Catheter-Associated Urinary Tract Infection (CAUTI)
A report that was given by the National Healthcare Safety Network (NHSN), in 2015, indicated that Urinary Tract Infections (UTIs) are the most common nosocomial infections burdening the healthcare sector in the nation. The catheter surfaces provide a surface upon which microorganisms among them Escherichia Coli develop microfilms which are sources of infection leading to bacteremia. Through technological advancement in the healthcare system, antimicrobial coated urinary catheters are available which act prophylactically to limit attachment of the microfilms. Some of the recently commonly used antimicrobial coated catheters are silver alloy-coated latex catheters and nitrofurazone-coated silicon catheters. Despite the technological advancements, Urinary Tract Infections as a result of catheter use remains to be on the rise in healthcare facilities in the United States. This clearly indicates that despite the material composition of the catheter, there are clinical practices during catheter use that contribute to the contraction of Urinary Tract Infection.
Some of the care provider practices that contribute to the patients’ contraction of infection during Urinary Catheter use include lack of sterility when handling the catheter and long duration of the catheter without change (Saint et al., 2016). Patients in critical care units under long-term care, who are dependent on the caregivers, form a larger percentage of patients who develop Catheter-Associated Urinary Tract Infection. This article focuses on a project proposal to implement various ways to reduce the occurrence of the CAUTI infection in a health facility setting.
Change Model Overview
The ACE Star model is a model of Evidence-Based Practice is utilized to understand the phases, nature, and properties contained in knowledge applied in evidence-based practices. It depicts the unique parts of the evidence-based practice by including the processes individuals are familiar with (Orta et al., 2016). It shows how evidence through research together with already existing knowledge are systematically put into practice; commonly referred to as an evidence-based practice. In the model, knowledge passes through five significant stages which include: discovery through research, a summary of the evidence obtained, translation of evidence findings to guidelines, integration of guidelines into practice and assessment or evaluation of the outcomes.
Currently, routine practices have no part to play in the nursing practices. Nursing practices are rooted in researches, and through the use of the ACE model of knowledge transformation, the already existing knowledge based on research can be put into practice. After evaluation, the identified gaps can be bridged through more scientific investigations, and this can bring even more significant changes in the nursing field than never before.
Evidence/Scope of Evidence Based Practice
Hospital-acquired infections among the patients are on the rise, CAUTI being the fourth leading hospital-acquired infections among the ill population. This is due to the failure of the health caregivers, including nurses as primary care givers, to follow standard guidelines available for infection control in their area of practice. In case of CAUTI, there is increased use of urinary catheters mostly on patients with no indication for use (Nicolle, 2014). Even with an indication, there is increased ineffective catheterization due to failure to follow the clinical algorithms provided to ensure safe catheterization. Care for the urinary catheters in situ is also poor accompanied by a long stay of urinary catheters without being changed. This has facilitated contraction and spread of infection among patients in the clinical settings.
This has been the case in my area of work. Through the department of infection control, it was found out that approximately 30% of patients who were admitted for various conditions ended up contacting new infection while in the facility. An estimate of 23% of this infections were urinary tract infections linked to urinary catheter use especially among the critically ill patients who received total nursing care. This has been a challenge not only to the facility alone but across all the facilities in the nation. A lot of funds are allocated towards treating this infection and arising complications which otherwise would have been better prevented, making the healthcare sector to lag behind in other developmental projects.
Stakeholders
The project will be spearheaded by eight members from different departments including the administrators. They will include me as a secretary of the team. Other members include the head of the infection control programs in the facility, the chief nurse in the facility, nurse in charge of the surgical ward, nurse in charge of the critical care unit, in charge of urology department, and two nurse practitioners. The work of the secretary will be to take notes in the meeting and facilitate communication between the members. The chief nurse of the facility will represent the administration of the facility and promote policy-making based on the final decisions made by the team, funding, and distribution of required resources. The nurses in charge of the three departments are to represent other in charges and help in disseminating the discussed agendas to other departments. Heading the departments likely to experience high CAUTI among patients, they will help the team identify factors that are facilitating contraction of CAUTI by patients. The two nurses represent the entire nursing practitioners operating at the ground level. They are the most beneficial part of the team. They will assist the team in determining the factors on the ground that facilitate the rise of CAUTI among patients. From the evidence, practices carried out by the caregivers in direct contact with the patients influence contraction of the CAUTI most.
