This paper focuses on Catheter-associated urinary tract infections (CAUTIs) and ways that healthcare professionals can employ to minimize the use of the indwelling urinary catheter. This paper makes use of the research work conducted by Dy, Major-Joynes, Pegues, and Bradway referred to as “A nurse-driven protocol for removal of indwelling urinary catheters across a multi-hospital academic healthcare system. Urologic nursing”, published in 2016. The research work highlights essential steps in drafting and implementing a protocol that is nurse-driven in the healthcare industry. This study is vital considering the extensive effects of the CAUTI in the United States and worldwide. The authors note that approximately one million seven hundred thousand people suffer from CAUTI, out of which ninety-nine thousand die every year. These figures are worrying, thus need urgent intervention before the situation worsens. The implementation of nurse-driven removal protocol (NDRP) for the indwelling urinary catheter can generate positive results in healthcare institutions that have acute care. The NDRP technique entails various requirements and cooperation from other healthcare providers to achieve positive results. The intervention of nurses in this initiative is an essential component in the CAUTI prevention efforts.
NDRP
Various strategies aiming to prevent the infection of CAUTI have been developed across the world. The authors cite a case of one hospital that had the highest rates of CAUTI in the state of Pennsylvania. Following the intervention of clinical decision support that reminded healthcare providers of timely removal of IUCs, a decline in CAUTI rates from 3.6 infections for every one thousand-device days in the financial year 2010 to approximately 2.5 in the year 2012 was recorded. Despite this improvement, the CAUTI rates escalated in the fiscal year 2013 to 3.5. Consequently, the executive leadership of the given healthcare organizations decided to carry out a performance improvement regarding nurse-driven removal protocol (NDRP) for indwelling urinary catheters.
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The researchers provide elaborate practices and techniques that aim at preventing CAUTI for all hospitals that have acute-care. Among these practices and procedures is providing systems and guidelines documentation, deploying appropriate supplies and personnel; ongoing assessment and education of provider competencies; surveillance that includes standardized processes and criteria; as well as proper insertion and management of indwelling urinary catheters. Besides, the researchers recommend for additional methods, such as employment of an organization-wide program of identifying and removing indwelling urinary catheters whenever they are unnecessary; systematic and accurate reporting and analysis of the catheters; and protocol development for the management of post-operative retention of the urinary catheters.
Method
The researchers measured the nurse-driven removal protocol rates of adoption after the implementation of the removal protocol in the year 2014 to determine its utilization. This study is comprehensive as researchers managed to make a comparison of IUC device utilization and the CAUTI rates for twelve months of implementing NDRP for the healthcare system and each hospital combined. The research began in June 2014 and ran until May 2015. The long duration of the study indicates that the research team had to acquire the approval of the selected healthcare organizations before the study commenced. At the hospital, unit-based CNSs, managers, Clinical Information representatives and a team of researchers educated nursing staff in three acute care hospital concerning the placement, assessment, management as well as removal of indwelling urinary catheters. Device day and patient day denominators were used to calculate the CAUTI rates.
One of the techniques that were used to minimize the researcher bias is the employment of a statistical and epidemiology software application Stat Calc program in Epi Info 7. The program calculates the rate ratios, p values for the utilization of the indwelling urinary catheter device, CAUTI rates, and ninety-five percent confidence interval. The study went ahead to refine research by excluding the CAUTI cases that took place before the year 2015, thus reflecting only on necessary changes to the surveillance definition of CDC CAUTI, which was applicable until January 2015.
Results
The research indicates that the NDRP was rapidly adopted for implementation in various healthcare organizations. A record of between 40% and 60% of all indwelling urinary catheter removal orders was selected, varying from one hospital to the other, despite the availability of alternatives, such as Provider Will Access and Time and Condition for the healthcare providers. About the healthcare system, a record of 19% decrease in CAUTI rate for every 1000 indwelling urinary catheter days in comparison to the baseline period where p-0.13 was made. The most significant impact of the nurse-driven removal protocol was felt at the hospital, where the utilization of the indwelling urinary catheter decreased 6% and the CAUTI rate for every 1000 indwelling urinary catheter days was decreased 28% from the baseline.
Besides, researchers note that hospital produced the highest rates of baseline CAUTI and the highest NDRP overall adoption. The research is precise and accurate providing valid and reliable results that can be implemented to reduce the number of unnecessary deaths resulting from complications acquired in various healthcare institutions. The NDRP focused on evidence-based, multi-faceted and inter-professional approach by the examination of the current issues, using the best available evidence, building an elaborate process, and engaging team members from other healthcare professionals, such as physicians, staff nurses, United-based CNSs, nurse managers, and representatives from other health-related professionals. The study provides crucial information from its findings that need further research, support, and implementation to eliminate CAUTIs. The management of the current care of the indwelling urinary catheter is within the scope of the practice of nursing, and it plays a vital role in minimizing the risks associated with both infectious and non-infectious disorders linked to the application of the IUC.
Ethical considerations
Throughout the research work, patient privacy has been kept, as none of the examined patients has been mentioned. The authors also state that they sought informed consent of the target healthcare organizations before carrying out the research, which a requirement before carrying out this sensitive research task. The study is valid and progressive as it aims to save lives of people by minimizing the spread of CAUTIs.
In conclusion, the objective of this paper to analyze the scholarly work by Dy, Major-Joynes, Pegues, and Bradway; establish the significance of incorporating the nurse-driven removal protocol, and minimize CAUTI has been achieved. For instance, the study findings reveal that reducing the utilization of the indwelling urinary catheter by 6% can decrease the CAUTI rate for every 1000 indwelling urinary catheter days by 28% from the baseline. Therefore, various governments, non-governmental institutions, and other stakeholders need to adopt the NDRP technique to minimize or eliminate CAUTIs.
References
Dy, S., Major-Joynes, B., Pegues, D., & Bradway, C. (2016). A nurse-driven protocol for removal of indwelling urinary catheters across a multi-hospital academic healthcare system. Urologic Nursing , (5). 243. doi:10.7257/1053816X.2016.36.5.243.
