Paper #1 Evidence-Based Group Project Paper



INDWELLING URINARY CATHETERS: PREVENTION OF CATHETER-ASSOCIATED URINARY TRACT INFECTIONS (CAUTIs)April Beresford, Benjamin Kasper, and Kara ElkinsFerris State UniversityAbstractCatheter-associated urinary tract infections (CAUTI) are of big concern today. They can leave patients with increased amount of unnecessary pain and discomfort, lead to increased length of stay in hospitals, and large amounts of money that could be better used elsewhere. We will review and critique three articles relating to CAUTI and the steps that are being researched to decrease the incidence of it, while also discovering if the research itself is strong enough or too weak to make a case for change in practice. Keywords: Urinary tract infection (UTI), foley catheter, straight catheter, hospital acquired, healthcare acquired, cystitis, CAUTI Indwelling Urinary Catheters: Prevention of Catheter Associated Urinary Tract Infections (CAUTIs)Catheter associated urinary tract infections (CAUTI) are the cause of many hospital acquired infections. According to Andreessen et al. (2012), “CAUTIs are the most common type of nosocomial infection, accounting for 40% of all infections in the hospital per year” (p. 209). Because of the increase in these numbers, nurses, physicians, and others in the medical field, have decided to come together to research the issue. In this document, we will discuss three different studies that have been conducted to find the root cause of this problem, and to come up with plans to reduce the cause, and therefore decrease the incidence of CAUTI. Description of Research ArticlesArticle OneThis first article written by Andreessen et al. (2012), focuses primarily on changing the current practice of nurses and doctors by giving them a tool to help prevent catheter associated urinary tract infections (CAUTI). The researchers have developed a bundle plan that will aid the nurses in insertion techniques and maintenance of urinary catheters. This plan will also include daily assessment of need by both the nurse and physician, and will require a q24 hour order to continue use of catheter in a patient. By changing practice, adding meticulous computer documentation, and reducing use and duration of catheters, these researchers hope in the long run to reduce the percentage of CAUTIs experienced by patients. This is proven to be an important study because it has been noted that “CAUTIs are the most common type of nosocomial infection.” This causes increased pain and discomfort felt by the patient, and also increases healthcare costs for both the patient and the medical facility (Andressen et al., 2012, p. 209). Medicare and Medicaid are no longer paying for treatment of CAUTI because it is something that the hospital is unnecessarily causing the patient to have (Andressen et al., 2012, p. 209). Because of this, hospitals are now required to pay out of pocket for the additional expenses related to CAUTI, which include but are not limited to antibiotic treatment and increased length of stay. Article Two Oman et al conducted a primary research study in 2011 to establish the effectiveness of nursing initiated interventions in regards to the incidence rate of catheter associated urinary tract infections (CAUTI). Because bladder catheterization is common in the hospital setting, and nursing professionals are utilized to manage these urinary drainage systems, Oman et al studied the effectiveness of specific nursing-initiated interventions in relations to urine elimination management within a hospital system. This study was conducted on two adjacent medical/surgical units at a Colorado hospital using a formally constructed nursing education program and measured CAUTI rates in a daily average census of 18 patients for a period of over one year. The goal of this study, which was carried out by five registered nurses and a physician, was to “decrease CAUTI rates through implementation of hospital-wide nursing interventions that emphasized education for inpatient nurses and specific unit-based nursing practice actions on a pulmonary medical and a general surgical inpatient unit” (Oman et al, 2011, p. 4). Article Three While indwelling catheter use remains a necessity on the medical intensive care unit (MICU), catheter associated urinary tract infections (CAUTIs) continue to be an ongoing battle. This study has shown that with use of guidelines for indwelling catheter use CAUTIs can be reduced or eliminated in MICU inpatients (Elpern et al., 2009, p. 535). A vast majority of the data presented in the article, “Reducing use of indwelling urinary catheters and associated urinary tract infections,” written by Elpern et al. (2009), was obtained from quality improvement indicators which were used to determine CAUTI rates in inpatients of the MICU which was studied. Other data collected during this study was duration of catheterization, appropriateness of catheterization and reason for inappropriate catheter use. This study focuses on appropriate indwelling catheter usage and CAUTI rates within a 6 month focus range in a 21 bed MICU.Critical Appraisal Article OneReview of literature The authors of this research article spent two months before beginning the study reviewing the literature for procedures and policies that would assist them in decreasing CAUTI incidence (Andreessen et al., 2012, p. 211). The several sources that are referenced are current and relevant to the study and the goals of the study. In this