A theory-based investigation of patient and healthcare professional behaviours linked to optimal removal of short-term urinary catheters

Abstract

Catheter-associated urinary tract infections (CAUTIs) are among the most prevalent healthcare-acquired infections. Prolonged catheter duration increases CAUTI risk by 5% per day. The average duration of postoperative short-term urinary catheterisation in the UK remains higher than recommended standards. Implementation of early catheter removal guidance is likely influenced by patient and healthcare professional (HCP) factors. This research investigates behavioural determinants (barriers and enablers) of prolonged catheter duration using the theoretical domains framework (TDF). Study 1 (literature review) highlighted that existing interventions and current guidance on catheter removal focus on either limiting the use of urinary catheters or on early catheter removal. A combination of strategies appears more effective than a singular strategy, but sustained improvement over time remains unclear. Current UK guidelines on the timing of catheter removal were non-specific. Two TDF-based interview studies explored barriers and enablers to prolonged catheter duration with hospital-based HCPs (doctors, nurses and ancillary staff) (Study 2) and with hospitalised/catheterised patients (Study 3). For HCPs, several key barriers to catheter removal practice were identified, for example, low motivation to remove catheters promptly due to competing demands; poor knowledge of removal guidance and evidence-based practice. Key enablers for HCPs included being highly skilled at removing catheters; the use of handover notes, reminders and daily task lists; and having senior and specialised colleagues as role models. Patient barriers to engaging with HCPs were, for example, perceived inability to manage without a catheter/dependence on the catheter, environmental and resource factors such as the lack of accessible toilets and staff assistance with toileting, staff attitudes, and ward culture. Patient enablers were: motivation to engage to speed-up hospital discharge and social support from the family. A range of modifiable barriers linked to HCP and patient-related behaviours were identified which may help explain the prolonged duration of short-term urinary catheters. A behaviour change intervention targeting these barriers whilst strengthening the enablers may reduce catheter duration and subsequently CAUTIs.