Introduction: Catheter-associated urinary tract infections significantly contribute to hospital-acquired complications globally, with adverse implications for patient outcomes, healthcare and fiscal resources. Most urinary tract infections are preventable. Consequently, nurse-led protocols for the early removal of urinary catheters to reduce the incidence of catheter-associated urinary tract infections have been trialled. A systematic review of nurse-led protocols for the removal of urinary catheters has not been conducted since 2010.
Purpose: To undertake a scoping review of published evidence for nurse-led practices of removing urinary catheters within the acute healthcare setting, with reference to the impact on catheter-associated urinary tract infection rates.
Methods: Five databases (CINAHL, MEDLINE, SCOPUS, EMCARE and INFORMIT) were systematically searched in a scoping review of all peer-reviewed publications up to 12/03/2021.
Results: Thirteen studies met the inclusion criteria. Eleven studies described a reduction in catheter associated urinary tract infections regardless of the type of intervention, one study did not demonstrate a change, and one study reported an increase in catheterassociated urinary tract infections. Settings, study duration and sample size varied substantially between the included studies. Interventions were exclusive nurse-led protocol for removal of urinary catheters, computerised reminder systems, bundle approaches or comprehensive packages. Outcome measures and definitions of catheter associated urinary tract infections were varied or absent. The quality of evidence of included studies in this review was low, attributed to a number of methodological issues related to sample size and statistical analyses. While the introduction of nurse-led protocols showed some improvements, the methodological inconsistencies make it difficult to highlight a specific protocol.
Conclusion: There is evidence that a reduction in catheter-associated urinary tract infection incidence could be achieved by utilising nurse-led protocols for the removal of urinary catheters. However, given the quality of existing evidence, caution is required in translating these f indings to policy and practice