Presented By: April Beresford, Benjamin Kasper, and Kara Elkins
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INDWELLING URINARY CATHETERS: PREVENTION OF CATHETER-ASSOCIATED URINARY TRACT INFECTIONS (CAUTI S) Presented By: April Beresford, Benjamin Kasper, and Kara Elkins
Presented By: April Beresford, Benjamin Kasper, and Kara Elkins
Presented By: April Beresford, Benjamin Kasper, and Kara
Elkins
Slide 3
Catheter associated urinary tract infections (CAUTI) are the
cause of many hospital acquired infections. Nearly 25% of
hospitalized patients are catheterized annually, and 10% of these
patients develop infections (Oman et al. 2011, p. 1). 40% of all
nosocomial infections are due to CAUTIs (Andreessen et al., 2012,
p. 209).
Slide 4
Patients have increased pain and discomfort due to CAUTIs.
CAUTIs are an unnecessary added expense to healthcare costs.
Slide 5
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Article One Literature Review The bundle that they created to
decrease percentage of CAUTI was put together based on the
information gathered in the review of literature 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).
Slide 7
Article One Hypothesis Dependent variable: duration of urinary
catheterization Independent variables: urinary catheter bundle,
which included proper insertion and assessment techniques to be
utilized, computerized documentation, and ordering templates. The
population defined in this case is acutely hospitalized patients
(Andreessen et al., 2012, p. 211). The study was performed using an
experimental pretest and posttest design. Andreessen et al.
performed an evaluation before and after the introduction of the
urinary catheter bundle.
Slide 8
Article One Data Collection Evaluation of 1,200 charts to
collect baseline data over three weeks Months of collecting data
after the urinary catheter bundle and other policies were put into
place Ended with another three-week post program evaluation and
review of 1,385 computerized medical charts to collect the outcome
data (Andreessen et al., 2012, p. 211). Documentation review was
performed by registered nurses, physicians, and infection control
nurses, along with the other members of the research team
(Andreessen et al., 2012, p. 211).
Slide 9
Article One Sample 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
due to patient majority being male at this VA facility.
Slide 10
Article One Sample All charts were reviewed for those male, and
eighteen and older (Andreessen et al., 2012, p. 211). 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).
Slide 11
Article One Limitations Conducted at a single site which causes
limitation in the results 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).
Slide 12
Article One Conclusion It 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).
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Article Two Purpose / Framework Oman et al used a pre/post
quasi-experimental design to test incidence rates of CAUTI in a
pulmonary and a general medical surgical unit at a Colorado
hospital, using nurses as champions of change. Dependent variables:
incidence rates of CAUTI, catheter duration, LOS, bladder scanner
usage, and product streamlining. Independent variables: solidified
as nursing interventions but was broken down into a series of
interventional options presented to nurses who were participating
in the study charge nurse rounds patient-related catheter
selections, not nursing preference daily evaluations of the need
for continued catheter use use of bladder scanners continuing
education for nurses and nurses aids (Oman et al, 2011, p.
2-3)
Slide 15
Article Two Framework / Data Collection Study was divided into
three phases PHASE ONE: baseline data on IUC duration and CAUTI
rates was obtained PHASE TWO: intervention begins hospital-wide,
including new protocols, updated training for staff, and product
evaluation was performed. PHASE THREE: interventions targeted the
targeted units, including: more education and journal review with
staff nurses, purchase of 2 new bladder scanners and additional
bedside commodes, charge nurse catheter rounds, and posting of
flyers throughout the department outlining facets of evidence based
best practice techniques and interventions. (Oman et al, 2011, p.
2-3)
Slide 16
Article Two Framework / Data Collection Electronic patient
records were used to identify patients with CAUTI and to determine
the length of catheterizations. CAUTIs were reported as an absolute
number and a number of infections per 1,000 catheter-days for
eligible patients. (Oman et al, 2011, p. 2-3)
Slide 17
Article Two Results It was found that nursing based
interventions did result in a decrease of CAUTI within the
designated units, although it was beyond the scope of the study to
determine which interventions were most and least effective. This
project suggests that a focused unit intervention may be indicated
when there is inadequate response to hospital-wide strategies (Oman
et al, 2011, p. 5)
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Article Three Purpose/Framework Intervention theory which
consisted of the following Removal of inappropriate catheters
Assessment for need for catheters Early removal of indwelling
catheters 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 (Elpern et al.
2009 p. 537).
Slide 20
Article Three Data Collection Subjects included in this study
consisted of all MICU patients during a six month period Data
collected during intervention phase Duration of catheterization
Appropriateness of catheterization Reasons for inappropriate
catheter use CAUTI rates based upon surveillance by nurse
epidemiologists Elpern et al. (2009)
Slide 21
Article Three Findings Pre Post intervention data analysis
showed a decrease in catheter use Eleven months previous to
intervention, 15 CAUTIs occurred during 3,429 device days During
the intervention phase, zero CAUTIs occurred in 1,432 device
days.
Slide 22
Urinary catheterization is necessary in many patient situations
Overuse has been demonstrated to be a significant contributor to
increased infection rates Questioning attitudes about catheter use
assist in CAUTI reduction Daily reassessment for catheter need
Catheter use based on patient need not nurse preference Education
for proper catheter care Development of practice policies
Slide 23
Andreessen, 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
http://www.nursingcenter.com/lnc/JournalArticle?Article_ID=1355891
http://www.nursingcenter.com/lnc/JournalArticle?Article_ID=1355891
Burns, 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/ajcc2009938 Oman, 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