Catheter Associated Urinary Tract Analysis

1) Summary of Article: Indwelling catheter use is common, but so are infections associated with them. About 80 percent of all urinary tract infections in hospitals are caused by catheters, and about 20 percent of all hospital infections total are UTIs. Evidence-based practice should be used for insertion, maintenance, and removal. Catheters should not be left in longer than they need to be. Unfortunately, this research shows poor administrative efforts are to blame for

Only when it is absolutely necessary should a catheter be inserted into a patient. Every patient is assessed for the need for a Foley catheter. If the Foley is inserted, assessments are also then done daily to see if the need is still valid. If the reason is not justifiable the catheter must be removed from the patient (Joint Commission releases new NPSG for CAUTI, 2011). Nurses must follow guidelines while inserting indwelling catheters as well. Aseptic technique is critical to maintain during this process. The use of sterile equipment and a sterile procedure helps to reduce the risk of CAUTI. If in any way the catheter becomes contaminated during the process of insertion, the nurse should discard of the entire catheter and start with a new, sterile kit. Proper hand hygiene is very important before and after contact with indwelling catheters to decrease risk of infection. Maintenance of a close drainage is system is also important that way bacteria are not able to get in and cause infection (Revello & Gallo, 2013). Decreasing the number of times Foleys are inserted and how long they stay in for can help reduce the risk of CAUTI since the longer a Foley stays in, the higher the risk of infection becomes. Nurses must keep the catheter line patent, with no kinks to allow urine to flow freely through into the collection bag. When a urine sample must be obtained it must be done in a sterile

National Patient Safety Goals (NPSGs), established in 2002 by the Joint Commission, is to help accredited organizations address specific areas of concern in regard to patient safety ("Catheter-Associated," 2015). NPSG.07.06.01 Implement evidence-based practices to prevent indwelling catheter-associated urinary tract infections (CAUTI) is a 2015 NPSG ("The Joint Commission," 2015). Our facility has 1.32 CAUTIs per 1000 device days (Carson, 2015). Decreasing CAUTIs can be achieved with a strict goal, addressing the financial implications, interdisciplinary collaboration, nursing leadership, a measurement tool, and discussing the future healthcare delivery methods.

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

The PICO question is as follows: In hospitalized patients who are susceptible to catheter associated Urinary Tract infection (CAUTI), if nurses and other assistive personnel develop an action plan with a systematic team approach of evidence-based infection control practices, compared to current practices, could it reduce or eliminate incidences of CAUTI?

Urinary tract infection (UTI) are extremely common healthcare-associated infections, it is estimated that about 6 million American are affected annually. One of the risk factors for developing UTI is associated with indwelling urinary catheter; approximately 80% of UTI are related to the use of indwelling urinary catheter (Lederer, Jarvis, Thomas, & Ritter, 2014). Indwelling urinary catheters are common sources of infection in the urinary tract because they are irritating to the tissue and, when inserted, may be a means of introducing bacteria directly into the bladder if sterile technique is not used

In the course of daily practice, nurses soon realize that many patients will acquire urinary tract infection (UTI) during their stay in hospital. Research and practice have both shown that the main cause of frequent UTI in hospital has been urethral catheter for the patients. Meddings, Reichert, Robers, Saint, Stephansky & McMahon (2012) find that most (59% to 86%) hospital-acquired urinary tract infections (UTIs) are catheter-associated urinary tract infections (CAUTIs) (p. 305). According to Dailly (2011), "approximately 20 per cent of all healthcare-associated infections are urinary tract infections (UTIs), with an estimated 80 per cent of those linked to urethral catheters," (p. 14). "It is estimated that 2 6% of people with catheters will develop a UTI," (Slater, n.d., p. 168).

One of the most common hospital-acquired infections being reported today by hospitals is urinary tract infections (UTIs), UTIs account for up to 40% of the infections reported by hospitals (Elpern, 2016). One of the most common reasons for hospital-acquired UTIs has been associated with the use of indwelling urinary catheters, these infections are known as catheter-associated urinary tract infections (CAUTIs). CUATIs have been shown to increase healthcare cost, increase in morbidity and mortality and are one of the most preventable complications that can arise from hospitalization (Elpern, 2016). The purpose of this paper is to explore hospital acquired infections and common problems and complications