area, they did not provide much of the information that they gathered from their review, but it is considered strong in that their sources are up to date, and the information used was shown to be a strong background for beginning the study. The “bundle” that they created to decrease percentage of CAUTI was put together based on the information gathered in the review of literature, and this bundle was the basis for the study. This would show that the researchers were very thorough and confident with the review. Hypothesis Andreessen et al. (2012) did not actually make a problem/purpose or a hypothesis statement that was recorded in the article. They did however ask the question “is a urinary catheter bundle with computerized documentation and ordering templates (including the daily assessment of continued need for a catheter) effective in reducing the use and duration of indwelling urinary catheterization in acute hospitalized patients” (Andreessen et al., 2012, p. 211). They also made a statement earlier in the article saying “The strongest predictor for CAUTI is the duration of catheterization, and catheterization lasting more than six days increases the risk for CAUTI seven times” (Andreessen et al. 2012, p. 210).Framework In this question they did introduce the following variables dependent variable: duration of urinary catheterization, and independent variables: urinary catheter bundle, which included proper insertion and assessment techniques to be utilized, computerized documentation, and ordering templates. The population was also defined which in this case is “acutely hospitalized patients” (Andreessen et al., 2012, p. 211). This is a strong hypothesis because all of the variables were defined and the question asked is relevant to the goals for the study.Research design/data collectionThis article is out to prove that the independent variables named (urinary catheter bundle, computerized documentation, and ordering templates) have a direct relationship with the dependent variable of catheter duration, which they feel, will influence the long-term research goal of decreasing CAUTI incidence. Because of the cause and effect noted in the relationship of these variables, The researchers have used causality in their research design for this study. The study that they performed was an experimental using the pretest and posttest design. According to Burns and Grove 2011), experimental pretest and posttest design focus on the study of causality between variables and look at the relationship before and after the manipulation of variables (p. 276). Andreessen et al. did an evaluation before and after the introduction of the urinary catheter bundle. The total amount of time it took these researchers to complete their project was eight months. During this time, they were collecting data daily from computerized charts. The initial three weeks included evaluation of 1,200 charts to collect baseline data, followed by many months of collecting data after the urinary catheter bundle and other policies were put into place. They ended with another three-week post program evaluation process that required the review of 1,385 computerized medical charts to collect the outcome data (Andreessen et al., 2012, p. 211). These charts were reviewed many times to find all patients with indwelling urinary catheters. They would then follow these patients to make sure the bundle and new policies were being adhered to with the hopes of the catheter duration for these patients would be decreased, and in turn resulting in less incidence of catheter acquired urinary tract infections Andreessen et al., 2012, p. 211). Registered nurses, physicians, and infection control nurses, along with the others that were involved in the research team, reviewed the documentation (Andreessen et al., 2012, p. 211). The research team put a lot of effort into their data collection process. This area of the research was strong, but could have been better with more detailed information as to what they were recording in their data collection and not just that they were looking for patients with indwelling catheters. Sample/setting“The research project took place at a VA (veterans affairs) medical center, and included patients with acute placement (less than thirty days) of an indwelling urinary catheter” (Andreessen et al., 2012, p. 211). Only male patients were included because the majority of the patient population at this center was male. All charts were reviewed for those male, and eighteen and older (Andreessen et al., 2012, p. 211). Those patients who needed long-term catheterization, or were diagnosed with a urinary tract infection within 24 hours of admission were excluded from the study to protect from misinformation in the data collected (Andreessen et al., 2012, p. 211). This sample a convenience sample. Burns and Groves (2011) define convenience sampling as “choosing subjects because they happen to be in the right place at the right time” (p. 305). The researchers chose the location of the study to be the VA hospital, and then chose the target population out of those who were admitted to the hospital during the time of the study. They didn’t have full control over those who were available when they were collecting data. The researchers did what they could to control outside variables that may construe the data, and therefore made this a strong sample for their research. Their choice to only include male patients also decreased the amount of bias in their study