Catheter-Associated Urinary Tract Infections, Term Paper Example

Introduction to Population/Summary of Environment

The prevalence and risk of infection in hospitalized patients is often higher in some population groups who require the use of specific tools or devices to manage their health. For example, an acute care internal medicine/telemetry unit provides treatment to patients with a number of significant health challenges that may require catheterization as part of a larger care strategy. However, catheterization creates additional concerns for patients because of the higher risk of infection related to this procedure. A body of evidence has been established in recent years which reflects the degree of risk associated with catheter-associated infections in some patients, particularly those who are hospitalized and possess limited mobility due to health status. Most importantly, healthcare providers must be able to recognize the value of interventions that will have a lasting impact on patient outcomes and aim to reduce the risk of infection as best as possible. Prior evidence supports an understanding of the risks associated with urinary catheters and to determine the causes and potential prevention strategies related to these risks. These catheters pose a problem for many patients because they are painful and increase the risk of infection in significant ways.

The risks associated with the use of urinary catheters must be identified and supported by evidence related to improving management and patient monitoring in order to reduce the risk of infection. This process requires healthcare providers to develop strategies that will minimize risk, improve bedside care, and expand communication to monitor patients for these risks more effectively. In the hospital setting, the use of urinary catheters requires an examination of existing protocols and a determination of where changes are required in order to meet expectations for patients that will support a reduced risk of infection and protocol development to encourage healthcare providers in this regard. The following discussion will address the risk of CAUTIs in greater detail and will emphasize protocol evaluation and change in order to effectively minimize infection risk for patients who require urinary catheters in the hospital environment.

Research Question/Hypothesis

For the purposes of this discussion, the primary research question to consider is the following: What are the primary risk factors associated with the development of catheter-associated urinary tract infections and what are the primary strategies that are available to minimize these risks? These issues must be addressed in order to determine how to reduce risk and provide patients with an improved experience during hospitalization that does not include additional complications such as infection. It is believed that with a comprehensive protocol method in place, nurses and other healthcare providers will be prepared to monitor infection risk through routine evaluations of the insertion site and proper hygienic methods to minimize bacterial formation for these patients. Over time, improved protocols and changes to existing methods will reduce the number of infections that are identified for this group of patients. Most importantly, it is necessary to develop strategies that will support protocol improvement to reduce the risk of CAUTIs in hospitalized patients, thereby enabling nurses to be proactive in working towards a set of solutions that will benefit these patients when urinary catheters are required.

From a healthcare perspective, the impact of protocols to improve outcomes for patients requiring urinary catheters may be significant and provide further support for this population in minimizing the risk of infection. This process requires an examination of issues related to the treatment of these patients and the potential risks that are likely to impact how treatment options and monitoring are considered. The issues related to this process require an examination of the different needs of employees to preserve the health of their patients who require urinary catheters. It is known that hospitals continue to expand their protocols with respect to urinary catheters in order to protect patients from unnecessary risk or harm, and this is best achieved through the development of a successful strategy that will enable employees to treat patients effectively and monitor urinary catheters with the intent to reduce infection risk. Most importantly, it is necessary to evaluate the conditions under which existing protocols are likely to have a positive impact on patients and provide further evidence of the needs of this population and their infection risk.

Hospitals have developed strategies of their own to address CAUTI risk in patients, using specific surveillance programs to accomplish these needs (Burns et.al, 2012). It is important to recognize these tools and the needs of the patient population in order to effectively manage the needs of this population so that if a risk assessment is required, it is properly managed at the highest possible level to reduce infection probabilities for these patients (Burns et.al, 2012). An overview or monitoring system at a high level will facilitate an effective response by healthcare providers to support improvements in catheter monitoring and to make a difference in supporting an environment where change and progress are likely to impact patient treatment methods and long-term prognoses.

The use of existing data to manage the risk of CAUTIs requires an examination of the different protocols that are available to impact patients and to provide further support in maintaining protocols that will impact patient outcomes in a positive manner. This reflects a need to be practical in supporting this population and in determining which steps are required to facilitate successful measures that result in a reduced risk of infection for hospitalized patients who require urinary catheters. From this perspective, it is likely that there will be additional measures based upon existing data in order to determine the best possible approaches to managing patients in this context. The National Database of Nursing Quality Indicators (NDNQI) provides statistical data regarding the use and prevalence of urinary catheters in ICU patients and noted the following: “As of the second quarter of 2008, 446 ICUs from 259 hospitals submitted CAUTI data to the NDNQI, with a pooled median rate of 2.6 CAUTIs/1,000 catheter days. The median pooled catheter utilization rate is 0.75, indicating that 15 out of 20 patients have indwelling catheters in place on a given day” (Simon, Klaus, & Dunton, 2009, p. 16). Based upon these statistics, it is important to identify the specific risk factors that are prevalent in advancing the needs of patients who require urinary catheters in order to minimize their risk of infection and to be proactive in working towards a set of protocol-based solutions that will positively impact their health and wellbeing.

