Catheter Associated Urinary Tract Infection Research Critiques and PICOT Statement

O- Reduced incidence of CAUTIs. T- 6months. Background information Catheter Associated Urinary Tract Infection (CAUTI) is currently the most common health problem faced by patients who undergo catheterization following surgery. Majority of these infections are due to use of an indwelling catheter for a long period of time. CAUTIs occur as a result of formation of a biofilm on the surface of the urinary catheter thus leading to bacteriuria and symptomatic urinary tract infection. Bundling these interventions gives best outcomes in preventing CAUTIs. Qualitative research article critique Meddings, J. , Rogers, M. A. , Krein, S. The researchers identified that urinary tract infections were the most common type of hospital-acquired infections (HAIs). These infections were associated with urinary catheter that was often uncomfortable, in most instances unnecessary, and would easily be forgotten by the caregivers.

They estimated that catheter-associated urinary tract infections contributed to an additional cost of between $749-1007 for every admission. It is on the basis of this problem that they reviewed studies to come up with recommendations for lowering the incidences of catheter-associated urinary tract infections that in essence could easily be avoided (Meddings, et al. Methodology and results The researchers begun the integrative review by updating the systematic review that had been conducted in the year 2012 on this topic. They also indicated that utilizing ultrasound for bladder would be an effective way of avoiding the use of indwelling catheters. Additionally, they pointed out that the use of condom catheters or alternatives for catheters that are in dwelling like catheterization that is intermittent would be effective in preventing or minimizing catheter-associated urinary tract infections in patients.

Also, the researchers pointed out that catheter use was to be considered for clinical situations in which the life, survival of, and outcomes of care for the patient would completely rely on catheterization. However, in such cases, the duration of use should be limited to necessity and as soon as an alternative existed, the patient was to be put on the alternative (Meddings, et al. Implications of findings in nursing practice Findings from this systematic review, show significant reduction in catheter-associated urinary tract infections when placement of catheters inappropriately is avoided. From the results of the study, UC reminders and stop orders appeared to reduce CAUTI rates and should therefore be used to improve patient safety. Many preventive strategies have been evaluated by different studies and implementation of these strategies is crucial because reducing urinary catheter use involves changing well-established habits (Meddings, et al.

This is especially important for the nursing team as they are part of the primary healthcare providers of the patient. Occasional evaluation of indwelling urinary catheters as well as standard procedures dictating aseptic urinary catheter placement should be enforced into the nursing practice. Practical assessment of urinary catheter care among nursing student is also essential in inculcating good nursing care practice. International Journal of Infectious Diseases, 17(9), e686-e690. This study clearly brings out the knowledge gap as well as the justification for carrying out the study. It acknowledges that several studies have shown that most developing countries that have implemented infection control programs and bundling interventions, experience low in the incidence of CAUTIs in their respective hospitals. It emphasizes the necessity to employ such prevention strategies and programs in other developing counties as well.

In light of this, the study in Lebanon was done which was aimed at reducing the high rates of CAUTIs in the selected Intensive Care Unit (ICU) (Kanj et al. Epi Info v. was used to calculate relative risk. Less than 0. 05 P-Values for the two-sided tests were considered significant. To compare the rates of CAUTIs at baseline and during the follow-up periods Poisson regression was used which further accounted for the cluster of the CAUTI rates over the study period (Kanj et al. Results In the course of study, 1506 patients were hospitalized during the 10,291 bed days in the ICU with 9829 urinary catheter-days. The characteristics of patients were similar in the two phases. Compliance to hand hygiene, correct positioning of the urinary catheter and keeping the collection bag hanging was noticeably great and the same for phase 1 and 2.

Regarding the rates of CAUTIs, 306 urinary was recorded with a usage mean of 0. 96 in phase 1 while in phase 2, the catheter-days dropped to 21 recorded CAUTIs and the urinary catheter use mean remained the same. Adopting the multidimensional approach used in this study will significantly reduce the rates of CAUTIs all over the world. It is upon nurses to implement the strategies in their places of work thus reducing length of patient hospitalization, improved quality of life and reduced treatment costs. Development of policies and inculcating these policies in learning institutions for nurses will be instrumental in the lowering the rates of CAUTI among patients in ICU (Kanj et al. Currently, there is greater shift to evidence based practice and results from this study serve as strong evidence of successful approaches of preventing CAUTIs among intensive care unit patients.

Ethical considerations The researchers clearly point out that ethical permission was sought before the research was carried out. Researchers in both studies suggest that health professionals should use a number of interventions to achieve the best outcome in regards to decreasing CAUTIs in hospitalized patients. Proposed evidence based practice change From this research, I would propose the implementation of CAUTI prevention bundle in hospitals and other health institutions. Most of the times, health care providers are restricted to applying only one or two interventions as they try to prevent CAUTI, however by so doing the significant reduction of the rates of CAUTIs is not realized. Research has shown that using a bundle approach is the most successful way to deal with this health problem.