Patient and Family Engagement in Catheter-Associated Urinary Tract Infection (CAUTI) Prevention: A Systematic Review



      Catheter-associated urinary tract infections (CAUTIs) are detrimental to health and are largely preventable with adherence to CAUTI prevention guidelines. Patient and family engagement in CAUTI prevention is often encouraged in these guidelines; however, little is known about how this engagement is operationalized in practice. A systematic review was conducted to synthesize the content, format, and outcomes of interventions that engage patients and/or families in CAUTI prevention.


      Two reviewers independently screened records from four databases up to March 2021 and searched reference lists of final articles. Included articles were primary research, tested an intervention, involved indwelling urinary catheters, and described at least one patient and/or family engagement method. Articles were appraised for quality using the Downs and Black checklist.


      After 720 records were screened, 12 were included. Study quality ranged from good to poor, scoring lowest in internal validity. The most common formats of patient/family engagement were flyers/handouts (83.3%) and verbal education (58.3%). Common content areas were urinary catheter care and maintenance strategies. Most study outcomes (83.3%) measured CAUTI rates, and half measured patient/family-related outcomes. Improvements were seen in at least one outcome across all studies, but less than half (41.7%) showed statistically significant results.


      The researchers found that most interventions lacked sufficient detail on the content, delivery, and/or outcome measurement of patient/family engagement, which limits transferability. More high-quality, generalizable trials are warranted in this area. Future research should focus on integrating publicly available resources into practice that can be tested for comprehension and revised based on feedback from target audiences.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Joint Commission Journal on Quality and Patient Safety
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Magill SS
        • et al.
        Multistate point-prevalence survey of health care–associated infections.
        N Engl J Med. 2014; 370 (Mar27): 1198-1208
      1. Centers for Disease Control and Prevention. Catheter-associated urinary tract infections (CAUTI). Oct 16, 2015. Accessed Jun 6, 2021.

        • Stone PW.
        Economic burden of healthcare-associated infections: an American perspective.
        Expert Rev Pharmacoecon Outcomes Res. 2014; 9: 417-422
        • Merchant S
        • et al.
        Epidemiology, microbiology and outcomes of catheter-associated urinary tract infection and complicated urinary tract infection in the USA.
        Open Forum Infect Dis. 2017; 4: S348
        • Klevens RM
        • et al.
        Estimating health care-associated infections and deaths in U.S. hospitals, 2002.
        Public Health Rep. 2007; 122: 160-166
        • Lo E
        • et al.
        Strategies to prevent catheter-associated urinary tract infections in acute care hospitals: 2014 update.
        Infect Control Hosp Epidemiol. 2014; 35 (May): 464-479
        • Letica-Kriegel AS
        • et al.
        Identifying the risk factors for catheter-associated urinary tract infections: a large cross-sectional study of six hospitals.
        BMJ Open. 2019; 9 (Feb)e022137
        • Smith SN
        • et al.
        Evaluation of the association between Nursing Home Survey on Patient Safety culture (NHSOPS) measures and catheter-associated urinary tract infections: results of a national collaborative.
        BMJ Qual Saf. 2018; 27: 464-473
        • Shang J
        • et al.
        Infection in home health care: results from national Outcome and Assessment Information Set data.
        Am J Infect Control. 2015 May 1; 43: 454-459
      2. Agency for Healthcare Research and Quality. Toolkit for Reducing Catheter-Associated Urinary Tract Infections in Hospital Units: Implementation Guide. Oct 2015. Accessed Jun 6, 2021.

        • Septimus EJ
        • Moody J.
        Prevention of device-related healthcare-associated infections.
        F1000Res. 2016 Jan 14; 5 (F1000 Faculty Rev 65)
      3. Centers for Disease Control and Prevention, Healthcare Infection Control Practices Advisory Committee. Guideline for Prevention of Catheter-Associated Urinary Tract Infections 2009. (Updated: Jun 6, 2019.) Accessed Jun 6, 2021.

      4. Agency for Healthcare Research and Quality. Patient and Family Engagement. Jul 2018. Accessed Jun 6, 2021.

      5. National Patient Safety Foundation, Lucian Leape Institute. Safety Is Personal: Partnering with Patients and Families for the Safest Care. 2014. Accessed Jun 6, 2021.

        • Carman KL
        • et al.
        Patient and family engagement: a framework for understanding the elements and developing interventions and policies.
        Health Aff (Millwood). 2013; 32: 223-231
        • Cox ED
        • et al.
        A family-centered rounds checklist, family engagement, and patient safety: a randomized trial.
        Pediatrics. 2017; 139e20161688
        • Dykes PC
        • et al.
        Prospective evaluation of a multifaceted intervention to improve outcomes in intensive care: the promoting respect and ongoing safety through patient engagement communication and technology study.
        Crit Care Med. 2017; 45: e806-e813
        • Davidson JE
        • et al.
        Guidelines for family-centered care in the neonatal, pediatric, and adult ICU.
        Crit Care Med. 2017; 45: 103-128
        • Park M
        • et al.
        Patient- and family-centered care interventions for improving the quality of health care: a review of systematic reviews.
        Int J Nurs Stud. 2018; 87: 69-83
      6. Agency for Healthcare Research and Quality. AHRQ National Scorecard on Hospital-Acquired Conditions Updated Baseline Rates and Preliminary Results 2014–2017. (Updated: Jul 2020.) Accessed Jun 6, 2021.

