Reduce Urinary Catheters And Infection Rates Essay Assignment Paper
Reduce Urinary Catheters And Infection Rates Essay Assignment Paper
Abstract
Background: Catheter-associated urinary tract infections (CAUTIs) are common nosocomial infections. In 2015, the Centers for Medicare and Medicaid Services began imposing financial penalties for institutions where CAUTI rates are higher than predicted.
However, the surveillance definition for CAUTI is not a clinical diagnosis and may represent asymptomatic bacteriuria. The objective of this study was to compare rates of urinary catheterization and CAUTI before and after the implementation of a bundled intervention.
Methods: This retrospective review evaluated trauma patients from January 2013-January 2015. The bundled intervention optimized the urinary catheterization process and culturing practices to reduce false positives. The CAUTI rate was defined as a positive surveillance CAUTI divided by total catheter days multiplied by 1,000 days.
Results: A total of 6,236 patients were included (pre: n = 5,003; post: n = 1,233). Fewer patients in the post bundle group received a urinary catheter (pre: 25% vs post: 16%; P < .001). After bundle implementation, the CAUTI rate reduced over one third (pre: 4.07 vs post: 2.56; incidence rate ratio, 0.63; 95% confidence interval, 0.19-2.07).
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Conclusions: Although the number of patients exposed to urinary catheters and catheter days was decreased, optimization of culturing practices was essential to prevent the CAUTI rate from increasing from a reduced denominator. Implementation of a CAUTI prevention bundle works synergistically to improve patient safety and hospital performance.Reduce Urinary Catheters And Infection Rates.
Keywords: Catheter-related infections; infection; urinary catheters; urinary tract infections.
The qualitative study by Fletcher et al., (2016) was based on the background knowledge that hospital acquired infections, particularly CAUTIs are common. Despite the fact that they can be prevented, most hospital units struggle to reduce the rates. Therefore, in order to assess CAUTIs prevention activities in hospital units, the guide to patient safety (GPS) is an important tool that may be used. Therefore, the researchers aimed at qualitatively validate the GPS tool. Participants from 2 units in 4 different hospitals were interviewed (Fletcher et al., 2016). The nurse manager in every unit was required to complete the GPS and discuss the findings with a research assistant. The researchers later compared the answers provided by unit nurses and physicians. Collectively, 49 participants from 4 medical and surgical units were interviewed. Based on the findings, nurse managers found the GPS to be helpful. The agreement between nurse managers and nurses was stronger and higher than with physicians (Fletcher et al., 2016). The results generally suggested that the GPS was effective in stimulating discussions between stakeholders to address major issues in CAUTIs prevention efforts. The integration of this article in the body of evidence is supported by the fact that it discusses on how CAUTIs can be prevented in hospital settings using the GPS tool.
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The quantitative study by Ferguson (2018) purposed to improve nurse’s knowledge on appropriate care of indwelling catheters to reduce the incidences of CAUTIs among patients in two units of an acute care setting, through the implementation of an interactive a CAUTIs education program. Reduce Urinary Catheters And Infection Rates.The researchers selected two units in an acute care setting that had a 393 bed capacity (Ferguson, 2018). The nurses actively participated in a one-hour comprehensive CAUTIs prevention education session where they were given one-on-one instructions, the knowledge and skills acquired were assessed. Within the period of 3 months, a total of 59 nurses had completed the education program. The summary score of nurse’s knowledge based on the paired t tests in all subscales had improved (p=0.00). In all hospital units, the rates of CAUTIs had reduced to zero (from 7.49) and to 1.56(from 4.12) per 1000 catheter days respectively after the implementation of the education program (Ferguson, 2018).
Search strategy: Nursing actions for prevention of CAUTI were identified based on search of electronic databases and Web-based search engines for national or international clinical practice guidelines focusing on this topic. Evidence related to the above nursing interventions was identified by searching electronic databases MEDLINE, CINAHL, the Cochrane Library, the ancestry of articles identified in these searches and Google scholar.
Results: Limited evidence suggests that the following interventions reduce the incidence of CAUTI in patients managed by short-term indwelling catheterization: (1) staff education about catheter management, combined with regular monitoring of CAUTI incidence, (2) a facility-wide program to ensure catheterization only when indicated and prompt removal of indwelling catheters, (3) daily cleansing of the urethral meatus using soap and water or perineal cleanser, and (4) maintenance of a closed urinary drainage system. Mixed evidence suggests that use of a preconnected system reduces inadvertent interruption of a closed urinary drainage system and may prevent CAUTI. Limited evidence suggests that routine catheter changes every 4 to 6 weeks reduce CAUTI incidence in patients managed by long-term catheterization.Reduce Urinary Catheters And Infection Rates. Existed evidence suggests that the following interventions are not effective for reducing CAUTI incidence: (1) use of sterile technique for catheter insertion, (2) use of antiseptic solutions or ointments during routine meatal care, (3) use of a 2-chambered urinary drainage bag, (4) use of antiseptic filters incorporated into a urinary drainage bag, (5) bladder or catheter irrigation, (6) frequent changes of the urinary drainage bag, and (7) placement of an antiseptic solution in the urinary drainage bag.
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