Exploring Barriers and Facilitators to the Implementation of Nurse-Driven Catheter-Associated Urinary Tract Infection Prevention Protocols in Intensive Care Units in Saudi Arabia: A Qualitative Study

Background: Catheter-associated urinary tract infection (CAUTI) remains a major healthcare-associated infection, particularly in intensive care units (ICUs). Nurse-driven urinary catheter removal protocols can reduce catheter duration and improve patient safety; however, their implementation remains inconsistent. This study explored barriers and facilitators influencing the implementation of nurse-driven CAUTI prevention protocols in Saudi ICUs. Methods: A qualitative study guided by the Consolidated Framework for Implementation Research was conducted in two tertiary hospitals in Riyadh, Saudi Arabia. A purposive sample of 23 ICU nurses, infection control nurses, and nurse managers participated in semi-structured interviews. Data were analyzed using Braun and Clarke’s thematic analysis approach, supported by NVivo. Results: Two overarching themes emerged. Facilitators included interprofessional communication and shared decision-making, clinical experience, and professional commitment. Barriers included workload and staffing pressures, physician dominance and nurse hesitation, knowledge deficits and poor adherence to guidelines, inconsistent documentation, and reduced awareness of catheter presence. Implementation was influenced by interconnected individual, organizational, and cognitive factors. Conclusions: Implementation of nurse-driven CAUTI prevention protocols is shaped by both enabling and limiting factors. Strengthening interprofessional collaboration, supporting nurse autonomy, improving documentation, and providing ongoing education may enhance protocol uptake and sustainability, ultimately improving patient safety.