as well since there were not many female patients available for study. They will have to conduct another study with female patients to see if in fact the same the same results are achieved, or if different tools need to be utilized. LimitationsThis study was conducted at a single site which causes limitation in that the results may be limited to hospitals of similar size and type to the VA medical center where the study took place. “The project also lacked CAUTI rates for comparison because the hospital had not collected this rate before this project began” (Andreessen et al., 2012, p. 211). Even though this study contained these limitations, the researchers did everything they could to control biases and chose their target population the best they could. Analysis/resultsA total of 90 charts were used in this study after all ineligible patients were removed. “In the pre-intervention stage of the study 2% of the charts had complete documentation on urinary catheter insertion dates, removal dates, and catheter maintenance, and in the post-intervention stage, the nurses had documented appropriately 98% of the time” (Andreessen et al., 2012, p. 214,). “The new catheter bundle template was being used 40% of the time, the new order template was being used 35% of the time, and only 2% of the charts were missing a documented order” (Andreessen et al., 2012, p. 211). The nurses were also following CDC guidelines regarding appropriate catheter size more frequently after the catheter bundle was introduced. DiscussionAccording to Andreessen et al. (2012), “the most important criteria was the daily questioning of the continuing need for catheterization (p. 215). This portion was included in the ordering criteria. After the post-intervention data was gathered, it showed that the use of the guidelines from the care plan bundle along with the need for daily assessment and order for a urinary catheter, assisted in reducing catheter use (Andreessen et al., 2012, p. 215). Proper education was given to the staff and residents regarding proper use of urinary catheters, including care when inserting and maintenance, proper assessment and appropriate uses, and detailed documentation. The researchers made it so that even after the data was collected, the staff would have the appropriate tools and knowledge to continue to work towards the goal of CAUTI rates decreasing. This proves that this study is important to them and they wish to see the rates continue to decrease. ConclusionIt was discovered at the end of the study that “the implementation of a set of guidelines (the urinary catheter bundle) for catheter use and care resulted in a reduction of catheter use by 57% and a significant decrease in catheter duration by 70%” (Andreessen et al., 2012, p. 216). The researchers that conducted this study felt that in the long-term, if this new plan of care continued, would contribute to the reduction of CAUTI, but in order to really research the reduction of incidence of CAUTI, the researchers would have to continue to watch and collect the data from the medical center. The effort lies with the staff and practitioners to keep up the newly introduced protocols, and then the researchers are confident that this will lead to decrease in CAUTI (Andreessen et al., 2012, p. 216). The researchers in this case did an excellent job with their study. The study was well thought out and the interventions were simple changes that nurses were able to execute easily. Even though there were limitations, and the information wasn’t able to be compared to previously recorded percentages of CAUTI, the conclusions validated in this study could be used in broader settings to assist in the prevention of CAUTI. Article Two Problem and PurposeOman et al began by describing the background and history of catheter associated urinary tract infections (CAUTIs). “Cather-associated urinary tract infections are common, morbid, and costly. Nearly 25% of hospitalized patients are catheterized yearly, and 10% develop urinary tract infections” (Oman et al, 2011, p. 1). They also state that CAUTIs create a financial burden, and attribute to hospital-acquired bacteremia on a large scale and point out that significant populations at risk are postoperative patients and inambulatory patients who “do not have a clear indication for indwelling urinary catheters” (Oman et al, 2011, p. 1). After building a strong concern for addressing the problem of CAUTI in the patient population, they state “Catheters may be inappropriately retained for days because of convenience, misunderstanding of their necessity/appropriateness, or lack of clear orders for removal. Therefore, efforts to reduce CAUTI prevalence must focus on evidence-based use of IUCs during insertion, maintenance, and removal” (Oman et al, 2011, p. 1). This can be considered as the problem statement, as it reflects the concerns regarding CAUTI that were reflected in the background review. The purpose statement is clearly identified on page two, and states “The purpose of this quality improvement process study was to develop and implement evidence-based, multifaceted, nurse-driven interventions to improve urine elimination management in hospitalized patients and to measure the impact of these interventions on the duration of indwelling urinary catheterization (dwell time) and the CAUTI incidence among patients on the target inpatient units” (Oman et al, 2011, p. 2). This accurately reflects the reason for the study. It is clear and concise