ways to prevent CAUTI

ways to prevent CAUTI

Introduction

Healthcare associated infections (HAI) are the leading cause of morbidity and mortality in hospitalized patients (Edward et. al, 2016). Even though the percentage of the of Catheter Associated Urinary Tract Infection (CAUTI) grew considerably in the last several years, the battle against these infections has made the difference in decreasing the number of infected patients. Populations at risk are elderly patients undergoing surgery and patients with incontinence. Among other purposes, urinary catheters are primarily used for draining urine after surgeries and for urinary incontinence (Singha et. Al, 2017), which often is the port of entry for bacteria. CAUTI is becoming a very serious issue in the healthcare industry, and really problematic with patient-family relationship with the hospital. Some tragedy to prevent this HAI is for instance reinforcing hand hygiene in the healthcare setting, maintain infection control, and the use of the of some catheter coated with 100% silicone.

Search Strategy

This research was done using Frostburg University library data base. To research my articles, words such as, CAUTI and hospitalized and elderly patients in the hospital setting were used. The purpose of the research was to find the way to prevent, and or reduce Catheter Associated Urinary Tract Infection (CAUTI). This research seeks the question, what are some ways to prevent CAUTI?

Using the population affected, some interventions that could potentially help solve the problem we found. The true problem here is what healthcare staff are missing, which are problems that stem from hand washing, proper hygiene when taking care of the of patients with catheter, or sterile technique when inserting the catheter. The source of microorganisms causing CAUTI can be endogenous, typically via meatal, rectal, or vaginal colonization, or exogenous, such as via contaminated hands of healthcare personnel or equipment. Microbial pathogens can enter the urinary tract either by the extra-luminal route, via migration along the outside of the catheter in the peri-urethral mucous sheath, or by the intraluminal route, via movement along the internal lumen of the catheter from a contaminated collection bag or catheter-drainage tube junction (CDC, 2009). With this high risk of contagion, is it possible to reduce or erase the number of affected patients by establishing a monthly reminder for hand washing and sterile technique in comparison to every six months? By looking into this research, some precautions that can prevent CAUTI, like the use of silver coated 100% silicone were found.

Some research intends to provide an expansive insight into the various antimicrobial agents currently being researched for urinary catheter coatings (Singha et. Al, 2017). According to CDC, approximately 75% of urinary tract infections are caused by urinary catheters and 15–25% of hospitalized patients undergo catheterization. Another research used an electronic survey to examine Indwelling Urinary Catheter (IUC) care practices for CAUTI prevention in three areas. The first area was equipment and alternatives, insertion and maintenance techniques; the second one was personnel, policies, training, and education; and the third one was documentation, surveillance, and removal reminders (Fink et. Al, 2012). In the last research a comprehensive chart review was conducted for all adult inpatients with Foley catheters who presented with positive urine cultures at least 48 hours after admission. Patients with chronic Foley catheters and catheters inserted in the surgical department were excluded (McArdle, 2005).

PICO

P- Hospitalized patient with critical condition. I- In-service every month about hand washing before and after care for each patient and maintaining sterile technique will be a good way to reinforce patient safety. C- Establishing in-service every month will be better reinforcement than every six months to improve quality of care. O- Reduce or erase Catheter Associated Urination Tract Infection in critically ill patient.

Infection acquired in the hospital is becoming more prevalent. The term CAUTI (Catheter-Associated Urinary Tract Infection) came about due to the fact that majority of infections in the hospital are derived from catheterization. In the hospital, they are emphases on hand hygiene before procedures and yet there is still an increase in the percentage of CAUTIs. The purpose of this project is to determine if proper hand hygiene can erase, if not reduce CAUTI in hospitalized patient.

Literature Review

During research, nurses were the most frequently reported IUC inserters. Training in aseptic technique and CAUTI prevention at the time of initial nursing hire was provided by 64% of hospitals; however, only 47% annually validated competency in IUC insertion. Systems for IUC removal were implemented in 56% of hospitals (Fink et. Al, 2012).

The research based on educating nurses was done using a quasi-experimental study on one group, before and another group after design was used to evaluate changes in CAUTI rates before and after the educational interview in the hospital in the southeastern among 63 nurses. At the end of the study, analysis of CAUTI rates were conducted using a chi square test to evaluate whether there was a significant difference in the CAUTI rates, and the results of this study demonstrated that educating nurses on the CDC recommended Evidence Base Practice (EBP) guidelines and providing them with leadership supports significantly decreased CAUTI rates on a medical surgical unit (Gordon et. Al, 2015). Following the study, findings suggested that using an effective approach to decrease CAUTI rates can create social change and initiate additional planning strategies for all healthcare settings (Gordon, 2015).

Another review was done using the silver-coated 100% silicone, to determine the impact on patient safety and CAUTI reduction; a decision was made to evaluate a silver-coated 100% silicone Foley catheter system in comparison to the current non-silver-coated latex Foley catheter system. The result revealed an overall CAUTI reduction of 75% with the implementation of a silver coated 100% silicone with the reduction of the resistant organisms in acute care hospital and a skilled nursing faculty (SNF) (McArdle, 2005). The problem with the silver coated Foley catheters is the cost associated with them.

