Enhancing Quality and Safety
Health care associated infections are infections that develop when one is receiving healthcare .One of the most common HAI reported to the National Healthcare Safety Network (NHSN) is the catheter acquired urinary tract infection (CAUTI) making up approximately 75% of the total UTI cases acquired in hospitals (Center for Disease Control and Prevention, 2019).The urinary catheter tube is usually inserted into the bladder through the urethra to aid passing of urine to reduce bladder dysfunction after anesthesia, surgery and immobility. The most crucial risk factor for occurrence of a CAUTI is prolonged us of the catheter. The infections lead to longer patient admission in the hospital and increase hospital bills. Nurses are very important in addressing a patient’s wellbeing. They have the power to educate patients, advocate for preventative measures and reviewing evidence-based practice methods to reduce CAUTIs (Gordon, 2015). It is important for nurses to improve catheter insertion skills to ensure a reduced risk of infection.
Factors Leading to Catheter Acquired Tract Infection Focusing on Medical Administration
The CAUTIs develop as a result of the organisms inoculated into the bladder by urethral catheters which in turn promote colonization by providing a surface suitable for adhesion of bacteria leading to mucosal irritation (Brusch, 2020). There are several ways in which the infection may occur including (Nall, 2017)
Delegate your assignment to our experts and they will do the rest.
Contamination of the catheter during insertion.
Failure to frequently drain the urine bag.
Movement of the bacteria in the bowl to the catheter
Backward flow of urine in the catheter bag into the bladder
Failure to regularly clean the catheter.
Prolonged use of the catheter.
CAUTIs cause increased morbidity, mortality, increased healthcare costs and longer hospital stays. The infections are especially dangerous for severe head and spine injury patients due to their already existing morbidity and mortality rates (Podkovik et al., 2019). The infections exhibit similar symptoms to one’s original illness making it hard to be diagnosed. According to the Infectious Disease Society of America, a catheter related urinary tract infection is diagnosed if it meets the following criteria
A urinary catheter is being used by the patient two days after insertion
A symptom of CAUTI occurs. The symptoms include suprapubic tenderness, fever, costovertebral angle tenderness, unexplained fatigue, vomiting and urgency or dysuria
Urine culture has more than 105 colony forming units (CFU)/mL of one bacterial species
Nurses are key parties in the prevention of CAUTIs but their effectiveness is hampered by limited institutional resources, little knowledge regarding the available evidence-based indications for urinary catheter insertion and maintenance and a suboptimal organizational culture (Olatunji, 2019). To help further harm to patients and save lives, it is important for nurses to focus on current evidence-based methods to indwelling catheter use that help reduce incidence of CAUTIs.
Evidence-based and Best Practice Solutions to Improve Safety
Nurses are largely in control of patient’s catechization duration. Careful execution of an education program designed specifically for nursing staff has a high chance of achieving better patient outcomes and reduction of infection rates of CAUTI. Important evidence-based guidelines to catheter use that help in CAUTI prevention developed by Brain Connor, an assistant professor at the Medical University of South Carolina College of Nursing in Charleston, and a colleague include (Connor,2018).
Always considering the smallest possible antimicrobial –impregnated catheter and documenting the time and date of insertion
Frequent monitoring and assessment of patients who have catheters. The data on the number of patients, the type, size and duration of each catheter is very important. Indwelling catheters should only be used in medically necessary instances. Some unnecessary reasons for catheter insertion include obesity, perceived patient discomfort, protection of skin integrity and urinary incontinence.
Careful insertion of the catheter. It is crucial that the tubing is never elevated or drainage bag secured above the insertion site.
Development of daily reminder systems that alerts physicians to assess the patient’s urinary status and consider removing the catheter if no legitimate reason for continued catheter use exists. Several studies have identified that prolonged catheter use greatly increases CAUTI risk. Most existing nursing documentation only cover a small area for genitourinary assessment.
The education of nursing staff members is critical part of ensuring the implementation of the current evidence-based practice procedures for insertion and removal of the catheter (Olatunji, 2019). Critical care nursing educators should identify the most effective ways of assisting their professional nurses gain the knowledge they require to practice the evidence-based practices for efficient reduction of infections.
