The Importance Of Evidence-Based Practice For CAUTI Prevention

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.

Bernard, M.S., Hunter, K.F., & Moore, K.N. (2012). A review of strategies to decrease the duration of indwelling urethral catheters and potentially reduce the incidence of catheter-associated urinary tract infections. Urologic Nursing 32(1)

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

The nurse driven protocol was tested in 4 intensive care units. It included evidence-based orders for discontinuing, handling, and properly managing the catheters. One of the most important factors was the removal of the catheters in a timely manner. The data pre

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

According to a study conducted in 2011 by the government, approximately 80% of urinary tract infections associated with indwelling catheters, increase the hospital length of stay by one to three days, and according to the Centers for Medicare & Medicaid Services (CMS), have an annual cost of

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:

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

Until recently it was not uncommon for patients admitted to an acute care facility to have an indwelling catheter anchored for unnecessary reasons. Patients that came in thru the emergency department typically were sent to the units with unnecessary indwelling catheters in place and it was not unusual for a surgery patient to have an indwelling catheter anchored before or during a procedure. Once a patient was admitted and was transported to the units nursing would also anchor indwelling catheters for multiple unnecessary reasons. These Catheters could be

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

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.

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

Brusch says, “Once a indwelling catheter is placed, the daily incidence of bacteriuria can be between 3-10%.” Another large problem that results CAUTI’s is that at times, catheters are left in a patient longer than necessary. Prolonged use of