Evidence-Based Population Health Promotion Programs
The program aims at reducing the incidence of catheter-associated urinary tract infections (CAUTIs) which is among the leading causes of preventable hospital-acquired infections. The program will focus on reducing the morbidity and mortality among elderly patients using catheters in the United States. The objective of the study is improving quality of medication as provided in the Healthy People 2020 goals ( Magers, 2013) . There are many evidence-based population health promotion programs for elderly patients using catheters. The strategies aimed at reducing the incidence of CAUTIs have been broadly studied by clinical experts from Centers for Disease Control and Prevention (CDC) and Centers for Medicare and Medicaid Services (CMS). Therefore, this study aims at improving on the already studied and approved evidence-based strategies to curb the ever-increasing burden of CAUTIs ( Magers, 2013) . The two preventive strategies to reduce CAUTI chosen to create my program are reducing the duration of catheterization and ensuring properly trained persons insert and maintain catheters while observing all good hygiene practices.
Control of the duration of urinary catheterization has a great impact on CAUTIs. Even though it seems like a simple measure, logistics indicate that it can reduce the frequency of infection among elderly patients. Studies have shown that prolonging the duration of indwelling catheters in a patient increases the risk of getting CAUTIs which have been ranked as the leading cause of nosocomial infections. The incidence of CAUTI increases by 5-10% per every day of catheterization ( Parry, Grant & Sestovic, 2013) . Therefore, in order to reduce patient discomfort, morbidity, mortality, and the healthcare costs incurred in treating patients with CAUTI, reduction of the period of catheterization is one of the major strategies to be employed by healthcare providers. The program will invest in reminder systems and nurse-driven protocols that can be employed by health facilities to ensure catheter removal is timely scheduled ( Parry, Grant & Sestovic, 2013) . According to previous studies, indwelling catheters should not stay for more than four days before changing because CAUTI incidence peaks up on the sixth day of catheterization.
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The general principles of infection prevention and control surround proper hygiene practices. Apart from proper insertion and removal of catheters by qualified personnel, hand hygiene, employing aseptic technique when handling catheters, hand decontamination, and personal protective equipment like gloves and gowns, are among the measures that can be employed in healthcare facilities to reduce the incidence of CAUTI ( Magers, 2013) . Therefore, this program will employ various ways that can be used to reduce the rate of infection. Before embarking on the measures, engaging both patients and medical practitioners to explain to them why the interventions are important will be important.
Therefore, patient education, designing an intervention toolkit that will remind and evaluate nurses' performance will be designed for the program ( Parry, Grant & Sestovic, 2013) . The toolkit will decide whether aseptic techniques, hand and personal hygiene and patient preparation are observed by all nurses that handle elderly patients with indwelling catheters. Since most of the above-mentioned measures have been studied, the program will focus on other minor measures that medical practitioners tend to ignore. For example, disinfection of insertion site prior to catheterization, maintaining sterility of the catheter throughout the period of catheterization and outlining various insertion procedures for different types of catheters. It has been shown that despite the use of antibiotics and reducing the period of catheterization, CAUTI remains a persistent challenge. Therefore, other measures like hygiene and proper procedures of insertion and removal of catheters should be employed because they have a significant contribution to the rate of infection with CAUTIs ( Parry, Grant & Sestovic, 2013) .
How Donabedian Model could be applied to Improve Outcomes of CAUTI Prevention
Donabedian model is a conceptual model that provides a framework for evaluating the quality of health care and examination of health services. The model divides dimensions of quality care into structure, process, and outcome. In terms of structure, the model helps to eliminate physical and human factors that may affect the success of the program. Therefore, the structure is the key to identification of possible problems such as patient non-compliance and lack of resources that may hinder the success of the project ( Magers, 2013) . The process helps to determine whether there are medical records and technical equipment required to provide quality care. Lastly, outcome contains the impact of the program on the targeted populations. Therefore, changes in health status and general behavior of patients are the important indicators of the success of the preventive strategies and if improvements are required.
