Community Acquired Urinary Tract Infection

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).

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

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

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 first step nurses can take to decrease the incidents of CAUTIs in older adults is avoiding unnecessary use of catheters altogether. Initially, this begins with nurses knowing both appropriate and inappropriate situations in which a catheter should be utilized. According to (Gould et al., 2017), an appropriate situation is one where a patient has acute urinary retention or bladder obstruction, whereas an inappropriate situation is one where a catheter is being used a means of obtaining urine for culture when the patient can voluntarily void. Nurses can also use basic techniques like palpation, percussion, and inspection to effectively assess urinary retention, which is the main reason for catheterization as mentioned earlier. When techniques like this do not achieve desired results,

The three questions addressed were: Who should receive urinary catheters, what are the best practices for those who require urinary catheters and for preventing CAUTI’s acquired from urinary obstruction. This updated guideline offers recommendations for the appropriate use of indwelling catheters utilizing appropriate indications for usage, proper techniques for insertion of indwelling catheters, proper techniques for indwelling catheter maintenance, quality improvement programs, administrative infrastructure and surveillance including identifying those at risk for CAUTI (Gould et al, 2009). The strengths of this guideline are that many questions and scenarios are examined in this document and answered in explicit detail. Any healthcare professional can refer to the document to answer most practice based questions that are posed to them regarding indwelling urinary catheters. One weakness identified is the lack of an alternative explored for the external catheterization for female patients, for example the Purewick solution. However, the Purewick was not released until January 2016 and this guideline was last updated in 2009. Integrative Review

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

(2014) article “Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: An integrative review,” was published in the British Medical Journal Quality Safety. Meddings et al. (2014) conducted a systemic review and a meta-analysis in a hospital setting. Also, Meddings et al. (2014) report CAUTIs was reduced by 53%. The authors conclude UC reminders and stop orders appear to reduce UC use and CAUTIs.

Your morbidity and mortality rate increase 2.8-fold when acquiring a CAUTI, and can add up to $1000 direct cost to your bill in the acute care setting. Medicare beneficiaries with CAUTI have a higher median Medicare reimbursement of $1500 in the acute care setting, and up to $8500 in the ICU setting, not to mention increasing your length of stay in the ICU an extra 8 days ("Catheter Associated Urinary Tract," 2011).

The next step will focus on educating the unit’s staff. Employees that place an indwelling catheter will be required to go through a refresher course on proper insertion technique, indications for catheterization, and catheter care. Additionally, there will be a class on the new flow sheet created to track indwelling catheters (Andreessen et al., 2012). Posters with information pertaining to catheter care, CAUTI prevention, the new charting system, and alternative bladder management systems will be placed in highly visible areas such as break

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,

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

A Urinary tract infection (UTI) including the bladder and kidneys, is an infection that encompasses the entire urinary system. The kidneys and bladder filter the blood to make Urine. A urinary catheter is a thin tube placed in the bladder to drain urine. Urine drains through the tube into a bag where the urine collects. When the whole system is compromised, a patient can become very ill. A catheter provides a link between the outside environment and a usually sterile system. Now that the catheter is in place, microorganisms are no longer removed by normal voiding. Germs do not usually live in the region of the urinary system, but when they are re-introduced through the absence of voiding, infection becomes a problem. A urinary catheter may be used when you cannot urinate on your own, to measure the amount of urine you produce, during and after certain types of surgery and during testing of the urinary system. Health care associated infections(HAIs) are an on-going issue, specifically the prevention of catheter-associated urinary tract infections (CAUTIs). Simply put, those with catheters have a higher chance of obtaining a CAUTI than patients who do not.

A urinary tract infection (UTI) is an infection involving any part of the urinary system, which includes the urethra, bladder, ureters, and kidneys. UTIs are the most common type of healthcare-associated infection (HAI). Between 15-25% of hospitalized patients receive urinary catheters during their hospital stay (Drekonja, 2010, p. 31). A urinary catheter is a drainage tube that is inserted into the bladder through the urethra. A catheter-associated urinary tract infection (CAUTI) occurs when bacteria enters the urinary tract through the catheter and causes infection. Common signs of UTIs are urgency, frequency and dysuria. These voiding symptoms will not be present in patients with indwelling catheters. Symptoms that may help classifying a CAUTI would be fever or hypothermia, suprapubic tenderness, or costovertebral angle pain or tenderness (Tillekeratne, 2014, p. 13). Catheter-associated urinary tract infections cause increased healthcare costs, length of stay, morbidity, and mortality. Infections can be acquired in many ways such as, on insertion of the catheter via cross contamination or accidental catheterization into the vagina, not ensuring aseptic technique, catheter care and maintenance, and cross-contamination when emptying the drainage bags. There are many ways to decrease the risk of catheter-associated UTIs and nurses play a major role in reducing these risks in order to prevent harm and save lives. To improve clinical care and reduce the risks of

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