Continuous Quality Improvement In Nursing

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).

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.

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

Joint Commission released national patient safety goals for hospitals in January of 2016. These patient safety goals were “established to help accredited organizations address specific areas of concern in regards to patient safety” (Facts about the National Patient Safety Goals, 2015). National patient safety goal 07.06.01 focuses on the prevention of catheter associated urinary tract infections (CAUTI) in hospitalized patients. Evidence based practice should be implemented to stop these common infections occurring in patients nationwide. Indwelling urinary catheters are only recommended in certain patients, for example to prevent further breakdown of sacral wounds or pressure ulcers in incontinent patients, for comfort in end of life care

Urinary tract infections are one of the most hospital-acquired infections in the country. With so much technology and evidence based practice, why is this still an ongoing problem worldwide? Could it simply be the basics of hygiene or just patient negligence? The purpose of this paper is to identify multiple studies that have been done to reduce or prevent hospital associated urinary tract infections. In these articles you will find the use of different interventions that will aid in lowering the risk of these hospital acquired infections.

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,

A nurse-driven protocol is the recommended tool to be used by the nurse to remove catheters without orders following set CDC guidelines and prevent CAUTI

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.

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

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

Educate healthcare personnel involved in the insertion, care and maintenance of urinary catheters about CAUTI prevention, including alternatives to indwelling catheters and procedures for catheter insertion, management, and removal.

Chen et al. (2013) article “Using a criteria-based reminder to reduce use of indwelling urinary catheters and decrease urinary tract infections” was published in the American Journal of Critical Care. Chen et al. (2013) conducted a randomized control trail in a medical center with 278 patients who had indwelling urinary catheters (IUCs) in place for more than 2 days. In 2013, Chen et al. reminder intervention reduced the incidence of CAUTIs by 48%. The authors’ findings show using reminder criteria in removing IUCs could reduce the need for UCs and decrease the chances of CAUTIs.

Catheter-associated urinary tract infection (CAUTI) is a fairly common complication in hospitalized patients. Nosocomial infection prevention and patient safety promotion has been issued and many researches have been conducted to improve patient’s quality of life. In this article, Saint et al. (2005) hypothesize that using a paper-based urinary catheter reminder can reduce the incidence of urinary catheterization, and consequently this will enhance the patients’ safety.

The overuse or misuse of indwelling urinary catheters (IUC) is a concern in the emergency department (ED) despite the well-known risks and complications. Although the medically indicated guidelines for use are specific, professionals often ignore the guidelines and insert an IUC without applying evidence-based practice strategies to manage urinary output.