Five-year sustainability of a de-implementation strategy to reduce inappropriate use of catheters: a multicentre, mixed-methods study.

BACKGROUND

The use of peripheral intravenous catheters (PIVCs) contributes to healthcare-associated infections. In 2017, we implemented a multifaceted de-implementation strategy that successfully reduced the inappropriate use of catheters in seven hospitals in the Netherlands (RICAT-1 study). Five years later, we investigated the sustainability of this strategy and the contributing factors.

METHODS

Multicentre mixed-methods study (RICAT-2), consisting of an observational study and interviews in five hospitals in the Netherlands from May 2022 to June 2023. We screened adult patients with PIVCs admitted to internal medicine and non-surgical subspecialty wards. We excluded patients admitted for an elective short stay or terminally ill. Primary endpoint was the percentage of inappropriate PIVCs. We used logistic regression analyses to compare RICAT-2 to the RICAT-1 baseline data. We interviewed 18 healthcare professionals and managers involved in RICAT-1 and/or quality management. We combined thematic inductive analysis and framework analysis.

FINDINGS

In RICAT-1 baseline, we included 22.0% (282/1284) inappropriate PIVCs. In RICAT-2, we included 13.8% (154/1113) inappropriate PIVCs (odds ratio 0.76, 95% CI 0.68 to 0.84, p < 0.001). We observed no association between the number of maintained strategy components and the sustained effect. For most hospitals, a small temporary investment in a de-implementation strategy was sufficient to achieve sustained effects. The main facilitator for reducing inappropriate catheters was intrinsic motivation to reduce catheter-associated infections. Main barriers were other priorities, lack of time, and not having a dedicated clinical champion.

INTERPRETATION

Since inappropriate PIVC use was still lower after five years than before the de-implementation strategy, healthcare professionals should be encouraged to adopt this strategy.

FUNDING

This project was funded by The Netherlands Organisation for Health Research and Development (project number: 839205002).