The process of embedding CAUTI care bundles in NHS Scotland

Introduction
Catheter-associated urinary tract infections (CAUTIs) are the most prevalent healthcare-associated infection globally and are one of the most common infections experienced in hospitals (Tambyah et al, 2012). The Scottish Patient Safety Programme developed a CAUTI care bundle to tackle the problem of CAUTI and assist with its reduction in Scotland. As a recent innovation in patient safety, there is much we can learn from the implementation, embedding and normalising of CAUTI care bundles in everyday practice.

Methods
Normalisation process theory (NPT) (May et al, 2009) has been used to study the implementation of complex healthcare interventions in a variety of healthcare areas. Using qualitative methodology, semi-structured interviews were conducted with 26 clinical leaders responsible for implementation, from 15 NHS Boards using NPT as a guiding framework. Framework analysis methods were applied to explore how clinical leaders make sense of the work of implementing the CAUTI care bundle (coherence); how they engage with it (cognitive participation); enact it (collective action) and appraise its effects (reflexive monitoring).

Results
Clinical leaders perceived the CAUTI care bundle approach to be a different way of working in comparison to previous urinary catheter management practices. There was general agreement that CAUTI care bundles met the needs of patients, staff and the organisation. A common challenge to implementation has been lack of consensus on the definition of CAUTI. Data illustrated that organisational support, staff education, awareness and stakeholder “buy-in” were paramount for success.

Discussion
This paper will present findings illustrating key barriers and enablers to the introduction of CAUTI care bundles from the perspective of clinical leaders responsible for implementation.

Declaration of interest
I do not have any conflict of interests to declare.