Hospital-wide implementation of a standardized urinary catheter removal and post-removal bladder management bundle and changes in febrile urinary tract infection rates: a single-centre interrupted time-series study

Background Avoiding unnecessary urinary catheterization is a well-established principle of infection prevention and control, but standardizing catheter removal and post-removal bladder management across wards remains difficult. We introduced a hospital-wide standardized workflow that combined indication review, same-day catheter removal, post-void residual assessment, threshold-based actions, and weekly multidisciplinary review. Methods We performed a single-centre interrupted time-series study using monthly aggregated key performance indicator data from May 2024 through October 2025. The primary outcome was febrile urinary tract infection (UTI) during indwelling catheterization per 1,000 catheter-days, based on an institutional surveillance definition. Segmented Poisson regression used log(catheter-days) as an offset and 12-month Fourier terms for seasonality. Results Febrile UTI rates decreased from 15.57 per 1,000 catheter-days before implementation (37/2,377) to 4.44 after implementation (32/7,202). The immediate post-intervention level change was an incidence rate ratio (IRR) of 0.22 (95% confidence interval (CI) 0.06–0.82; P = 0.024). The post-intervention slope change was not clear. Urine culture was performed in 45 of 69 episodes; 25 cultures were reported as positive and 20 as negative. Catheter utilisation did not show a similar sustained decline. Conclusion Hospital-wide standardization of urinary catheter removal and post-removal bladder management was associated with a lower febrile UTI rate. The pattern suggests that workflow standardization may contribute beyond reduced catheter exposure alone, but causal interpretation should remain cautious because of the short pre-intervention period, the institutional outcome definition, and the single-centre single-group design.