How Nurses can Help Coordinate Care to Increase Patient Safety
One of the most important responsibilities of nursing is to improve patient outcomes. To achieve the best outcomes, evidence practice gaps need to be identified and best practices implemented to bridge those gaps. Several studies suggest that deaths caused by CAUTIs are preventable and nurses are key partners in the prevention of harm to patients. Nurses are required to implement best practices in the insertion of catheters, proper maintenance of the catheters and timely withdrawal of the catheters. The implementation of the daily reminder systems with all information regarding a patient is important in the catheter management. Nurse driven protocols are efficient in addressing CAUTI infection control issues (Hamilton, 2018). There are several frameworks that have been developed to review the existing structures within healthcare institutions that are linked to indwelling urinary catheters and provide the basis for improving and achieving optimal patient outcomes.
The CAUTIs best practice guidelines will empower nurses to challenge IUC usage and inappropriate indications. Due to the key role nurses play, it is also important that they are provided with the evidence-based knowledge required to advocate for good patient’s outcomes (Gordon, 2015). By advancing nursing practices through education of nurses, CAUTI rates are likely to reduce.
Stakeholders with whom Nurses would Coordinate to Reduce CAUTIs Risks
Patient safety is a vital component of quality healthcare. All healthcare stakeholders have the responsibility of ensuring that minimal or no harm occurs to patients. The stakeholders include patients themselves, nursing educators, the society, researchers, governments, physicians, accrediting agencies and professional associations. Patients have the right to information regarding their illnesses and treatments required so as to help nurses make patient-informed choices based on patient opinion. This increases the safety of their care and are able to express their symptoms for better diagnosis and treatment processes (Hamilton, 2018). Nursing educators have the crucial responsibility of teaching nurses on how to handle CAUTI cases and the current guidelines in reducing their occurrence. It is important to coordinate with physicians to prevent prolonged use of the catheters and to ensure the catheters are not inserted for unnecessary purposes. Researchers are important in the reduction of CAUTI infection rates, as they analyse research evidence and stakeholder feedback to come up with evidence-based interventions. Government bodies, accrediting agencies and professional associations are important in ensuring the implementation of national guidelines to reduce occurrence of CAUTIs to prevent further harm to patients.
Conclusion
It is clear that implementation of evidence-based nurse-driven protocols significantly reduce the prevalence of CAUTIs which subsequently leads to better patient outcomes. The nurse-driven protocols play a big role in empowering the nurses to take charge of a patient’s welfare and lessen their risk of contracting a CAUTI. Also, it is important to focus on the education of nurses on recent evidence-based approaches to indwelling catheter use.
References
Brusch, J. L. (2020, May 3). Catheter-related urinary tract infection (UTI): Transmission and pathogens, guidelines for catheter use, diagnosis . Diseases & Conditions - Medscape Reference. https://emedicine.medscape.com/article/2040035-overview
Centers for Disease Control and Prevention. (2019, October 1). Catheter-associated urinary tract infections (CAUTI) . https://www.cdc.gov/hai/ca_uti/uti.html
Connor, B. (2018). Best Practices: CAUTI Prevention. American Nurses Association .
Gordon, P. R. (2015). The Effects of Nursing Education on Decreasing Catheter Associated Urinary Tract Infection Rates [Unpublished doctoral dissertation]. Walden University.
Hamilton, E. (2018). Nurse-Driven Protocol to Reduce Catheter Associated Urinary Tract Infection [Doctoral dissertation].
Nall, R. (2017, March 20). Catheter associated UTI (CAUTI) . Healthline. https://www.healthline.com/health/catheter-associated-uti
Olatunji, O. (2019). Education Program for Critical Care Nurses on Preventing Catheter-Associated Urinary Tract Infections [Unpublished doctoral dissertation]. Walden University
Podkovik, S.,et al ., (2019). Prevalence of catheter-associated urinary tract infections in neurosurgical intensive care patients – The Overdiagnosis of urinary tract infections. Cureus . https://doi.org/10.7759/cureus.5494
