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Catheter-Associated Urinary Tract Infections: Annotated Bibliography
Alexaitis,
I., & Broome, B. (2014). Implementation of a nurse-driven protocol to
prevent catheter-associated urinary tract infections. Journal of Nnursing
Ccare
Qquality,
29(3), 245-252. doi:10.1097/NCQ.0000000000000041
Alexaitis and Broome examine the effectiveness of a quality improvement initiative aimed at the reduction of the catheter associated urinary tract infections (CAUTIs) in an academic medical center. They report that for the reduction of the infections, intermittent catheterizations should be used alongside bladder ultrasonography. Indwelling catheters, however, should be discontinued as they were found to be the most significant factors promoting the increased prevalence of CAUTIs. After the total embracement of the protocol, the study established that the infection rates had gone down. The duration of catheterization had also decreased significantly, as well as the costs of treating the conditions.
The research was conducted on 183 patients who were utilizing urinary catheters (indwelling) in neurosurgical intensive care unit (NSICU). It was so extensive that it included the 107 registered nurses at the facility. Results revealed a 2.5-day decrease in catheter duration and a 20% decrease in CAUTI rate. Catheter utilization was increased by over two percent. The study faced shortcomings like the absence of heterogeneity in the population observed and small sample size that could have influenced the results. Though the article concludes that the protocol is effective, more comprehensive statistical analyses would be needed to ensure that it can be relied upon on a large-scale and more representative basis for the management of urinary catheterization.
In my role, integrating Alexaitis and Broome’s protocol into the evidence-based practice proposed by Magers, as well as the adequate documentation of nursing practices discussed by Dailly, will be pivotal in the establishment of a comprehensive intervention towards the urinary tract infections. The knowledge acquired will be instrumental in the practice of my profession both in the field and also in medical research.
Dailly, S. (2012). Auditing urinary catheter care. Nursing Standard, 26(20), 35-40. doi:10.7748/ns.26.20.35.s48
The article by Dailly reports on an investigation that was conducted in Hampshire Hospital on whether the hospital maintained the best standards for the minimization of catheter-associated urinary tract infections (UTIs). It is a quantitative research based on an audit that had revealed that the hospital did not have enough documentation to prove the adherence to best practices. After establishing that the hospital lacked sufficient evidence on the provision of the best care to patients with the catheters, Dailly proposes an assessment and monitoring tool to be used for the urinary catheter care.
The audit was conducted on 400 patients from 22 wards. It was found that 76 patients had urinary catheters. The audit further found that 32 of the patients with the catheters did not receive adequate care. They were being attended by medics without aprons, and there were no records on the daily meatal hygiene. To combat the flaws on the issue, infection prevention, and control nurses were offered training on the importance of the catheters, and how care could be improved to ensure that the patients with them received sufficient care to prevent the infections associated with the tools. Further, a urinary catheter assessment and monitoring tool was piloted on several wards to test its effectiveness before full implementation. It was established that most users found the tool to be useful. The author concludes that the urinary catheter assessment and management (UCAM) form significantly improved the situation in the hospital. The paper is substantially objective and representative.
Being a family nurse practitioner, I will be able to utilize the evidence provided by the audit to ensure that the best practices suggested regarding the UCAM are embraced in all my endeavors for the mitigation of catheter-associated UTIs.
Magers, T. L. (2013). Using evidence-based practice to reduce catheter-associated urinary tract infections. AJN The American Journal of Nursing, 113(6), 34-42. doi:10.1097/01.NAJ.0000430923.07539.a7
Magers’ article reports on a study that was carried out to establish the usefulness of an evidence-based seven-step approach in the reduction of CAUTIs. The protocol used was nurse-driven and involved the reduction of catheterization duration among adult patients. The primary objective of the AJN project was to implement best practices and enhance the quality of care. The evidence based practice (EBP) project was aimed at integrating evidence from care data and other studies with the values and preferences of the patients, as well as the clinician expertise. Magers’ paper reports on a project in which the author, together with a multidisciplinary team, applied the approach in the Mississippi Hospital for Restorative Care through the reduction of the duration of adult patient catheterization.
The article narrates all the processes from Step Zero to the seventh one, including all analyses and findings in each stage. Graphical illustrations are presented to paint a clearer picture of the implications of the seven-step intervention carried out. Statistical analysis is also part of the report; thus, the quantitative aspect of the research is well covered. After collecting data and analyzing the findings, they found out that the incidences of catheter-associated infections had been significantly reduced after the intervention. The study adheres to statistical consistency, is representative, and overly objective. The players involved in the study can also be said to have sufficient technical expertise to carry out the study.
As a future family nurse practitioner, I have gained a lot from the article and learned that an evidence-based practice could be combined with adequate documentation of nursing practices in the amelioration of health care for the catheterized adult patients.
Purvis,
S., Gion, T., Kennedy, G., Rees, S., Safdar, N., VanDenBergh, S., & Weber,
J. (2014). Catheter-associated urinary tract infection: a successful prevention
effort employing a multipronged initiative at an academic medical center. Journal
of Nnursing
Ccare
Qquality,
29(2), 141-148. doi:10.1097/NCQ.0000000000000037
This compendious article by Purvis et al. reports on a quantitative study conducted at an academic medical center to establish the implication of a broad spectrum of interventions on the rate of catheter-related infections in the urinary tract. Some of the approaches included staff education, electronic health records (EHR) icons, bladder management models, data reporting, and indwelling urinary catheter strategies. So far, this is the most comprehensive approach among those evaluated in this bibliography. Before the implementation of the protocol by the interdisciplinary workgroup, the CAUTI rate was around 4.7 for every 1000 catheter days. However, after the implementation, the rate was almost halved to a commendable 2.4 per 1000. Further, the catheter days reduced tremendously. A graphical representation shows that there was a downward trend of catheter days from January 2011 to February 2013. The paper concludes that on top of the multifaceted approach, the teamwork of the interdisciplinary was instrumental to the success of the intervention.
One notable shortcoming of the study is that so many strategies were used that it became difficult to identify the most important strategies. Trying to single out those approaches that performed best is a daunting task that cannot be accurately completed. All in all, the conglomeration of methods and the interdisciplinary workgroup managed to mitigate the prevalence of CAUTIs.
To effectively perform my tasks as a family nurse practitioner, an extensive understanding of the essential concepts associated with catheterization is fundamental. This article presents all these concepts in a well-founded approach support by reliable evidence; therefore, can help in the enhancement of one’s knowledge regarding the infections and how to help reduce their prevalence.