Greene (2015) conducted a surveillance study on a 30-bed medical/surgical/neurological intensive care unit at Northwestern Hospital in Minneapolis, MN. A comprehensive approach to decrease catheter associated urinary tract infections (CA-UTIs) and to sustain CA-UTI rates below the National Healthcare Safety Network (NHSN) benchmark was implemented. 29 CA-UTI cases from April 2013 to March 2014 were reviewed in depth to define trends (Greene, 2015). The attitudes of nurses and doctors towards indwelling urinary catheters were assessed per surveys and aseptic technique for foley catheterization was assessed to define gaps. The CA-UTI cases reviewed indicated that 66% were from indwelling urethral catheters placed on the units, 39% occurred

The authors studied multiple articles and used a total of 20 articles to validate their results concerning CAUTIs. The author studied how urinary catheter placement was one of the biggest reasons of hospital-acquired infections today. The authors also studied current percentages of catheters placed where no need of one is indicated. They also studies education regarding compliance, appropriate uses, nurse derived initiatives and overall prevention of infections. The citing of references were properly placed and had a sufficient reference page. Majority of the articles were up to date. Fifteen of the twenty articles were written since 2010 and nine in the past three

Urinary catheterizations are both invasive and traumatic to the pediatric patient and increase the risk of acquiring an infection. The automatic catheterization of children with suspected urinary tract infection is often unnecessary, as evidenced by the Children's Hospital of Philadelphia, which reported "of 63% of febrile children screened for
UTI by urethral catheterization; screens were positive in only a
small percentage of cases, with cultures positive in only 4.3%" (Lavelle et al., 2016). Thus, a disconnect occurs in the actual necessity for the catheterization process. A less invasive technique, as proposed by Lavelle et al.’s employment of the urinary bag to retrieve urine samples prior to catheterization, provides an opportunity for new protocol in ED screening that does not increase treatment time, and does not compromise correct detection of UTI

There have been extensive technological advancements in the healthcare field, one of them being the indwelling urinary catheter. The use of indwelling urinary catheters in the hospital setting has proven to be an effective way of treating certain urinary problems, when necessary. For example, when a patient is in pain because his or her bladder is distended due to urinary retention, or when a patient is post-op and unable to void. However, the use of indwelling catheters is not always free of consequence. Healthcare providers must consider the risks and benefits of catheter insertion, as indwelling catheters pose a risk of urinary tract infection from the moment they enter the patient. The American Nurses Association used evidence-based practice to develop the CAUTI Prevention Tool, which has been effective in reducing the incidence of catheter-associated urinary tract infections in hospitals.

It is very important for the researcher to control the extraneous variable that could affect the study results. The extraneous variables that would affect the results in this study include, the catheter material, the catheter care, and the method of obtaining the urine sample. To control the catheter material, this study will be using the antimicrobial and antiseptic-impregnated catheters instead of the standard catheters as recommended by the Centers for Disease Control and Prevention (CDC) 2009 guidelines because they are effective in reducing the risk of CAUTIs. To control the catheter care, the study will follow the CDC guidelines for routine catheter care by ensuring that all the indwelling urinary catheters (IUC) maintain a sealed drainage system, and an unobstructed urine flow. In addition, the nursing staff will be cleansing the meatal area daily with warm soapy water instead of antiseptics, while maintaining the standard precautions including hand hygiene and wearing of gloves while performing peri-urethral care. To control the procedure for obtaining urine sample, the study will use the CDC recommendation for collecting the urine sample aseptically, by aspirating the urine from the sampling port with a sterile syringe after thoroughly cleansing the port with an antiseptic wipe (Gould et al., n.d.).

Foley catheter insertion is a sterile procedure used for multiple reasons in the hospital. The CDC has a list of appropriate indications for placement of an indwelling catheter. The catheter which is a thin sterile tube placed into the urinary bladder through the urethra. It is important to remain sterile throughout the insertion process to help prevent a catheter associated urinary tract infection (CAUTI), which are the most common type of healthcare-associated infection (HAI). Due to Foley insertion being an invasive technique it can only be performed by a trained and licensed personnel. There must be a doctor’s order indicating the need of a catheter insertion. Foleys are available in different sizes so it is important to pick the smallest

The Quality Improvement nursing process that I have chosen to research is patient safety. I have chosen to focus specifically on the topic of catheter associated urinary tract infections (CAUTI’s) during hospitalization and their preventions. It is estimated that 15-25% of hospitalized patients receive a urinary catheter throughout their stay, whether or not they need it. A large 80% of all patients diagnosed with a urinary tract infection (UTI) can be attributed to a catheter (Bernard, Hunter, and Moore, 2012). The bacteria may gain entry into the bladder during insertion of the catheter, during manipulation of the catheter or drainage system, around the catheter, and after removal.