Community Acquired Urinary Tract Infection

Nurses lacked knowledge in the use and was unaware of the importance of the underlying evidence- base recommended criteria’s indicated on the nurse driven protocol to remove inappropriate UC’s. A nurse driven indwelling catheter removal protocol is an evidence base tool recommended by infection control organization and experts for the early removal of unnecessary or inappropriately placed urinary catheters (UC). Evidence shows that urinary catheters are the source of catheter associated urinary tract infection (CAUTI). CAUTI, is the leading cause of hospital acquired infections in the United States. The purpose of this evidence-based quality project is to evaluate the effectiveness of an educational intervention on the importance and use of the nurse driven protocol on nurses ' knowledge and CAUTI rates.

Accessible multidisciplinary services including assessment (urodynamics investigation where appropriate), diagnosis and management for people with urinary incontinence and other bladder dysfunctions.

According to the Centers for Disease Control and Prevention [CDC] (2017), “Urinary tract infections (UTIs) are the fourth most common type of healthcare-associated infection, with an estimated 93,300 UTIs in acute care hospitals in 2011. UTIs additionally account for more than 12% of infections reported by acute care hospitals. Virtually all healthcare-associated UTIs are caused by instrumentation of the urinary tract” (p. 7-1).

PadScan HD5 bladder volume scanner is a non-invasive, portable ultrasound imaging device that gives real time 3-dimensional ultrasound image of the bladder and measures the volume of urine held inside the bladder. The urine held inside the bladder provides an ideal environment for microscopic organisms and pathogens, which can lead to urinary tract contaminations, prompting harm of the renal structures, painful urination, and pyelonephritis (inflammation of kidney tissues due to bacterial infection in urinary tract). HD5 Bladder scanner uses ultrasound waves to calculate the fluid volume in the bladder. It is generally used in intensive care units, long-term care, rehabilitation centers, hospitals and GP surgeries. The utilization of HD2 bladder

The indwelling urinary catheter can be inserted for a long period with frequent changes between 4-6 weeks (Taylor, Lillis, LeMone, & Lynn, 2011). However, the Foley can also be a potential source for UTI and bacteriuria (Taylor et al., 2011). The necessity of reducing the patient’s period of time on a Foley and helping him or her to quickly regain normal bladder function is significant. Performing bladder training through clamping the urinary catheter is reported to decrease the frequency of urinary retention, shorten the period of returning to normal bladder function, and stimulate normal bladder filling and emptying by improving bladder tone and sensation (Nyman, 2012). When one thinks critically, bladder retraining seems to be reasonable and necessary but there is always the need of evidence-based evaluation. The following journals are trials providing evidences and statistics about bladder retraining prior to Foley removal in different populations presented with urinary retention problem.

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

First, neurological disorders can occur, as seen with Alzheimer’s disease and Parkinson’s disease, which can lead to neurogenic bladder (“Neurology/Neurogenic Bladder,” 2017). Next, physiological disorders can occur as seen with enlarged prostate in men or shortening of the urethra in women (Jaipaul, 2017). Anticipating the above changes appropriately will aid in understanding what leads to urinary retention in older adults, the resulting need of catheterizations, and the CAUTIs that can follow. Having a foundation to build on, it would be beneficial to explore what nurses can do prevent urinary tract infections in patients who require catheterization.

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.

According to the evidence based research done by Overton Brooks VA Medical Center “implement a bladder retraining trial in compliance with the NPSG to prevent CAUTIs. The goal was to decrease infection risk by decreasing the length of time catheters were in use and reinsertions. Decreasing reinsertion rates not only reduces infection risk but also decreases post-op length of stay, saving money and resources.” (Shreveport, 2013).The way I would share with my employment would be to have in service education for all staffs and share the information about normal bladder function. Also instruct nurses to teach patients to have voiding schedule that incorporates regular delay of voiding by using interruption and relaxation techniques, self-monitoring,

National Patient Safety Goals (NPSGs) were established in 2002 by the Joint Commission 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 our 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.

The patient and their families must be aware of the infection, the source of infection, signs and symptoms, treatments, and measures to apply at home to decrease their risk of receiving an infection. Because geriatric patients are incontinent they may need a catheter in place to help remove their urine. Nurses must perform aseptic technique, wearing proper gloves when inserting or removing device. Another way to help reduce the risk of elderly urinary tract infections would be to avoid or remove catheter soon as possible. Once patients are cleared for discharge they must be aware of the steps to take to insure proper bladder

The team will oversee the evidence-based practice aspects of CAUTI prevention and will be set up using aspects of the guidelines established by Andreessen et al. (2012). Several different types of nurses will be recruited to assist including infection control (for evidence-based practice guidance), nurse educators (to help set up the education program), and staff nurses (to advise from staff’s point of view) (Andreessen et al., 2012). Leadership including, nurse managers, clinical nurse leaders, and the medical director, will assist with implementation. The team consisting of resource type individuals such as urologists, will guide evidence-based practices and information technology will assist to set up flow chart and tracking processes (Andreessen et al., 2012).

Presented by BMJ Quality and Safety, Meddings et al (2013) sought to review interventions to reduce unnecessary catheter usage and prevent catheter-associated urinary tract infections. The review panel consisted of six individuals all listed as authors on this integrative review who utilized two

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

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?