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Background: Urinary catheter nurse-driven protocols (UCNDPs) for removal of indwelling urinary catheters (IUCs) can potentially prevent catheter-associated urinary tract infections (CAUTIs). However, they are used inconsistently. The objective of this study was to examine the barriers to and facilitators of implementation of UCNDPs in acute care hospitals., Methods: Between September 2017 and January 2019, researchers interviewed 449 frontline staff (nurses, physicians), managers, and executives from 17 US hospitals to better understand their experiences implementing, using, and overseeing use of UCNDPs. Our semistructured interview guide included questions about management practices and policies regarding enactment of a UCNDP., Results: Although the features of UCNDPs differed across hospitals, the analysis revealed that hospitals experienced common issues related to implementing and consistently using UCNDPs as a result of three major barriers: (1) nurse deference to physicians, (2) physician push-back, and (3) miscommunication about IUC removal. Interviewees also described several important facilitators to help overcome these barriers: (1) training care team members to use the UCNDP, (2) discussing IUC necessity and UCNDP use during rounds, (3) reminding care team members to follow UCNDPs, and (4) developing buy-in for UCNDP use across the hospital., Conclusion: Although UCNDPs are fundamental in efforts to reduce and prevent CAUTIs, hospitals can proactively support their implementation and use by developing the skills that care team members need to enact UCNDPs when patients meet the clinical indications for removal, and increasing awareness about the value and importance of such protocols for reducing CAUTIs and improving patient safety., (Copyright © 2020 The Joint Commission. Published by Elsevier Inc. All rights reserved.)

Previous studies using knockout mice document a key role for the integrin CD103 in promoting organ allograft rejection and graft-versus-host disease. However, a determination of whether blockade of the CD103 pathway represents a viable therapeutic strategy for intervention in these processes has proven problematic due to the lack of reagents that efficiently deplete CD103+ cells from wild type hosts. To circumvent this problem, we conjugated the nondepleting anti-CD103 monoclonal antibody, M290, to the toxin, saporin, to produce an immunotoxin (M290-SAP) that efficiently depletes CD103+ cells in vivo. Herein, we show that M290-SAP dramatically reduces the frequency and absolute numbers of CD103-expressing leukocytes in the blood, spleen, mesenteric lymph nodes and intestinal epithelium of treated mice. We further demonstrate that M290-SAP promotes indefinite islet allograft survival in a fully MHC mismatched mouse model. The prolonged islet allograft survival resulting from M290-SAP treatment was associated with multiple effects in the host immune system including not only depletion of CD103-expressing leukocytes, but also an increase in CD4+CD25+FoxP3+ T regulatory cells and a predominance of effector-memory CD8 T cells. Regardless of the underlying mechanisms, these data document that depletion of CD103-expressing cells represents a viable strategy for therapeutic intervention in allograft rejection.