and easy to understand, and clearly includes ties to nursing practice and builds on existing nursing research. Review of LiteratureOman et al did not do a formal presentation of the literature reviewed in preparation for or in process of their study. Instead, they used facts and other information during the study to assist in explaining or conceptualizing their data. The literature cited and the information included was all current with the exception for only four of their 23 sources cited, and for those citations it was framed that the data was historical. None of the literature presented was thoroughly or critically appraised, nor was there a method to determine which research mentioned was primary or secondary research. No quotations were utilized but information stated from outside sources was properly cited. There was no contradictory theory or information presented. All of the sources cited were appropriately listed at the end of the study with no citation errors found. Study FrameworkOman et al were very clear in their description of this study framework. Relatively early in the study description, they state “This project used the following framework for implementation: Recruit a multidisciplinary team; Examine the evidence; Identify and understand product(s); Measure outcomes” (2011, p.2). The concepts contained within the framework were all clearly stated, and included “A pre/post intervention design….to test the impact of nurse-driven interventions based on current evidence to reduce CAUTIs in hospitalized patients on 2 medical/surgical units” (Oman et al, 2011, p.1). Variables in this study were numerous. The dependant variables in this study were incidence rates of CAUTI, catheter duration, LOS, bladder scanner usage, and product streamlining. The independent variable was solidified as “nursing interventions” but was broken down into a series of interventional options presented to nurses who were participating in the study. Oman et al also described additional technology provided to the unit, such as bladder scanners, as well as numerous methods of educational support provided to nurses and nursing assistants on the sample unit. Because there were multiple variables at work within the sample unit simultaneously, it was it was impossible within this framework to identify which nursing intervention was most effective or which were not highly effective, nor was the educational component of the study evaluated from the standpoint of effective education of the nursing staff. Although there were several variables to consider in this study, each was clearly outlined and identified by the researchers. The relationships between the concepts were presented in very clear terms. Hypothesis and Research QuestionsThis study was based on a quality improvement approach, and Oman et al describe a gap between the evidence-based nursing practices current to our nursing practice and the availability of these concepts to disseminate within the nursing population. “The goal of this quality improvement study was to decrease CAUTI rates through implementation of hospital-wide nursing interventions that emphasized education for inpatient nurses and specific unit-based nursing practice actions on a pulmonary medical and a general surgical inpatient unit” (Oman et al, 2011, p. 4-5). The hypothesis was not written in a single declarative sentence, but can be derived indirectly by referencing the framework and assessing the reflection at the end of the study, which state that “The findings of this project support the effectiveness of implementation of a CAUTI program that encompasses nursing education, competency training, products, and surveillance to positively impact patient outcomes. Re-examining a common nursing procedure resulted in improved practice with IUC care and improved patient outcomes” (2011, p. 5). Quantitative DesignThe Oman et al study was a quantitative study, which sought to systematically describe variables, test their relationships, and examine the cause-and-effect of nursing interventions on CAUTIs in hospitalized patients. Oman et al used a quasi-experimental pretest/posttest design which was specifically identified as their chosen method, and further subdivided this study into three phases (baseline data collection; house-wide intervention; second data collection) which were all critically evaluated. This was a quasi-experimental and not a true experimental study because complete control over all of the variables was possible. The design of the study was very effective in examining the results of the study because the variables were clearly identified and the relationships between those variables was clearly constructed. Threats to the internal validity of the study were controlled by explaining in detail each of the nursing interventions encouraged in the intervention group, and how each one correlated to a reduction in the use of or the infection rates of urinary catheters. One threat that could not be controlled was the sample population; although two units were utilized (one medical and one surgical) the population diversity among the patients was minimally described, and the nursing staff was not described, including but not limited to years of experience within the nursing staff. This study was conducted using only that single trial at a single hospital which creates a study bias. Definition of the ‘Student T’ test was not cited and not explained or summarized which left a gap in the study instrumentation which