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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 (UTIs) is increased by unnecessary placement and prolonged use of urinary catheters.

Aim: 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 e-mails and support rounds for staff members. Data on catheter use and infections were collected during a six-month baseline and a six-month intervention period on 13 wards in four hospitals in the Netherlands. Dutch Trial Register: NL7178.

Findings: Between June 25th, 2018, and August 1st, 2019, 6556 patients were included in 24 point-prevalence surveys, 3285 (50%) at baseline and 3271 (50%) during the intervention. During the intervention, 249 app users and a median of seven new app users per week were registered (interquartile range: 5.5-13.0). At baseline, inappropriate catheter use was registered for 175 (21.9%) out of 798 catheters, compared to 55 (7.0%) out of 786 during the intervention. Time-series analysis showed a non-significant decrease of inappropriate use of 5.8% (95% confidence interval: -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 odds ratio 0.541 (0.408-0.716; P < 0.001).

Conclusion: Although UTI significantly decreased after the implementation, 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.

R G Bentvelsen,1 B J Laan,2 T Bonten,3 R van der Vaart,4 D J Hetem,5 R Soetekouw,6 S E Geerlings,2 N H Chavannes,3 K E Veldkamp7

  1. Clinical Microbiology, Leiden University Medical Centre, Leiden, The Netherlands; Microvida Laboratory for Microbiology and Immunology, Amphia Hospital Breda, Breda, The Netherlands. Electronic address: .
  2. Infectious Diseases, Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, The Netherlands.
  3. Public Health and Primary Care, National eHealth Living Lab, Leiden University Medical Centre, Leiden, The Netherlands.
  4. Unit of Health, Medical and Neuropsychology, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, The Netherlands.
  5. Clinical Microbiology, Haaglanden Medical Centre, The Hague, The Netherlands.
  6. Internal Medicine, Spaarne Gasthuis, Haarlem/Hoofddorp, The Netherlands.
  7. Clinical Microbiology, Leiden University Medical Centre, Leiden, The Netherlands.
Source: Bentvelsen RG., Laan BJ., Bonten T. et al. Patient engagement to counter catheter-associated urinary tract infections with an app (PECCA): a multicentre, prospective, interrupted time-series and before-and-after study. J Hosp Infect. 2024 May:147:98-106. doi: 10.1016/j.jhin.2023.11.005.