Tag: Research proposal

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Catheter Associated Urinary Infection (CAUTI): Evidence Based Practice

Abstract

After selecting the topic of study, a team will be responsible for implementation and evaluation of the project will be formed. The selection of the team members will be directed by the topic and involve all responsible stakeholders. Thereafter, a brainstorming session will be held to determine the available sources and the key terms that will be used as guide in the research. Electronic databases such as Proquest, Cinhahl, and Cochrane will be used as a source of evidence.

The obtained evidence will be graded, an EBP standard developed and implemented and later an evaluation of the project outcomes will be done. The aim of this project is to reduce incidences of Catheter Associated Urinary Infections (CAUTIs). CAUTIs are ranked as the most common nosocomial infections. Surveys indicate that CAUTIs account up to 40% of all infections acquired in hospitals per year. Approximately 80% of these infections worldwide have been associated with insertions of indwelling urethra catheters.

In the US alone, hospital related infections account for about 5 to 10% of all hospitalized patients every year. The risk of developing CAUTI increases proportionately with the duration of catheterization. CAUTI pose a huge economic burden in the health care sector. It has been estimated that about 45 billion dollars are spent in the US for maintaining direct health costs and account for over 100, 000 deaths each year. CAUTIs also cause several complications such as gram –ve bacteremia, epididymitis, and orchitis in males, cystitis, and pyelonephritis, endocarditis, meningitis, prostatis, and septic arthritis in all patients.

These complications cause discomfort among patients, increased care cost, prolonged hospital stay, and high mortality Researchers report that there is need for re-education of clinicians about insertion of catheters to ascertain that best practice is maintained. Therefore, the project will be geared towards using this evidence-based intervention in promoting patient outcomes.

Project Proposal

Problem Description

Hospital acquired infections in the urinary tract are classified as the most common infections acquired in nursing homes as well as hospitals. Research has indicated that these infections are caused by insertion of indwelling catheters. It has been projected that these infections would be more worse were it not for the current modifications that have been done on the catheter itself (Gordon, 2015). CAUTIs reduce the quality of life of patients by subjecting them to discomfort, prolonged hospital stay, increased health costs as well as high mortality.  

Solution Description

Management and care of an IUC patient is within the scope of nursing practice. One of the most effective ways that will be used to prevent CAUTI will be through re-education of nurses on placement, early removal, and management catheters. According to Meddings, (2014), improved care processes and care outcomes can be achieved through examination of best evidence serve as a guide in nursing practice and developing support systems that offer education and enhanced product accessibility to attain maximum care.

Although challenging, online learning programs will be created to serve as a guide for registered nurses. The intervention will also aim at updating clinical policy in a manner that it provides consistent, factual, and succinct content that will be an essential vessel for improving current practice (Scanlon et al., 2012). More importantly, clinicians will be re-instructed on how to best insert catheters and how to appropriately locate the drainage bag to minimize occurrence of reflux and CAUTI risks.

However, it has been documented that the most important strategy for preventing CAUTI is to maintain awareness on the existence of a catheter (Sutherland et al., 2015). It is for this reason that practitioners will be educated about how to use catheter reminder interventions such as daily checklists, electronic reminders, and sticker reminders.

Implementation Plan

The first step during implementation of this project will be to request for approval. It will be crucial for the entire organization to understand the necessity of reducing CAUTI. Project leaders will shed light to the leaders in the top management regarding the prevalence of catheter use, the risk that CAUTI predisposes to patients, and the health care costs related to management of CAUTI.

The project leaders will also engage fellow staff/colleagues by first making the problem real. This will be done through narrating a story of a patient who is suffering from CAUTI in the clinical area. Additionally, it will be illustrated that hospital acquired infections occur in 25% of the patients with indwelling catheters which in turn increases the cost of care (Bartlomé et al., 2015; Clarke et al., 2013).

The members will then be urged to join the fight against CAUTI, which is ranked as one of the conditions that can be easily controlled. The clinicians will be notified that the Centers for Medicare & Medicaid Services has stopped reimbursing costs associated with CAUTI since it can be prevented (Parry et al., 2013). Therefore, it is the duty of health care providers to come up with effective strategies for maintaining CAUTI.

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Evaluation Plan

After implementation, some of the variables that will be evaluated include;

Clinical outcomes

The evaluation team will identify the number of patients with symptomatic CAUTIs in the clinical setting monthly. Data from National Health Safety Network (NHSN) will be used to benchmark the progress. The data is essential because it provides the limitations on the number of CAUTI cases that an institution should record (Stacy, 2015). Comparison will also be done between the rates of ICU occurrence in the clinical setting and compared to the occurrences in other clinical settings in the hospitals with similar conditions.