is important also to internal validity. Sampling ProcedureThe target population is identified several times throughout the study, including an introduction to this population in the very first sentence of the study which reads “Hospital-acquired, catheter-associated urinary tract infections (CAUTIs) are a common and costly health care concern” (2011, p.1). The target population is later clarified in the purpose statement, which was “The purpose of this quality improvement process study was to develop and implement evidence-based, multifaceted, nurse-driven interventions to improve urine elimination management in hospitalized patients…” (2011, p. 2). The population included within the selected nursing units was not adequately described within the study: ages, backgrounds, comorbidities, etc. Although it is necessary to acknowledge that Oman et al did include a table to identify the mean age and the breakdown of the male/female proportions on each unit, no correlation between that data and the context of the study was made. The sampling procedure was not descriptively identified, and it was only briefly mentioned that the average daily census of each nursing unit was 18 patients per day for a sum of approximately 150 patients per month. It was not specified whether or not all of part of the patient population on these units was included in the study, and the reader was left to assume that this was a convenience sampling of the accessible population. A convenience sampling is a weak approach to enforcing the internal validity of a study because it “provides little opportunity to control for biases; subjects are included in the study merely because they happen to be in the right place at the right time” (Burns & Grove, 2011, p. 305). This accounts for both the population of the patients as well as the population of the nurses who were included in this study. Because this study was only conducted in two nursing units at a single hospital, the potential biases are numerous and it is too narrow to consider it a complete and accurate representation of both the nursing and the patient populations at large. “Our assessment of the focused interventions within 2 units may have provided only a snapshot of the overall effectiveness of the education, policy and product changes implemented in this study as a more comprehensive assessment of the impact of the intervention were not undertaken” (Oman et al, 2011, p. 5). The issue of subject dropout was completely omitted.Data CollectionData collection and measurement was explored extensively in this study. “Demographic patient data, CAUTI rates, and IUC duration were collected at baseline (phase 1) and after the two intervention phases” (Oman et al, 2011, p. 3). Oman et al describe the data collection intervals for the incidence rate of CAUTI, and indicate that demographic data was compiled but the group fails to include any of that information in the study. Catheter duration, length of stay (LOS), bladder scanner usage, and product streamlining were also measured and correlated as part of the study outcome (Oman et al, 2011, p. 4). The descriptions of these, as well as the instruments of measurement used to evaluate each variable was included and adequately described each so that the effectiveness of the interventions as a whole could be validated. There were no extensive analytical models presented as a component of any of the variables; instead “All variables were summarized using descriptive statistics appropriate for the level of measurement. Statistical analyses were conducted to compare the differences between the baseline and the 2 post-intervention catheter-days… CAUTI rates were not compared because of the low numbers of incidences and rates” (Oman et al, 2011, p. 3). This statement is a bit confusing, and does not precisely identify which rates were compared (or not compared) at the conclusion of the study to validate the effectiveness of the nursing interventions as an independent variable. Thorough attention was paid to describing the educational methods used to train nursing staff including attendance rates, defining characteristics of catheters used, variances in the LOS among the patient population, and bladder scanner usage. The data collection component of this study was thorough and only minimally biased, but would have benefitted from a definition of the Student t test (Oman et al, 2011, p. 3), a population description of the nursing staff including years of experience. Study FindingsThe study findings at the end of the research study report directly reflect the problem and the purpose statements at the beginning. “The findings of this project support the effectiveness of implementation of a CAUTI program that encompasses nursing education, competency training, products, and surveillance to positively impact patient outcomes” (Oman et al, 2011, p. 5). Because of the study framework and the methods of data collection, it was not determined which of the nursing interventions included in the study (education of patients and families, questioning physician orders, education of nurses and supportive care staff, bladder scanner use, alterations in catheter equipment, charge nurse catheter rounds, and increased availability of bedside commodes) were most effective. Determining which interventions were most effective were not a part of the hypothesis or scope of this study. “It was beyond the scope of this quality improvement project to determine which of the individual components