Practice Recommendations

One of the most effective ways to avoid CAUTIs is by educating patients and nursing staff. When making an effort to promote better outcome learning and education is key, if all staff members in all departments at the hospital become aware of how critical the matter is it will be a good start on the path towards change. Hospitals may set up in-service to teach about the importance of following protocol. This implication from the studies indicates the influence that hospital have in whether the percentage of CAUTI decreases or not. Nurses for example promote preventive measures, provide education and evaluation in the nursing department. Educating patients about assessing the need for catheter will be helpful. Having a Foley catheter might make it easier to measure urine output put it is an easy access for bacteria and could be detrimental to patients in the long run. So early removal is crucial in preventing CAUTI. The results from research study suggest that education coupled with practical application of an evidence-based intervention will increase nurses’ perceptions and attitudes of EBP and contribute to successful adoption of the intervention (Connor, 2011).

Reinforcing sterile technique, hand washing before and after each procedure will definitely make a huge difference in term of keeping the patient safety. Prevention practices commonly followed included wearing gloves (97%), hand washing (89%), maintaining a sterile barrier (81%), and using a no-touch insertion technique (73%) (Fink et al., 2012). Sometimes in the hospital one tends to forget to maintain this barrier. Simple hand washing after taking care of one patient and before administering care to another can make a significant difference. Sometimes one might think that by wearing gloves there is no need for hand washing, but that isn’t the case because hand washing is also very important after taking off gloves. Remove catheters when no longer needed, maintain a close system keeping bag and tubing below the bladder are the key components of basic practices (Edward et al., 2016). One of the important things also is tried to follow the procedure on how to insert a catheter. Clean the perineal area before insertion will prevent pushing bacteria in the urinary system.

A study was made about the use of silver-coated 100% silicone Foley catheters, and the result showed a decrease in the percentage of patients with CAUTI at the hospital compare to the patients using the latex Foley catheter system. This study was conducted comparing the two kind of catheter, findings suggested that silver-coated 100% silicone Foley catheters are effective at reducing the incidence of CAUTI and resistant organisms in an acute care hospital and a SNF, thereby increasing patient safety (Mc Ardle, 2005).

Conclusion

At the end of the day, we are beginning to discover that CAUTI is a true problem that is being faced by hospitals all over the continent. By studying these researches, we can see that a lot is being done with the intention of resolving the problem. We saw in some studies the high percentage of infected patients at the hospital every day. One thing we as healthcare staff should know is that, the very simple way to stop germs are hand washing and maintaining sterility when necessary. Now the way to succeed in this plan, is through education of the staff, by doing in service.  In addition to these alarming statistics, the increasing cost and health related complications associated with catheter associated UTIs make the research for antimicrobial urinary catheter coatings even more pertinent (CDC, 2009).

APPENDIX A

Individual Evidence Summary

References

TILLEKERATNE, LG; et al. Major article: A multifaceted intervention to reduce rates of

catheter-associated urinary tract infections in a resource-limited setting. AJIC:

American Journal of Infection Control. 42, 12-16, Jan. 1, 2014. ISSN: 0196-6553.

CONNOR, BT. Exploring Factors Associated with Nurses’ Adoption of an Evidence-Based        Practice to Reduce Catheter-Associated Urinary Tract Infections. 2011. 106 p. Thesis   (Ph.D.) – Medical University of South Carolina.

MARRA, AR; et al. Major article: Preventing catheter-associated urinary tract infection in the

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MCARDLE, P. Increasing patient safety through the use of silver-coated 100% silicone Foley      catheter system. American Journal of Infection Control. 33, 5, e130, June 2005.       ISSN: 01966553.

GORDON, PR. The Effects of Nursing Education on Decreasing Catheter Associated Urinary

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Parker, D; et al. Nursing interventions to reduce the risk of catheter-associated urinary

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SINGHA, P; LOCKLIN, J; HANDA, H. Review article: A review of the recent advances in        antimicrobial coatings for urinary catheters. Acta Biomaterialia. 50, 20-40, Mar. 1, 2017.             ISSN: 1742-7061.

FINK, R; et al. Major article: Indwelling urinary catheter management and catheter-associated     urinary tract infection prevention practices in Nurses Improving Care for Health System            Elders hospitals. AJIC: American Journal of Infection Control. 40, 715-720, Oct. 1, 2012.        ISSN: 0196-6553.

Edward J., S; Julia, M. Prevention of Device-Related Healthcare-Associated Infections [version   1; referees: 2 approved]. F1000Research, Vol 5 (2016). 2016. ISSN: 2046-1402.

CDC (2009) GUIDELINE FOR PREVENTION OF CATHETERASSOCIATED URINARY

            TRACT INFECTIONS

https://www.cdc.gov/hai/pdfs/cautiguideline2009final.pdf