Introduction
The primary focus of this study is to assess the effectiveness of a simple reminder system to aid clinicians and nurses in remembering that a patient has a urinary catheter can decrease the duration of time that a patient is catheterised and successfully reduce the rates of CAUTIs. The study was completed by a team medical doctors and registered nurses with the aim of confirming the efficacy of this simple reminder intervention. Both the title and the abstract of the article give the reviewer a clear idea of the purpose and intent of the study.
Purpose of the study
The purpose of this study was to assess whether, if simple interventions were used properly they will reduce the number of catheter associated urinary tract infections. The researchers found that there were a lot of catheter associated urinary tract infections; particularly in the duration of indwelling catheterization was a factor. The researchers found many hospitals in the United States did not monitor the duration of catheter use. Nor were the physicians aware of patients who were catheterised for some duration.
The research also notes that there was a cost factor involved with lengthy duration of indwelling catheters.

Method - Design and Data collection
The study follows a quantitative analysis, using a controlled trial method. A pre intervention and post intervention study was conducted and the data was collected over three time periods. The Pre intervention commenced September 2008 followed by three months post intervention December 2008 and then again in March 2009 was the second post intervention period. The research was conducted in a 473 bed hospital. It included patients from a variety of units. The research was conducted on urethral catheterised patients who had been admitted for at least 48 hours. The researchers considered at least eight factors for data collection of patients with indwelling catheters, these factors were, age, gender, principle diagnosis, presence of diabetes mellitus, duration of catheter and presences or absence of catheter associated urinary tract infections. A total of 400 patients were used during the 3 study periods, which was sufficient for the research design. It is also noted that population base was taken hospital wide. The design of the research was centred on a reminder sticker for the physicians to check for inappropriate catheters and one infection control nurse was assigned to each unit to monitor one day a week during the pre-invention and post invention periods. The researchers indicate that all investigations strictly followed explicit criteria.
Data Collection
The research shows that urine culture results were collected and then analysed by the lab. A statistical analysis was conducted also of these results. This analysis was done because it was what the researchers were looking for with the study question will proper catheter management reduce frequencies of CAUTIs.
Results
The results in the research are clearly presented under a section headed results. It entails a detailed summary. The results are also presented clearly in tables. A simple method of using a sticker on patient charts and an allocated infection control nurse proved to be effective. It was found within the first three months that the inappropriate use of catheters decreased as did also the number of catheter associated urinary tract infections. Again after 6 months the research confirmed further success rates with reduced catheter associated urinary tract infections. The research also stated that the overall outcomes were significantly positive that on-going use of the sticker reminder system continues.
Discussion
The study found this simple intervention to be highly effective. The infection quality control improvement initiative clearly demonstrated a positive impact of this intervention regarding the use of indwelling catheters and more importantly the risk factors of catheter associated urinary tract infections. The study also highlighted positive and practical aspects of the intervention, such as the reminder sticker being very practical, minimal costs to the hospital budgets; this is due to the product being an inexpensive item. Other literature reported on in this study states that the hospital wide use of a computerised based catheterization order system (CPOE) to remind physicians to remove unnecessary catheters has proven a slow implementation. The study suggests a major contributing factor to this is that fewer than 80% of physicians do not enter their orders electronically. The study goes on to propose a non-computerised intervention could be introduced relatively easy. The study goes on to further suggest the use of a non-computerised intervention could be used in other hospitals where a CPOE system has not been entirely adopted.
The study recognises that CAUTI rates appear lower in their institution compared to those rates reported in tertiary hospitals the rational around may be explained by the greater complexity of illnesses that patients present in tertiary hospitals, therefore the rates in catheterization of these patients are more likely. However the study did show an increase in CAUTI rates at the end of the six month period. There was a small variation in the rate from December 2008 to March 2009, however did not reach statistical significance (2.08 vs 2.72; P=79). The study suggests that by this time some of the participants had become tired of following the protocol.

Limitations
The researchers indicate that limitation was noted as there being a possible bias because it was a un blinded study. But an investigative criterion was strictly followed, thus reducing the possibility of a bias.
Also although there were few cardiac patients, the researchers did not think this was significant enough to alter the findings in anyway.