Questions and Answers
What is your target population and topic?
The target population is elderly patients using catheters ( Magers, 2013) .
Topic – Preventive Measures to Reduce the Rate of Catheter-Associated Urinary Tract Infections
What might the name of your proposed program be?
Step by Step, Evidence-Based CAUTI Prevention Collaborative Program.
What evidence-based data and program(s) are you basing your program upon?
CAUTI are among the leading causes of morbidity, mortality, and increased the cost of medical care among nosocomial infections.
Reducing the duration of catheterization. The incidence of CAUTI increases by 5-10% per every day of catheterization ( Parry, Grant & Sestovic, 2013) .
Poor hand and personal hygiene increase chances of a patient getting CAUTI. Therefore, observing good hygiene practices is a key strategy for reducing the incidence of CAUTI.
Improper insertion and removal of indwelling catheters increase the risk of getting CAUTI ( Parry, Grant & Sestovic, 2013) . Therefore, ensuring catheters are handled by qualified personnel is the first step towards reducing this problem.
How might your program be innovative?
The program aims at studying the current evidence-based preventive measures that have been studied before by medical experts from recognized medical research institutions like CDC and CMS ( Magers, 2013) .
The program will aim at improving on the methods by coming up with strategies that can help healthcare providers stick on the programs.
Also, it will look into minor practices that medical practitioners ignore yet they have a significant contribution to the rate of CAUTI. The program will focus on coming up with a toolkit that will work as a reminder for nurses to timely change catheters ( Parry, Grant & Sestovic, 2013) .
It will also provide simple steps for changing catheters that patients can learn and remind their caregivers when they forget or omit a step.
What is your proposed population health promotion strategy?
Reducing the duration of catheterization.
Observing good hygiene practices and ensuring catheters are handled by qualified personnel ( Magers, 2013) .
What length of time are you proposing for your population health program?
The program will take 18 months.
It will be divided into three months of collecting and comparing data in the selected health facility, nine months of the study, 1 month of analyzing the data, 2 months of approval, and 3 months of implementation of the program if it is successful ( Parry, Grant & Sestovic, 2013) .
What teaching material might you have for your proposed program?
Physician and nurse toolkit with protocols on how to limit insertion of catheters to only those conditions for which there is an indication and to remove catheters as soon as possible ( Parry, Grant & Sestovic, 2013) .
Nurse-driven step-by-step charts and manuscripts on proper hygiene practices and procedures for handling various types of catheters.
How did the program developers evaluate their program? How will you evaluate your program?
The developers of the original study on preventive measures of reducing the incidence of CAUTI evaluated their strategy by determining whether it meets the nine aims for quality improvement.
They ensured the program is population-centered, equitable, risk-reducing, health-promoting, efficient, effective, straightforward, and vigilant ( Magers, 2013) .
They also used a summative and outcome evaluation to determine the impact of the program on the target group (elderly patients using catheters).
For my program, I will use formative and process evaluation before actualizing the study ( Magers, 2013) . This is because the study is based on improving previous studies therefore, the formative evaluation will provide qualitative feedback that will be used to improve on areas that previous studies were unable to effectively accomplish.
References
Magers, T. L. (2013). Using evidence-based practice to reduce catheter-associated urinary tract infections. AJN The American Journal of Nursing , 113 (6), 34-42. Retrieved from https://www.nursingcenter.com/cearticle?an=00000446-201306000-00027&Journal_ID=54030&Issue_ID=1552701
Parry, M. F., Grant, B., & Sestovic, M. (2013). Successful reduction in catheter-associated urinary tract infections: Focus on nurse-directed catheter removal. American journal of infection control , 41 (12), 1178-1181. Retrieved from http://www.ajicjournal.org/article/S0196-6553(13)00662-7/fulltext
