PICOT Research
UMUC
APPLYING EVIDENCE-BASED PRACTICE
Catheter-associated urinary tract infection (CAUTI) is a frequent hospital-acquired infection, is costly for the hospital and prolongs the patient’s hospital length of stay. Catheter-associated urinary tract infections can cause sepsis and significant morbidity and mortality in critically ill patients. Catheter-associated urinary tract infections (CAUTIs) represent over 30% of hospital-acquired infections with an annual incidence of 560,000 CAUTIs per year in the United States. An estimated 13,000 deaths are attributable to CAUTIs annually (Sorour, Nuzzo, Tuttle, Naidus, Donovan, Bekhit, & … Fabrizio, 2016). The risk of catheter-associated urinary tract infections occurs either during catheter placement or after placement through the intraluminal or extraluminal route. Contamination also occurs with an inadequate cleansing of the perineal area before and after insertion of the catheter tip, through the tap of the drainage bag when emptying, or when residual urine remains in the drainage bag. Bacteria can conjugate on the tubing, and since it is a directly placed in the bladder, the bacteria have a direct passage to travel to the bladder.
As a nurse, it is essential to have the proper education for the care of Foley catheters. CAUTI have evidence-based prevention guidelines, therefore, if acquired in the hospital, that hospital will receive reduced payment for that case because CMS believes they can reasonably be prevented through the application of evidence-based guidelines (The Joint Commission, 2016). Using evidence-based practices nurses can prevent CAUTI and save the hospital financially. Nurses protocols for prevention of CAUTI are as follows: use an aseptic technique for insertion, secure catheter to prevent movement, perform hand hygiene. Additional protocols are performed routine meatal cleansing, keep drainage bag below the level of the bladder, keep free of kinks, empty drainage bag regularly, disinfect port to obtain samples, have the catheter removed when no longer implicated and educate the patient on the care of Foley catheter.
PICOT: In patients with Foley catheters do prevention interventions such as cranberry products, metal alloy and antimicrobial meatal care further reduce the incidence of catheter-associated urinary tract infection?
P-patient problem: Hospital-acquired catheter-associated urinary tract infection (CAUTI)
I-Intervention: will research the use of antimicrobial to the meatal and cranberry products for the further prevention of CAUTI.
C-Comparison: antimicrobial and cranberry products added to further prevention vs increasingly resistant microorganisms.
O-Outcome: There will be an increase in the prevention of CAUTI with bundle-based interventions such as cranberry products and antimicrobial.
T-time- unknown
Nurses lack knowledge about the use and importance of a nurse-driven urinary catheter removal protocol, an evidence-based tool empowering them to remove urinary catheters that are no longer needed or are inappropriate based on set criteria, without calling a physician (Peters, 2016). It is very convenient to leave a Foley catheter in place versus having to perform incontinence care on a patient continually or frequently assist a patient to the commode. However, this is an unnecessary reason to have a catheter, and the harm it could cause is not worth the convenience. The research conducted is to educate nurses on evidence-based practice for the prevention of catheter-associated urinary tract infections and to provide some new incite on prevention with the use of cranberry products.
Reference
Peters, J. (2016). Can Empowered Nurses Decrease Catheter Associated Urinary Tract Infection (CAUTI) Rates? Retrieved March 22, 2018, from https://epublications.regis.edu/theses/723/
Sorour, K., Nuzzo, E., Tuttle, M., Naidus, E., Donovan, L. M., Bekhit, M., & … Fabrizio, P. (2016). Addition of bacitracin and cranberry to standard Foley care reduces catheter-associated urinary tract infections. Canadian Journal of Infection Control, 31(3), 166-168.
The Joint Commission. (2018). Sentinel Event Policy and Procedures. Retrieved March 22, 2018, from https://www.jointcommission.org/sentinel_event_policy_and_procedures/
The Joint Commission. (2016, December 12). Requirement, Rationale, Reference: New and revised NPSGs on CAUTIs. Retrieved March 21, 2018, from https://www.jointcommission.org/assets/1/18/R3_Report_Issue_9_CAUTI.pdf
