A national collaborative approach to reduce catheter-associated urinary tract infections in nursing homes: A qualitative assessment

Am J Infect Control. 2017 Dec 1;45(12):1342-1348. doi: 10.1016/j.ajic.2017.07.006. Epub 2017 Aug 12.


Background: Reducing health care-associated infections (HAIs), such as catheter-associated urinary tract infection (CAUTI), is a critical performance improvement target in nursing homes. The Agency for Healthcare Research and Quality Safety Program for Long-term Care: Health Care-Associated Infections/Catheter-Associated Urinary Tract Infection, a national performance improvement program, was designed to promote implementation of a CAUTI prevention program through state-based or regional collaboratives in more than 500 nursing homes across the United States.

Methods: Qualitative interviews were conducted with 8 purposefully selected organizational leads (who led implementation activities for a group of facilities) and 8 facility leads (who led implementation activities at a given facility) to understand implementation successes and challenges and experiences of participants involved in the program. Key themes were identified using a rapid analysis approach.

Results: Key themes related to general perceptions, changes due to program participation, and factors influencing program implementation were identified. In general, the program was viewed positively by organizational and facility leads with changes in catheter care practices, staff empowerment, and improvements in knowledge identified as benefits. Implementation challenges included the time required for program start-up as well as issues with staff and physician support, logistic barriers, and staffing turnover.

Conclusions: Despite some challenges, the observed program success and positive views of those participating suggest that collaboratives are an important strategy for providing nursing homes with enhanced expertise and support to prevent HAIs and ensure resident safety.

Keywords: Infection prevention; Long-term care; Qualitative interviews; Quality improvement; Resident safety.

MeSH terms

  • Catheter-Related Infections / prevention & control*
  • Cross Infection / prevention & control*
  • Humans
  • Long-Term Care
  • Nursing Homes
  • Patient Safety
  • Qualitative Research
  • Quality Improvement
  • United States
  • Urinary Tract Infections / prevention & control*