Literature Review of Articles on Catheter-Associated 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.

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

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,

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.

After an initial search of scholarly databases, a total of fifteen articles was selected for their application to the PICO question. An appraisal of each article uses the following format:

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

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

(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.

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.

For patients that have indwelling catheters, with the evidence-based practice and standards of care, UTI’s does still continue to be an ongoing problem today. In one of the large hospitals in my area had recently developed a poster and video approach with special focus on alternatives to urinary catheterization, removing catheters early, and the reinforcement of sterile technique prior insertion and foley catheter care were used to educate nursing staff and improve outcomes. The purpose of this paper is to educate nursing on

This literature review essay will demonstrate a review of four different research articles and research related methodology The articles and review are based on the prevention of Catheter-associated Urinary Tract Infection (UTI). The aim of this literature review is to review publications concerning the management of Catheter-related to UTI 's including the prevention. Articles reviewed include the various precaution and preventions concerning Catheter-associated urinary tract infection (CAUTI) The article evidence summarized bellow was generated using a literature search conducted for Randomised Controlled Trials, Systemic Review or quantitative and qualitative research.

site every couple of days lessens the associated risks of the catheter. One study, as reported by MEDSURG Nursing (2016), placed 755 patients into two groups. One group was the control which had the routine rotation every 72 hours. The other group was the experimental group that only had their I.V. changed when clinically indicated. Both groups had similar results. The control group has 60 per 1,000 device days, compared to the test groups 61 per 1,000 device days. This outcome shows that there is no statistic significance between either group (p. 45). The evidence stated by Worldviews on Evidence-Based Nursing also backs the results found by MEDSURG Nursing. Morrison and Holt (2015), researched studies and found that in a nonblind randomized control test, focused on phlebitis and infiltration rates, 33% participants in the control group and 38% in the test group had to have their catheter removed because of phlebitis and infiltration (p. 190). Both of these studies and many others all come to the same conclusion that changing the catheter does not greatly affect the outcome of I.V. associated risks. Not only is this practice unnecessary it also causes a rise in healthcare

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.