Patient Engagement to Counter Catheter-associated urinary tract infections with an App (PECCA): a multicentre, prospective, interrupted time series and before-and-after study

BACKGROUND:The risk of urinary tract infections is increased by unnecessary placement and prolonged use of urinary catheters. We aimed to assess whether inappropriate use of catheters and catheter-associated UTI were reduced through patient participation. METHODS:In this multicentre, interrupted time series and before-and-after study, we implemented a patient-centred app which provides catheter advice for patients, together with clinical lessons, feedback via emails and support rounds for staff members. Data on catheter use and infections were collected during a 6-month baseline and a 6-month intervention period on 13 wards in 4 hospitals in the Netherlands. Dutch Trial Register: NL7178. FINDINGS:Between 25 June 2018 and 1 August 2019, 6,556 patients were included in 24 point-prevalence surveys, 3,285(50%) at baseline and 3,271(50%) during the intervention. During the intervention 249 app users and a median of 7 new app users per week were registered (IQR 5.5-13.0). At baseline, inappropriate catheter use was registered for 175 (21.9%) of 798 catheters, compared to 55 (7.0%) of 786 during the intervention. Time series analysis showed a non-significant decrease of inappropriate use of 5.8% (95%CI -3.76 to 15.45, p=0.219), with an odds ratio of 0.27 (0.19 - 0.37, p<0.001). Catheter-associated UTI decreased by 3.0% (1.3 - 4.6, p=0.001), with OR 0.541(0.408-0.716, p<0.001). CONCLUSION:Although UTI significantly decreased after the implementation, we found that patient participation did not significantly reduce the prevalence of inappropriate urinary catheter use. However, the inappropriate catheter reduction of 5.8% and an odds ratio of 0.27 suggest a positive trend. Patient participation appears to reduce CAUTI and could reduce other healthcare-associated infections. FUNDING:Netherlands Organization for Health Research and Development.