The Norwegian Patient Safety Campaign
Intervention and measurement document
Healthcare associated urinary tract infections
The Norwegian Patient Safety Campaign
The Norwegian Patient Safety Campaign “In safe hands” are working to improve patient safety and
provides both organizational and safe clinical practices, and tools to reduce patient harm.
Goals and Objectives
The overall goal of In Safe Hands is to improve patient safety in Norway. To reach this goal the campaign
has defined three objectives:
1. Reduce preventable patient harm with 20 % by the end of 2013, and by 50 % within five years.
2. Establish lasting structures, such as competence and routines for patient safety
3. Improve the patient safety culture in health and care services
Target Areas
A group of health care experts has identified several target areas where the potential for clinical
improvements is significant and possible interventions are proven effective. The target areas are:
• Safe surgery, with a particular focus on post-operative infections
• Medication reconciliation
• Drug review in nursing homes
• Stroke treatment
• Pressure ulcer prevention
• Urinary tract infection prevention
• Central line infection prevention
• Suicide and overdose prevention
• Fall prevention
Because patient safety is a management responsibility, the campaign also promotes relevant leadership
interventions.
All healthcare thrusts are expected to implement all campaign interventions within the campaign period
(2011 - 2013).
Primary healthcare is invited to implement all relevant interventions. The campaign steering group has
set the overall aim that 25 % of all municipalities will be involved in one or several of the campaign
interventions within the end of 2013.
More about the campaign can be found on the website: www.pasientsikkerhetskampanjen.no
Health care associated urinary tract infections
The “intervention-package” and the measurements from Patient Safe Sygehus (Denmark) were
translated and sent for consultation to all hospitals and municipalities. Pilot projects at Health Førde and
Aurland Nursing home have tested, evaluated and further adjusted the interventions and
measurements resulting in the present document.
Aim: The objective is to reduce the number of healthcare associated urinary tract infections (HAI-UTI) by
preventing unnecessary use of bladder catheters.
Background: Patients with bladder catheters have an increased risk of acquiring a urinary tract infection.
The longer the catheter is used, the greater the risk of infection (1, 2). Approximately 80% of HAI - UTIs
in hospitals are catheter related, and reduced use of urinary catheters is the most important preventive
measure to reduce the incidence of HAI-UTI (2-4). Studies show that up to 50% of catheters admissions
have no clear indications, that physicians might be unaware of the patient’s catheter or add how long it
has been in use (2, 5).
Definitions and procedures:
Bladder Catheter: In this context the bladder catheters considered is only permanent use (à demeure).
Health care-associated urinary tract infection: A healthcare associated urinary tract infection (HAI-UTI) is
defined as a urinary tract infection for signs / symptoms observed after 48 hours of admission to nursing
homes / hospitals and physician makes a diagnosis and initiate appropriate treatment. UTIs that occur
after insertion of bladder catheters in hospitals should be defined as an HAI UTIs even if the patient has
been less than 48 hours in the hospital / nursing home.
Procedures for admission, care of, sampling and withdrawal of the catheter: Check local guidelines.
The National Institute of Public Health (FHI) will soon (probably January 2013) publish a Guideline for
prevention of urinary tract infections in hospitals which include these elements.
Indication of bladder catheter: Suggestions and examples relative to adequate indication of the use of
permanent bladder catheter can be obtained from FHIs Guideline for prevention of urinary tract
infections.
Interventions
Intervention 1
Ensure catheter placed based on appropriate indication
• Physician must prescribe insertion of catheter
• Nurse / physician must document the date and indication for insertion and withdrawal of the catheter.
This applies to all catheters
Intervention 2
Consider daily needs for all catheter
Intervention 3
Systematic training in local guidelines regarding bladder catheter for relevant health professionals. Mini
Audits can be used to identified processes where knowledge is lacking, and be used for further learning.
Measurements
Result indicator 1: Number of new health care associated urinary tract infections per 100 catheter days
Description: Number of new health care associated urinary tract infections per 100 catheter days per
month.

Number of new health care associated urinary tract infections per month/Number of catheter
days per month
The data will be entered into the Extranet once every month. Extranet automatically multiplies by 100.
The data will also be analyzed as days between urinary tract infections in the Extranet.
Process Indicator 1: Proportion of patients with appropriate and relevant needs for bladder catheter.
Description: Proportion of patients with appropriate and relevant needs for bladder catheter.
Requirements must be documented. With appropriate means, that at the time of measurement is still a
need for bladder catheter.

Number of patients with bladder catheter that has appropriate and relevant needs for bladder
catheter/ Number of patients with bladder catheter
The data will be entered into the Extranet once a week.
Appendixes available in Norwegian:
Appendix 1: Registration for current and relevant needs of bladder catheter and HAI-UTI.
Appendix 2: Form fro KAD-round
Appendix 3: Questions for MiniAudit
References:
1. Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA, Healthcare Infection Control
Practices advisory Committee (HICPAC). Guideline for prevention of catheter-associated
urinary tract infections 2009. HICPAC, 2009
2. Hooton TM, Bradley SF, Cardenas DD et al. Diagnosis, prevention, and treatment of
catheter-associated urinary tract infection in adults: 2009 International Clinical Practice
Guidelines from the Infectious Diseases Society of America. Clin Infect Dis
2010;50(5):625-663.
3. Lo E, Nicolle L, Classen D et al. Strategies to prevent catheter-associated urinary tract
infections in acute care hospitals. Infect Control Hosp Epidemiol 2008;29 Suppl 1:S41S50.
4. Tenke P, Kovacs B, Bjerklund Johansen TE, Matsumoto T, Tambyah PA, Naber KG.
European and Asian guidelines on management and prevention of catheter-associated
urinary tract infections. Int J Antimicrob Agents 2008;31 Suppl 1:S68-S78.
5. Chenowth CE, Saint S. Urinary Tract Infections. In: Jarvis WR, editor. Bennett and
Brachman's Hospital Infections. Lippincott Williams and Wilkins; 2007:507-516.
6. http://www.fhi.no/eway/default.aspx?pid=233&trg=MainArea_5661&MainArea_5661=
5631:0:15,3421:1:0:0:::0:0