of this comprehensive intervention were the most effective in changing practice. However, our results suggest an important impact of the house-wide intervention on catheter duration apart from the focused intervention” (Oman et al, 2011, p. 5). Additional limitations within this study were disclosed, and included a concern regarding external validity. “In addition, the number of CAUTIs on the intervention units during the study period was low, and the confidence intervals around the CAUTI rates were relatively large, making it difficult to assess the impact of the intervention on the outcome of interest” (Oman et al, 2011, p. 5). Table 3 on page 4 describes per-patient catheter duration measured in days, and shows an improvement on both the pulmonary and the general surgery units by indicating a decrease in the number of days patients remain with an indwelling urinary catheter. The researchers also individually address each of the primary patient outcomes: catheter duration (per table 3), incidence of CAUTI (decreased from 3.4 patient days to 2.2 in the third period), length of stay (from 6.91 to 6.55 days on the surgical unit and from 7.39 to 6.72 on the pulmonary unit), bladder scanner usage (50 recorded uses total with only 2 patients out of those 50 who required a catheter reinsertion), and product streamlining (removal of silver alloy indwelling catheters in a cost-savings effort did not negatively affect the CAUTI rates). After reviewing the evidence presented in an objective manner, it seems logical to conclude that these interventions did have a positive effect on decreasing the CAUTI rates.Implications for PracticeBecause this study was directly aimed at assessing the effectiveness of nursing interactions within the population of hospitalized patients who require an indwelling urinary catheter, assimilation of the results of this study are relatively simple. “Focusing on nursing-driven interventions to improve the nursing care of ICUs was found to positively impact CAUTI rates. Re-educating on the importance of a perceived ‘basic’ skill and infusing best evidence into current practice were important to raise awareness of simple interventions that positively impacted patient outcomes” (Oman et al, 2011, p. 5). It is not possible to select which intervention was the most successful or effective, but to provide emphasis on a larger scale that best practice methods in nursing do have positive effects on patient outcomes. The researchers caution, though, that nurses are not completely independent. “To effectively change practice, multifaceted efforts are necessary to reduce CAUTI in hospitalized patients. IUCs are often indicated in the management of patients in acute care hospital facilities, and efforts that re-examine practice and strategies for care management based on best evidence are needed and must be continuously revisited” (Oman et al, 2011, p. 5). Article Three Review of LiteratureElpern et al. did not include literature review in their study. Greater than 50% of their sources are current; however, there was no indication of databases used for acquisition of sources. They also did not include a critical appraisal of their sources. No quotations were used in the article, however, the sources which were used appeared to have proper citation throughout.Study framework/theoryElpern et al. did not identify a specific framework used for this study. However, the authors appear to have used intervention theory. According to Burns & Grove, “Such theories direct the implementation of a specific nursing intervention and provide theoretical explanations of how and why the intervention is effective in addressing a particular patient problem” (Burns & Grove, 2011, p. 238). In the case of this study, the intervention is removal of inappropriate catheters, assessment for need of catheters and early removal of indwelling catheters.HypothesisThe hypothesis used was, “days of use of urinary catheters and number of CAUTIs would decrease during the intervention months compared with the 11 months before the intervention. Total days of use of catheters and monthly CAUTI rates before and during the intervention were compared using unpaired t tests. Significance was set at P <.05” (Elpern et al., 2009, p. 537). Elpern et al. defined a CAUTI as “an infection in a patient with a urinary catheter who met National Healthcare Safety Network definition of a urinary tract infection” (Elpern et al., 2009, p. 537). The authors also used a formula to calculate CAUTI rates. CAUTI rates were defined as, “the number of CAUTIs divided by the number of urinary catheter device days multiplied by 1000. CAUTI rates were computed monthly” (Elpern et al., 2009, p. 537). Research design/data collectionElpern et al. (2009) state that, “this study was a before-and-after evaluation of a low-technology intervention to reduce duration of urinary catheterization and occurrence of CAUTIs in an MICU.” Subjects included in the research study consisted of all MICU patients admitted from December 1, 2007 to May 31, 2008 who had indwelling catheters as part of their unit stay (Elpern et al., 2009). The data collected during the intervention phase of this study was duration of catheterization, appropriateness of catheterization, and reasons for inappropriate catheter use. Surveillance for CAUTIs was completed by nurse epidemiologists from the medical center’s infection control department (Elpern et al., 2009, p. 537). There are many threats to the external