Patient engagement to counter catheter-associated urinary tract infections with an app (PECCA): a multicentre, prospective, interrupted time-series and before-and-after study

Background: The risk of urinary tract infections (UTIs) is increased by unnecessary placement and prolonged use of urinary catheters. Aim: To assess whether inappropriate use of catheters and catheter -associated UTI were reduced through patient participation. Methods: In this multicentre, interrupted time -series and before -and -after study, we implemented a patient -centred app which provides catheter advice for patients, together with clinical lessons, feedback via e -mails and support rounds for staff members. Data on catheter use and infections were collected during a six-month baseline and a six-month intervention period on 13 wards in four hospitals in the Netherlands. Dutch Trial Register: NL7178. Findings: Between June 25 th , 2018 and August 1 st , 2019, 6556 patients were included in 24 point -prevalence surveys, 3285 (50%) at baseline and 3271 (50%) during the intervention. During the intervention 249 app users and a median of seven new app users per week were registered (interquartile range: 5.5-13.0). At baseline, inappropriate catheter use was registered for 175 (21.9%) out of 798 catheters, compared to 55 (7.0%) out of 786 during the intervention. Time -series analysis showed a non -significant decrease of inappropriate use of 5.8% (95% confidence interval: -3.76 to 15.45; P = 0.219), with an odds ratio of 0.27 (0.19-0.37; P < 0.001). Catheter -associated UTI decreased by 3.0% (1.3-4.6; P = 0.001), with odds ratio 0.541 (0.408-0.716; P < 0.001).