Nurse initiated evidenced based interventions for CAUTI prevention

CAUTIs are associated with high morbidity and mortality owing to increased risk of secondary bloodstream infections. In practice, evidence-based guidelines are there for the management of indwelling urinary catheter but they remain to be not consistently followed. The major consideration that underlies proper nursing care for catheterized patients is on the main principle treatment of CAUTIs, which essentially is on the prevention strategy. If the indwelling catheter is not clinically indicated by the physician, then nurses should not insert and proper monitoring should be done such that if it is no longer required, timely removal be done. ` Background information Majority CAUTI infections are due to long term catheterization. Most hospitals have bundled interventions that requires the attending clinicians to apply them strictly and follow the CDCs guidelines in order to achieve the expected outcomes.

in practice, the use of evidence based practice and bundled intervention is more effective in preventing CAUTIs (Clarke et al. Among the interventions that have proofed to be effective in preventing CAUTIs and related complications include the need for nurses to assess the dire need for catheterization, the use of appropriate insertion and maintenance guidelines, proper selection of the right size catheter, short duration of catheter in place, adoption of quality indicators of infection. In practice, the combination of all these interventions gives best outcomes in prevention of CAUTIs (Kanj et al, 2013). The problem Urinary tract infection (UTI) is one of the commonest healthcare-associated infection (HAI) (Chen,et al, 2013). The study will focus on the health care practice domain. In the study, all the patients who shall be admitted to the adult intensive care unit during the entire 28-day period (approximately 1 month) will be included.

The study will consist of two periods, a pre-intervention period and the intervention phase. The pre-intervention observation phase will last for two weeks, 14 days characterized by observing nurses use the existing in-house protocols on catheterization followed by monitoring CAUTI incidences after. The second phase will be the intervention period, which will last for 14 days, here a comprehensive evidence-based CAUTI prevention bundle encompassing avoidance of catheter insertion wen not necessary, maintenance of sterility and proper hand hygiene, IDC product standardization to ensure sterility, reminder interventions among nurses and early catheter removal as soon as the patient no longer requires. Overall, there might be an increased workload with these interventions implementation of which nurses might resist. Review of Literature Multiple studies done before have pointed out the good Impacts of interventions meant to discourage unnecessary catheter insertion, when compared to having no interventions at all.

The interventions that decreases the inappropriate catheter insertion, those that requires strict placement restriction and the CDC patient requirement for catheterization coupled to the nurse’s daily evaluation for removal of the IDC have indeed decreased the use of catheters and therefore reduce the incidences of CAUTIs (Parker et al. In practice, nurses are the ones tasked with the responsible for catheter insertion and its ongoing catheter management and removal even though they are not the ones ordering for the insertion of the device. For this reason, nurses are good stewards which evidence has shown that their need for training on the use of evidence based practices on catheter protocols has led to a reduction in CAUTI incidence (Kanj et al, 2013).

Aseptic insertion technique remains a primary recommendation as a standardized care but is limited by lack of epidemiological evidence (Meddings et al. But stronger epidemiological and clinical evidence supports the value of adopting sterile, closed, unobstructed urinary drainage system during catheterization (Meddings et al. Bundling interventions are equally too important CAUTI prevention strategies not to ignore which calls for adherence to infection control, bladder ultrasound which may avoid catheterization, condom catheters instate of indwelling catheters, not using catheters unless when necessary and early removal as soon as the patient no longer requires it (Nicolle, 2014). Kanj et al (2013) in their study to assess the impact of a multidimensional infection control that help in reducing CAUTI incidence found that there was a higher rate of CAUTI (13.

07 in every 1000 urinary catheter-days) during the pre-intervention phase which significantly was decreased when bundled interventions of infection, nurse education, prompt lookout for CAUTI incidence, process surveillance, and performance feedback. Titsworth, et al. (2012), to investigate if implementation of prevention bundle encompassing avoidance of catheter insertion, maintenance of sterility, product standardization, and early catheter removal decreases the catheter-associated UTI rate. They found that the rate of catheter-associated UTIs was significantly reduced from 13. 3 to 4. 0 per 1000 catheter days after the intervention (Titsworth, et al. It is hence imperative that nurses should consider employing evidenced-based interventions that seek to avoid unnecessary catheterization through strict placement guidelines that adhere to CDC criteria for placement and prompt removal of catheter as soon the patient no longer requires it through reminders and stop orders, this should follow nurse-initiated removal protocols (Parker et al.

Going by the results, the strength these evidence is high and of economic sense since these interventions are of low cost, low risk, effective and sustainable even though it presents with some unique challenges for implementation which ;luckily, they can be solved if anticipated prior to intervention (Parker et al. References Chen, Y. Y. , Chi, M. American Journal of Critical Care, 22(2), 105-114. Clarke, K. , Tong, D. , Pan, Y. , Easley, K. D. , Alamuddin, L. , Kanafani, Z. , & Molaeb, B. Impact of a multidimensional infection control approach on catheter-associated urinary tract infection rates in an adult intensive care unit in Lebanon: International Nosocomial Infection Control Consortium (INICC) findings. , & Saint, S. Reducing unnecessary urinary catheter use and other strategies to prevent catheter- associated urinary tract infection: an integrative review.