        • Moher D
        • et al.
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        J Clin Epidemiol. 2009; 62: 1006-1012
        • Mathes T
        • Klaßen P
        • Pieper D.
        Frequency of data extraction errors and methods to increase data extraction quality: a methodological review.
        BMC Med Res Methodol. 2017 Nov 28; 17: 152
        • Downs SH
        • Black N.
        The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions.
        J Epidemiol Community Health. 1998; 52: 377-384
        • Elkbuli A
        • et al.
        Targeting catheter-associated urinary tract infections in a trauma population: a 5-S bundle preventive approach.
        J Trauma Nurs. 2018; 25: 366-373
        • Inman DM
        • et al.
        Effects of urinary catheter education for patients undergoing prostatectomy.
        Urol Nurs. 2013; 33: 289-298
        • Joseph K
        • et al.
        The “TRAUMA LIFE” initiative: the impact of a multidisciplinary checklist process on outcomes and communication in a trauma intensive care unit.
        Am J Surg. 2018; 215: 1024-1028
        • Mody L
        • et al.
        A national implementation project to prevent catheter-associated urinary tract infection in nursing home residents.
        JAMA Intern Med. 2017 Aug 1; 177: 1154-1162
        • Oman KS
        • et al.
        Nurse-directed interventions to reduce catheter-associated urinary tract infections.
        Am J Infect Control. 2012; 40: 548-553
        • Purvis S
        • et al.
        Catheter-associated urinary tract infection: a successful prevention effort employing a multipronged initiative at an academic medical center.
        J Nurs Care Qual. 2014; 29: 141-148
        • Sarpong Y
        • et al.
        Improvement in quality metrics outcomes and patient and family satisfaction in a neurosciences intensive care unit after creation of a dedicated neurocritical care team.
        Crit Care Res Pract. Epub. 2017 Oct 8;
        • Spencer TS
        • Flynn Makic MB
        • Shaw K
        Decreasing catheter-associated urinary tract infections in urologic oncology patients discharged with an indwelling urinary catheter: a quality improvement project.
        J Perianesth Nurs. 2019; 34: 394-402
        • Theobald CN
        • et al.
        A multifaceted quality improvement strategy reduces the risk of catheter-associated urinary tract infection.
        Int J Qual Health Care. 2017 Aug 1; 29: 564-570
        • Lee K-C
        • et al.
        A nurse-family partnership intervention to increase the self-efficacy of family caregivers and reduce catheter-associated urinary tract infection in catheterized patients.
        Int J Nurs Pract. 2015; 21: 771-779
        • Roe BH.
        Study of the effects of education on patients’ knowledge and acceptance of their indwelling urethral catheters.
        J Adv Nurs. 1990; 15: 223-231
        • Wilde MH
        • et al.
        Self-management intervention for long-term indwelling urinary catheter users: randomized clinical trial.
        Nurs Res. 2015; 64: 24-34
        • Krein SL
        • et al.
        Barriers to reducing urinary catheter use: a qualitative assessment of a statewide initiative.
        JAMA Intern Med. 2013 May 27; 173: 881-886
        • Cené CW
        • et al.
        A narrative review of patient and family engagement: the “foundation” of the medical “home.
        Med Care. 2016; 54: 697-705
        • Meddings J
        • et al.
        Systematic review of interventions to reduce urinary tract infection in nursing home residents.
        J Hosp Med. 2017; 12: 356-368
        • Saint S
        • et al.
        Translating health care–associated urinary tract infection prevention research into practice via the bladder bundle.
        Jt Comm J Qual Patient Saf. 2009; 35: 449-455
        • Araujo da Silva AR
        • et al.
        Interventions to prevent urinary catheter–associated infections in children and neonates: a systematic review.
        J Pediatr Urol. 2018; 14: 556.e1-556.e9
      7. International Society for Infectious Diseases. Guide to Infection Control in the Hospital: Chapter 16: Bundles in Infection Prevention and Safety. Wasserman S, Messina A. (Updated: Feb 2018.) Accessed Jun 6 2021.

      8. US Department of Health and Human Services, Office of Disease Prevention and Health Promotion. 6 Test Your Site with Users with Limited Literacy Skills: 6.4 Test Whether Your Content Is Understandable and Actionable. (Updated: Jun 8, 2016.) Accessed Jun 6, 2021.

        • Fok CCT
        • Henry D
        • Allen J.
        Research designs for intervention research with small samples II: stepped wedge and interrupted time-series designs.
        Prev Sci. 2015; 16: 967-977