CAUTI Summary

However, there are additional guidelines in terms of assessing the patient for prolonged catheter use. There should be frequent assessment and evaluation of the patient’s need for continued use. It is important to note that in addition to determining the patient’s need for catheterization, prior to insertion the nurse should also complete the following:

For nurses, (P) on 2 South caring for patients with urinary catheters, will education, on the importance and proper use of a nurse -driven indwelling catheter removal protocol (I), change knowledge on the use of the nurse driven protocol, as compared to knowledge before receiving an education, (C), as evidenced by (O), change in knowledge in the use of the nurse -driven indwelling catheter removal protocol, and CAUTI rates as evidenced by, pre and posttest scores and CAUTI audits after three months? The project will utilize a

1) Summary of Article: A review of literature shows the length of time a catheter remains in the body is directly associated with CAUTI.

In 2013, a magnet recognized hospital, Baptist Health Lexington, reduced CAUTI rates in ICU patients by 60% (Roser, Piercy & Altpeter, 2014). The study included six interventions that were followed by the staff in the effort to reduce CAUTI. The six interventions included: “communication of CAUTI data to interdisciplinary teams, a nurse-driven, physician approved protocol, problem analysis using Lean principles, daily unit-based surveillance rounds, silver alloy urinary catheters, and an antimicrobial bundle comprised of two cleansing products for patients with an indwelling urinary catheter” (Roser, Piercy & Altpeter, 2014). The nurse-physician protocol allowed for nurses to assess whether the catheter was still necessary and if found not to be, the nurse could discontinue it. This resulted in a 58% decrease in the number of catheters used (Roser, Piercy & Altpeter, 2014). An education session was implemented by nurses using principles from the Lean system that checked the capability of nurses to understand just how dangerous CAUTI can be. It was found that no single intervention alone could reduce the occurrence of CAUTI development. Nurses must integrate several interventions to have an effective result at lowering the rates. However, this particular study found that after the use of the antimicrobial bundle, rates of CAUTI did decline. Roser et al. (2014) emphasized that education and awareness of

Urinary tract infections are the most common type of healthcare infection, and CAUTI is the 2nd most common cause of nosocomial bloodstream infection in the healthcare setting. ("Catheter Associated Urinary Tract," 2011). The goal of our facility is to reduce CAUTIs by 50% by the end of the year, measured by the quality department on a monthly basis, and implemented through performance improvement factors including the interdisciplinary team through a strong focus on the nursing leadership team.

Also another serious complication of CAUTI is BSI (Blood stream infections) that can be fatal if not caught and treated promptly. “The Clinical Performance of Quality Health Care, along with Joint Commission” offers standards and objectives for facilities to assess measure and improve their standards at the lowest cost possible. The database covers nursing care and education, along with guidelines on prevention. Moreover the JCAHO regulatory standards for catheterized patients are explained and the documentation that is expected when JCAHO inspections are rendered in a facility. The source “Stop orders to reduce inappropriate urinary catheterization in hospitalized patients” states that by following standard precautions with every patient these infections can be prevented. . Also the source explored whether catheters should be used at all in an effort to decrease the incidence of CAUTI’s. Intermittent catheterizations along with supra-pubic were explored with a decreased incidence of bacteria being present in the bladder afterwards. The source “Strategies to prevent catheter-associated urinary tract infections in acute care hospitals” offered ways of cleansing and disinfecting the skin before insertion to reduce the risk of infection. Many CAUTI’s are linked to bacteria harboring in or around the site at insertion. By using not only aseptic technique but also cleansing the skin with chlorhexadine can decrease he incidence of infection

Usage of indwelling urinary catheters in critically ill patients can seem to be a permanent fixture in intensive care units. Most critical care nurse expect their patients to have an indwelling urinary catheter (IUC) in place without much regard to the risk of catheter associated urinary tract infections (CAUTI) or the ability to implement IUC alternatives. Critical care patients may require IUC usage due to diagnosis, need for accurate hourly intake and output measurements, or other specified documented reasons. The risk of acquiring a catheter associated urinary tract infections is a result of IUC usage. The Centers for Disease Control and Prevention’s Guideline for Prevention of Catheter-associated

Until recently it was not uncommon for patients admitted to an acute care facility to have an indwelling catheter anchored for unnecessary reasons. Patients that came in thru the emergency department typically were sent to the units with unnecessary indwelling catheters in place and it was not unusual for a surgery patient to have an indwelling catheter anchored before or during a procedure. Once a patient was admitted and was transported to the units nursing would also anchor indwelling catheters for multiple unnecessary reasons. These Catheters could be

Focus on enhancing quality of care has exaggerated on a nationwide scale. Decreasing preventable damages within the health care settings is being on focus furthermore. From this there has been an immediate connection between repayment to quality through pay-for-reporting and pay-for-execution programs. Around 25% of the hospitalized patients have an indwelling catheter in place (Saint, Kowalski, Forman et al., 2008) and there is a 3% to 7% has the probability to get urinary tract infections in such cases. The infection could cause the signs of bladder distress, trouble in urination, and high temperature in such patients. Analysis shows that 48% of patient who has indwelling catheter complains of pain from the catheter, 42 % experience inconvenience from the catheter and 61% found that their daily activities are exceptionally constrained by these catheters (Saint, Lipsky, Baker, McDonald, & Ossenkop, 1999). Urinary tract infections may prompt bacteremia (infection

Limiting catheter use and, when a catheter is indicated, minimizing the duration the catheter remains in situ are primary strategies for CAUTI prevention.

The leadership team in my organization took a conventional approach in assisting the frontline nurse with CAUTI. Indeed, the infection control department and the educational committee collaborated; an effort to curtail CAUTI, had an audit done amongst the five Emory Healthcare Hospitals, to understand the main reason behind the upsurge CAUTI. The results indicated staffing shortage, increase agency staff usage, nursing misunderstanding related to essential reasons why patients have an indwelling urinary catheter, and nurses’ lack of knowledge related to the indwelling removal protocol. Because of all the aforementioned, the committee established a nurse-focused indwelling catheter removal protocol that is essentially based

A study done in Thailand showed that the longer a catheter is in place was the main factor that increased the incidence of CAUTI (Danchaivijitr, Dhiraputra, Cherdrungsi, Jintanothaitavorn, Srihapol, 2005). The first week of placement showed a 37.6% incidence of infection followed by 27.7% the second week (Danchaivijitr et al., 2005). These statistics reinforce the importance of only placing a catheter when medically necessary. Catheters should only be placed for the length of time absolutely necessary and not a second longer if

Brusch says, “Once a indwelling catheter is placed, the daily incidence of bacteriuria can be between 3-10%.” Another large problem that results CAUTI’s is that at times, catheters are left in a patient longer than necessary. Prolonged use of

As a nurse in an intensive care unit it was noticed there was increase in CAUTIs on the unit, which the unit did also have a large amount of new hires during that time. Therefore, an investigation took place as to why there was in increase into CAUTIs. Thus, data was gathered from the last three months, which the charts of all patients who had a urinary catheter were reviewed. In addition, a research on CAUTIs was completed using the latest information from professional journal articles, government based data, and current unit based CAUTI information from the nursing manager.

There are several quality outcomes I hope to achieve through the implementation of this initiative. The most important outcome is to improve the quality of patient care and minimize hospitalization lengths. The second outcome is to improve the process used in the hospital status post insertion of urinary catheters and to minimize the length of time the catheters remain indwelling in the patient. The third outcome is to decrease the monetary toll that CAUTI takes on the facility by working to prevent the infections from occurring in the first place.