Evidence Based Practice and Applied Nursing Research

Evidence Based Practice and Applied Nursing Research

Patricia Nsini

3/13/19

Western Governors University

Healthcare problem

The occurrence of catheter associated urinary tract infection has ravaged the health care industry and is identified has one of the top leading problems associated with health care acquired infections. The chance of the infection occurring increases with the duration the catheter is left in place, as patients begin to grow bacteria within 24-48 hours of catheterization. “Catheter-associated urinary tract infections is responsible for 40% to 50% of hospital-acquired infections and increases healthcare cost, extended hospital stay and increase patient mortality rate. (Peter, Sanatombi, & Nayak 2018).

Significance of the problem

The high prevalence of CAUTI will cause acute care settings significant problems. It has been demonstrated that 21-55.7% of patients have been inserted urinary catheter for improper indication or for non-medical reasons( Meddings et al., 2014). The removal time of the catheter is not reassessed in a timely manner to determine its continuation. It is approximated that 449,000 CAUTI affects Americans causing an overwhelming 13,000 annually deaths in the United States (Meddings et al., 2014). In 2008, catheter associated urinary tract infections were categorized non reimbursable by Medicare (Durant, D. 2017).

Current practice related to the problem

Physician orders usually initiate the insertion of a Foley catheter for reasons such as strictly measuring intake and output, post-op patient or preventing further skin breakdown on patient with pressure ulcer. Maintaining sterility of the catheter is the current stressor or practice to avoid CAUTI, frequent hand washing and maintaining the urinary bag below bladder level. Current research also advise that a daily peri- care using chlorhexidine gluconate (CHG) wipes will diminish the microbial load on a patient’s skin, thereby decreasing health associated infections.

Impact of the problem and/or patient’s cultural background

The incidence of CAUTI impacts not only patients, but also the hospital, and the employees. For instance, the already compromised patient may require prolong hospital stay, the hospital might be forced to pay out of their budget if the associated infection occurred after admission which will increased medical cost. Tension may rise between nurses and doctors when nurses question placement of the order or when a nurse breaks sterility and an infection occurs.

Research and Non-Research Evidence

The first research article addressed that clinical regulations for CAUTI were successful in infection control for those who conformed to those rules and eventually diminished the incidence of CAUTI in acute care settings (Peter et al., 2018).

In the second article, researchers examined the various risks and causes associated with CAUTI in children following complicated surgeries. All members were pediatrics patients with indwelling catheter postoperatively. According to the research, "the time frame of urinary catheter placement is a significant risk for acquiring UTI since the duration of a urinary catheter in CAUTI patients was four times longer than the duration in non - CAUTI patients (Kabbani et al., 2016). Within the data collected in this study, the researchers concluded that CAUTI bundles such as "the vigilant daily evaluation and assessment of urinary catheter is a necessity that should be carried out regularly to minimize the leading risk factor for CAUTI after pediatric surgery," (Kabbani et al., 2016). If the catheter is no longer indicated, these guidelines should call for immediate removal, and it would be essential to have a team on the unit to implement this CAUTI prevention effort.

The third non- research article, a quality improvement study was performed to evaluate whether the implementation of a CAUTI bundle such as proper hand hygiene, proper Foley insertion with sterile technique and direct observation by a second observer would lessen CAUTI incidence rates at a 603 bed academic medical center in the medical ICU. The study states that 70 percent of cases of CAUTI may be preventable, if protocols based on evidence based are followed during the insertion of the catheter and medical workers follow infection control practices suggested in the CAUTI bundles. The researcher concluded that by applying CAUTI bundles "urinary catheter use and infection rates were reduced consequently improving patient outcomes"(Galiczewski & Shurpin, 2017).

The last article was a non-research literature review in which the authors elaborated on proper catheter management for nurses to follow evidence base practices in order to prevent CAUTIs (Ferguson, 2018). The authors concentrated in 4 practice guidelines nurses should implement before a urinary catheter is placed, these tasks include: catheter indication, the use of sterile techniques during insertion, proper care or maintenance of a catheter and the immediate cessation of Foley catheter when its not longer needed.

PICO Question

Patients with an indwelling catheter, does CAUTI prevention bundles reduce CAUTI risks and occurrence of infections as compared to current practice of no CAUTI bundles?

Evidence Matrix - See attachment

Intervention for Recommended Practice Change

The study reveals the dedication of multidisciplinary team to set reminders and apply strict EBP practice guidelines such as early catheter removal, hand washing, maintenance of the catheter close drainage system and using antimicrobial agents prior and after cleaning private area (Peter et al., 2018). In this study, the author stressed and urged clinical nurse specialists in developing countries to consider the use CAUTI bundles to prevent CAUTI. Two years after its implementation there was a drastic decrease in infections between the prebundles and post bundles patients (Duzkaya et al., 2016). The qualitative research done by (Carter et al., 2016) supports that CAUTI bundles tremendously decreases the incidence of catheter associated urinary infections if the nurse leaders emphasizes a prevention programs involving all the clinical nurses to adheres to its regulations. He states that clinical nurses are pilot to observe the workflow around the initiation of catheter insertion, advocating for its refraining use and manage