
Bethany Gregg1, Edmond Ramly2, Diveena Davis3
1Hackensack Meridian School of Medicine, Nutley, NJ; Hackensack Meridian Health, Edison, NJ.
American Journal of Infection Control
|July 28, 2026
Summary
Agile Implementation rapidly optimized alternatives to indwelling urinary catheters (IUCs), significantly reducing catheter-associated urinary tract infections (CAUTIs). This approach proved vital for successful and sustainable infection prevention strategies.
Area of Science:
- Healthcare Management
- Infection Prevention and Control
- Agile Methodologies in Healthcare
Background:
- Inconsistent adoption of alternatives to indwelling urinary catheters (IUCs) hinders catheter-associated urinary tract infection (CAUTI) reduction.
- External urinary devices offer a viable alternative to reduce CAUTIs.
Purpose of the Study:
- To accelerate the implementation of external urinary devices across a large hospital network using an Agile Science framework.
- To optimize the adoption and sustainability of IUC alternatives for CAUTI prevention.
Main Methods:
- Utilized an Agile Implementation process with multidisciplinary teams to co-design iterative
- sprints
- targeting EMR changes, auditing, education, and workflow integration.
- Monitored process measures (learning module completion, audit compliance) and outcome measures (CAUTI Standardized Infection Ratio [SIR], indwelling catheter Standardized Utilization Ratio [SUR]).
Main Results:
- Successfully pivoted from daily to risk-based audits, achieving 99%-100% compliance.
- Increased learning module completion from 34% to 99% within 18 months.
- Achieved a 36% reduction in network CAUTI SIR, reaching 0.52 by Q3 2025, and sustained SUR below the national median.
Conclusions:
- Agile Implementation's iterative approach and feedback mechanisms were crucial for adapting interventions and ensuring success.
- Rapid adoption of IUC alternatives, supported by integrated systems and risk-based auditing, can lead to meaningful CAUTI reductions and promote sustainability.
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