Process Evaluation

Under process evaluation, some of the factors that will be monitored include indications for catheter placement, maintenance of aseptic conditions during catheter use, and the proper removal of catheters that are no longer useful to the patient. The daily prevalence rate will also be collected by dividing the number of patients that are catheterized in the ICU by the total number of patients admitted in the ICU (Zhou et al., 2015; Calfee, 2013). If the survey notes that the rate of CAUTI has spiked, an in-depth investigation will be conducted to identify the causes of the occurrence.

Patient Safety Culture

A survey will be conducted to assess this variable. The survey will be done after every three months annually. The results obtained will be used in the identification of improvement opportunities and allow project managers in designing specific strategic plans that will be used in addressing areas that indicate that staff perception is not as desired (Bell, et al., 2015; Andreessen et al., 2012). Some of the tools that will be used in accomplishing the evaluation process include brochures, Power Point presentation, and handouts.

Dissemination of Evidence

Nurses who will have gone through the education program will be posted in the various units in the hospital where they will serve as important vessels for teaching fellow colleagues about how the project is vital and why they should embrace it. Trained practitioners will also be encouraged to visit neighboring hospitals and help on spreading the message. The progress will be posted in blogs and hospital website where health care providers across the globe can easily access.

Review of Literature

Various scholars ascertain that UTI infections due to indwelling catheters are the most common hospital acquired infections. For instance, according to Giles et al., (2015), the major determinant of CAUTI development is the catheterization duration. Marra et al., (2011) propose that the most significant intervention to prevent these conditions is to discontinue the use of catheters the moment they are feasible and to limit the indwelling use of catheters.

References

Andreessen, L., Wilde, M. H., & Herendeen, P. (2012). Preventing catheter-associated urinary tract infections in acute care: the bundle approach.Journal of nursing care quality, 27(3), 209-217.

Bartlomé, N., Conen, A., Bucheli, E., Schirlo, S., & Fux, C. A. (2015). Change management with empowerment of nursing staff to reduce urinary catheter use. Antimicrobial Resistance and Infection Control, 4(Suppl 1), P217.

Bell, N., Eagan, J., Warren, M., Graham, J., Kamboj, M., & Sepkowitz, K. (2015). Catheter Associated Urinary Tract Infection (CAUTI) Surveillance: Less Charts, More Prevention. American Journal of Infection Control, 43(6), S35.

Calfee, D. P. (2013). Catheter-Associated Bloodstream Infections. InEssentials of Hospital Medicine: A Practical Guide for Clinicians (pp. 703-716).

Clarke, K., Tong, D., Pan, Y., Easley, K. A., Norrick, B., Ko, C., & Stein, J. (2013). Reduction in catheter-associated urinary tract infections by bundling interventions. International journal for quality in health care, 25(1), 43-49.

Giles, M., Watts, W., O’Brien, A., Berenger, S., Paul, M., McNeil, K., & Bantawa, K. (2015). Does our bundle stack up! Innovative nurse-led changes for preventing catheter-associated urinary tract infection (CAUTI). Healthcare Infection, 20(2), 62-71.

Gordon, P. R. (2015). The Effects of Nursing Education on Decreasing Catheter Associated Urinary Tract Infection Rates.

Marra, A. R., Camargo, T. Z. S., Gonçalves, P., Sogayar, A. M. C. B., Moura, D. F., Guastelli, L. R., & Edmond, M. B. (2011). Preventing catheter-associated urinary tract infection in the zero-tolerance era.American journal of infection control, 39(10), 817-822.

Meddings, J. (2014, October). Systematic Review of Interventions to Reduce Catheter-Associated Urinary Tract Infection in the Long-Term Care Setting. In ID Week 2014. Idsa.

Oman, K. S., Makic, M. B. F., Fink, R., Schraeder, N., Hulett, T., Keech, T., & Wald, H. (2012). Nurse-directed interventions to reduce catheter-associated urinary tract infections. American journal of infection control, 40(6), 548-553.

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.

Scanlon, M. K., Deluca, G., & Bono-Snell, B. (2012). Reducing Catheter-Associated Urinary Tract Infections in Home Care: A Performance Improvement Project. Home Healthcare Now, 30(7), 408-417.

Stacy, K. M. (2015). Challenges in Hospital-Associated Infection Management: A Unit Perspective. AACN advanced critical care, 26(3), 252-261.

Sutherland, T., Beloff, J., McGrath, C., Liu, X., Pimentel, M. T., Kachalia, A., & Urman, R. D. (2015). A Single-Center Multidisciplinary Initiative to Reduce Catheter-Associated Urinary Tract Infection Rates: Quality and Financial Implications. The health care manager, 34(3), 218-224.

Zhou, Q., Lee, S. K., Hu, X. J., Jiang, S. Y., Chen, C., Wang, C. Q., & Cao, Y. (2015). Successful reduction in central line–associated bloodstream infections in a Chinese neonatal intensive care unit. American journal of infection control, 43(3), 275-279.

Appendix A

Credible Sources

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