Multifaceted Intervention Essay

Urinary tract infections (UTIs) are the most common nosocomial infection; accounting for up to 40% of infections reported by acute care hospitals. Up to 80% of UTIs are associated with the presence of an indwelling urinary catheter. Catheter associated urinary tract infections (CAUTIs) represent the largest proportion of healthcare associated infections (HAI). Catheter-associated urinary tract infection (CAUTI) increases hospital cost and is associated with increased morbidity and mortality .CAUTIs are considered by the Centers for Medicare and Medicaid Services to represent a reasonably preventable complication of hospitalization. As such, no additional payment is provided to hospitals for CAUTI treatment-related costs.CAUTIs can lead to

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,

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

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.

The Effectiveness of Response to Intervention on Student Achievement in Mathematics and English in a Rural Kentucky High School

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

(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.

According to the American Nurses Association (ANA) “there are three areas to improve evidence-based clinical care to reduce the rate of CAUTI: prevention of inappropriate short-term catheter use, nurse-driven timely removal of urinary catheters, and urinary catheter care during placement” (2016). Good Samaritan has done a wonderful job with maintaining the prevention of this source of infection with the last documented CAUTI being 11/14/2015. Their current high target achievement score is 0.5 and there low target achievement is 0.451. Actual measurement for CAUTI is 0 on a year to date accountability (Graphs B and C). I find that they are following the above three areas of prevention in their patient cares and this ongoing practice is

“Of all forms of mental activity, the most difficult to induce even in the minds of the young, who may be presumed not to have lost their flexibility, is the art of handling the same bundle of data as before, but placing them in a new system of relations with one another by giving them a different framework, all of which virtually means putting on a different kind of thinking-cap for the moment. It is easy to teach anybody a new fact…but it needs light from heaven above to enable a teacher to break the old framework in which the student is accustomed to seeing.”

The practice issue identified in collaboration with the MICU nurse manager for this task is non-adherence to the current catheter associated urinary tract infection (CAUTI) prevention protocol.

The most common health care associated infection (HAI) is CAUTI. Forty percent of all hospital-acquired infections are UTIs and 80% of these are directly linked to having an indwelling urinary catheter in place (Underwood, 2015). Urinary catheters are required in up to 25% of hospitalized patients and bacteriuria results in about 25% of patients with a catheter for greater than 5 days and this number increases by 1 to 5% for each day the catheter is in place after that. The harmful consequences of CAUTI include increased length of stay, higher health care cost, and increased mortality. CAUTI is known to cost health care in the U.S. $400-$500 million annually (Leuck et al., 2015).

CAUTIs can result to patient’s complications such urethritis, urethral strictures, bloody urine, bladder obstruction and sepsis. In addition, the catheter drainage bag may be a reservoir of pathogens that can result to more critical HAIs (Apostolopoulou, 2015). Approximately 13,000 deaths are associated with UTIs every year. A total health care cost of approximately $0.4 – $0.5 billion is spent for CAUTI incidences and it’s complications in the United States annually. The length of hospital stay related to CAUTIs extends from two to four days (Gould, 2015).

W., Donahue, M., Brentlinger L., Dion K., & Polito S. C., (2014). A quasi-experimental study to test a prevention bundle for catheter-associated urinary tract infections. Journal of Hospital Administration, 3(4), 101-108. doi:10.5430/jha.v3n4p101

Galiczewski’s article was aimed at medical professionals and the role they play in preventing catheter associated urinary tract infections (CAUTIs). The author provided significant statistical information on CAUTIs and the impact they have on patients in the intensive care unit (ICU) of hospitals. Using information from various research articles and their associated electronic data bases, Galiczewski effectively summarized interventions that have the maximum effect in preventing CAUTIs. For example, removing catheters when they are no longer deemed necessary was shown to significantly decrease the risk of CAUTIs in adult ICU patients. The author used a plethora of empirical evidence to successfully support her findings that health care