Evidence
The department of infection control and management was the first to raise a safety management concern on this practicing issue on increased Hospital Acquired Infections. This was in line with the increased expenditure on the treatment of infections that were not primary diagnoses of the patients. In the patient report book, there were found numerous unsatisfactory patient concerns on the care they received in general. Wide variations in urinary catheter care among the caregivers indicated conflicting practices showing the standard clinical guidelines were not keenly followed. This was a major concern because it not only increased the expenditure but also had negative impacts on the patients’ outcome. Many developed complications and were forced to stay longer increasing the workload for the caregivers.
Recommendations for Change Based on Evidence
Among the recommendations provided based on evidence including the use of urinary catheter only when indicated and not for easy management of patients especially in the critical area. Among the indications for catheter use include blockage leading to complete or partial retention of urine, and before and during surgical procedures. Otherwise, the catheter ought to be removed as soon as clinically feasible (Tenke, Köves, & Johansen, 2014). Frequent change of the urinary catheter to be avoided unless the catheter is blocked or shows signs of being infected. Clinical practitioners should use clinical logarithms available to ensure the standard care of urinary catheter and duration of the indwelling catheters before being changed.
Action Plan
The eight members of the team are to spread widely the findings and recommendations that are set in their various areas of practice. At the administrative level, there will be a formulation of policies and reinforcement of existing rules on infection control and collaborative management of patients using standard clinical practices. There will be various sessions of teaching the staff at their different working places by the team members on the current state and resolutions to solve the challenge. Hard prints containing the standard clinical guidelines on urinary catheter handling and care shall be printed out and pinned at strategic points of operations in the clinical areas. This is to act as a reminder of standard practices hence unifying the practices among the clinical practitioners on urinary catheter care.
Dissemination of Findings
The findings shall be printed out and distributed to the various clinical departments in the facility. The results can also be spread through the facility website and social media groups containing the caregivers of the facility. During health education on the subject, the finding can also be read to those in attendance. Any general findings that shall be helpful to the community, outside the facility, shall be posted in other open websites and social media.
Conclusion
Nurses play a vital role when it comes to solving challenges that are experienced in the clinical setting on the ground. This is because they are in close contact with the patients and tend to spend longer time with them. Nursing had the largest number of care providers means more significant results will be achieved in the healthcare sector when change starts with them. In the case of Hospital Acquired Infection Control, CAUTI being one of them, nurses among other caregivers should be encouraged to focus on standard clinical practices based on evidence. Collaborative management of the patients using standard clinical practices will reduce the infections acquired in the clinical setting.
References.
Nicolle, L. E. (2014). Catheter associated urinary tract infections. Antimicrobial resistance and
infection control, 3(1), 23.
Orta, R., Messmer, P. R., Valdes, G. R., Turkel, M., Fields, S. D., & Wei, C. C. (2016).
Knowledge and competency of nursing faculty regarding evidence-based practice. The
Journal of Continuing Education in Nursing, 47(9), 409-419.
Saint, S., Greene, M. T., Krein, S. L., Rogers, M. A., Ratz, D., Fowler, K. E., …& Faulkner, K.
(2016). A program to prevent catheter-associated urinary tract infection in acute
care. New England Journal of Medicine, 374(22), 2111-2119.
Tenke, P., Köves, B., & Johansen, T. E. (2014). An update on prevention and treatment of
catheter-associated urinary tract infections. Current opinion in infectious diseases, 27(1),
102-107.