validity of this study. Some of the threats are discussed by the authors, such as the subjectivity which was involved in daily evaluations, appropriate catheter use was consensus based and not evidence based, and differences of opinion on catheter use were deferred to the judgment of the nurses providing direct patient care.Study FindingsElpern et al. provided detailed statistical information to support their research findings. The data analysis is included with the results of the study. It is reported that, “during the 6-month intervention, 337 patients had indwelling urinary catheters for a total of 1,432 days. Before the intervention, the mean number of urinary catheter days was 311.7 device days per month (d/mo)”(Elpern et al., 2009, p. 538). Continuing on with the data analysis, Elpern et al. stated that the comparison of data pre and post intervention has demonstrated a decrease in the mean catheter days to 238.6 d/mo, for a total reduction of 73.1 d/mo. “In the 11 months before the intervention, 15 CAUTIs occurred during 3,429 device days or 4.7 per 1000 days. In the intervention phase, zero CAUTIs occurred in 1,432 device days” (Elpern et al., 2009, p. 538). The stated statistical findings are significant.Implications for PracticeIt is very apparent that by assessing the actual need for indwelling urinary catheters and using guidelines which allow catheter use for specific purposes only, the CAUTI rates had been completely eliminated in this study. It is not a feasible idea for complete elimination of CAUTIs due to the nature of the invasiveness. Elpern et al. stated that, “despite strict adherence to indicators, some CAUTIs will inevitably occur. Reasonable goals are to avoid overuse of indwelling urinary catheters and reduce CAUTI rates” (Elpern et al., 2009, p. 540). Recommendations Urinary catheterization is a necessary component of patient care in many different types of patient situations, yet overuse of catheters has been demonstrated in all three articles to be a significant contributor to high infection rates. In addition to possessing a questioning attitude with catheter use, there are other actions that can be taken by a nurse to assist in the reduction of CAUTI for those that do require prolonged catheterization: daily reassessment of the need for the catheter, intentional catheter selection based on individual patients and not nurse preference, detailed patient care documentation, charge nurse rounds on every shift, education of patients and family members about proper catheter care, and ongoing competency training for both nurses and nursing assistants. Because CAUTI can become a significant comorbidity, and is not a reimbursable medical condition for some major insurance payers, careful attention to this condition is vital. As a group, we recommend careful consideration of the need for each and every indwelling catheter that is placed, and for hospitals to develop practice policies that reflect the recommendations listed above.ConclusionEach of these three articles was chosen because they appeared to be strong studies that directly reflected the potential for nurse-specific interventions related to CATUI. Although each quasi-experimental study had its own challenges and areas of bias, each was constructed differently enough from one another to cover those gaps, at least in part. There is enough evidence included within the three studies to make a strong recommendation for changes in nursing practice and to validate the importance of doing so.ReferencesAndreessen, L., Wilde, M., Herendeen, P.,(2012). Preventing Catheter-Associated Urinary Tract Infections in Acute Care. Journal of Nursing Care Quality. 27(3), 209-217. Retrieved from , N. & Grove S. K. (2011) Understanding nursing research: Building an evidence-based practice. Maryland Heights, MO: Elsevier Saunders.Elpern, E.H., Killeen, K., Ketchem, A., Wiley, A., Patel, G., & Lateef, O. (2009). Reducing use of indwelling catheters and associated urinary tract infections. American Journal of Critical Care, 18(6), 535-541. doi:10.4037/ajcc2009938Oman, K., Makic, M.B., Fink, R., Schraeder, N., Hulett, T., Keech, T., & Wald, H. (2011). Nurse-directed interventions to reduce catheter-associated urinary tract infections. American Journal of Infection Control. doi:10.1016/j.ajic,2011.07.018 Paper #1 Evidence-Based Group Project PaperGrading Criteria30% of grade for paper can be deducted for APA errors including Spelling and grammar after paper graded.HeadingsPossible pointsPointsEarnedCommentsAbstract and Title Page10Introduction(What is the problem or question; Provide support for relevance of the question; Clearly describe the aim of the project & paper)10A descriptive summary of the most relevant & best evidence to answer the research question (there is not analysis here, just a description of what you found in the literature)20An analysis of the evidence (this is a critical appraisal of the evidence and what you feel as a group the evidence suggests and whether there is strong or weak evidence to support the suggested findings) 20Describe how the evidence is affected by your experiences as nurses, patient preferences, nursing's or other's values and how these factors would influence your decision to utilize the evidence in practice20 Make a recommendation as to whether or not to utilize the evidence (support your recommendation with rationale)20APA spelling and Grammar DeductionsTotal points100 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download