• Sarah L Krein, Christine P Kowalski, Molly Harrod, Jane Forman, and Sanjay Saint.
• Center for Clinical Management Research, Veterans Affairs Health Services Research & Development (Stop Code 152), Veterans Affairs Ann Arbor Healthcare System, PO Box 130170, Ann Arbor, MI 48113, USA. sarah.krein@va.gov
• JAMA Intern Med. 2013 May 27;173(10):881-6.

ImportancePreventing catheter-associated urinary tract infection (CAUTI), a common health care-associated infection, is important for improving the care of hospitalized patients and in meeting the goals for reduction of health care-associated infections set by the US Department of Health and Human Services.ObjectiveTo identify ways to enhance CAUTI prevention efforts based on the experiences of hospitals participating in the Michigan Health and Hospital Association Keystone Center for Patient Safety statewide program to reduce unnecessary use of urinary catheters (the Bladder Bundle).DesignQualitative assessment of data collected through semistructured telephone interviews with key informants at 12 hospitals and in-person interviews and site visits at 3 of the 12 hospitals. The analysis focused on perceptions and key issues identified by hospitals as influencing implementation of CAUTI prevention practices as recommended by the Bladder Bundle initiative.SettingTwelve purposefully sampled hospitals in Michigan.ParticipantsKey informants including infection preventionists, clinical personnel, and senior executives.ResultsCommon barriers to Bladder Bundle implementation and appropriate urinary catheter use included (1) difficulty with nurse and physician engagement, (2) patient and family request for indwelling catheters, and (3) catheter insertion practices and customs in the emergency department. Strategies to address these barriers were also identified by several of the participating hospitals, including (1) incorporating urinary management (eg, planned toileting) as part of other patient safety programs, such as a fall reduction program, (2) explicitly discussing the risks of indwelling urinary catheters with patients and families, and (3) engaging with emergency department nurses and physicians to implement a process that ensures that appropriate indications for catheter use are followed.Conclusions And RelevanceThe Bladder Bundle program provides a model for implementing strategies to reduce CAUTI. These findings provide actionable information to inform CAUTI prevention-related activities in hospitals throughout the country.

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