Based upon the aforementioned statistics and other indicators, it is believed that the development and/or maintenance of specific protocols will play an important role in shaping how organizations respond to any and all risks associated with the need for urinary catheters and to determine what is required to manage this patient population effectively and with as few complications as possible. For example, it is recommended that organizations should “Implement an organization wide program to identify and remove catheters that are no longer necessary, using one or more methods documented to be effective” and “Establish a system for analyzing and reporting data on catheter use and adverse events from catheter use,” (Simon et.al, 2009, p. 17), among other recommendations. These tools will provide further support and guidance in determining which steps are required to maintain and manage the needs of this patient population and in determining what other tools might be available to meet the demands of patient care in managing urinary catheters. These and other tools are necessary in the continued growth and development of frameworks to support protocol development that will protect the safety and integrity of all patients who require urinary catheters for clinical purposes.

A study by Daniel & Kaiser indicates that the risk of catheter-associated urinary tract infections is likely to increase the risk of mortality in some patients who already possess compromised health circumstances, along with a lengthier stay in the hospital and other complications. The Department of Health and Human Services have established an objective to reduce the rate of CAUTIs by 25 percent, due in large part because they are no longer a covered treatment by the Centers for Medicare & Medicaid Services (Daniel & Kaiser). However, other factors play a role in this determination and require an examination of the different variables which impact how patient care is supported by the needs of this population and other factors that influence outcomes. Patients who require urinary catheters must be treated with a sense of urgency and a focus on their wellbeing, as this supports a greater understanding of their overall needs and the expectations of the surgical unit in preventing these infections. Based upon prior research, “studies have shown that improper positioning of the collection bag and associated tubing increases risk of catheter-associated bacteriuria due to potential reflux of urine from the collection bag back into the bladder, dislodging bacteria from biofilms that may have developed intraluminally” (Daniel & Kaiser, p. 1). As a result, it is necessary to develop strategies to manage patients that will be effective in working towards a set of solutions that will positively impact the treatment of these patients and the overall strategies that are utilized to improve expectations and outcomes for this group. It is expected that careful and routine monitoring of the insertion site may have a significant impact on these patients and also provide further support and guidance in managing their treatment strategy throughout their hospitalization to minimize infection risk.

The ability to monitor patients who require urinary catheters requires a level of care and execution that will make a difference in the management of this patient population and in meeting their specific needs. Therefore, it is important for an organization to examine its priorities with respect to patients requiring urinary catheters and to take the steps that are required to facilitate an effective response to modifying protocols as necessary to reduce infection risk throughout this patient population. One of the most important areas to consider is catheter management, which encompasses routine monitoring of patients who require urinary catheters and to be proactive in working to minimize possible infections (Trautner, 2011). This is best accomplished with the development of protocols that increase the level of monitoring for these patients, including the insertion site, as well as removal of these catheters before the infection risk becomes too significant (Trautner, 2011). Therefore, determining when patient catheters should be removed must be a critical priority for these patients and must provide a means of understanding how to best address the challenges of working with patients who require catheters with the intent to reduce their overall risk (Trautner, 2011).

It appears that current trends support the need to determine when the removal of urinary catheters is appropriate and to be cautious when working with patients in order to effectively manage their risk of disease over time. This is best accomplished in a context similar to the following: “Several strategies show promise for decreasing inappropriate insertion of urinary catheters and duration of catheterization, including a combined educational intervention and an indication checklist for use in an emergency department, and nurse-led multidisciplinary rounds in the hospital. These studies confirm earlier work along these lines concerning computerized stop orders for urinary catheters, computer-based order entry for urinary catheters, nurse-generated reminders, and nurse empowerment to remove catheters” (Trautner, 2011). From this perspective, it is imperative that nurses must play an important role in determining which steps are required to facilitate a coordinated response to managing these patients and in supporting an environment in which patients receive the best possible monitoring of their individual circumstances to prevent prolonged use of urinary catheters in this context. This will facilitate a response that will aim to minimize the possible risk of infection and support the removal of catheters for these patients on a proactive basis rather than in a reactive state.

Research Methods

The development of a research protocol to examine the risk of catheter-associated urinary tract infections requires an examination of existing methods and the rate of infection within a given hospital environment. This process is instrumental in determining the actual rate of infection per number of patients and in determining which steps are required to facilitate an effective response to these concerns so that patient care is not compromised in the process. It is believed that there must be a significant emphasis on the development of a strategy that will facilitate effective outcomes for patients and provide further evidence of the need to improve protocols and address primary concerns among patients. It is important to evaluate the different conditions that impact patients with urinary catheters and to recognize the value of understanding the dynamics of this clinical situation so that patients are able to receive the appropriate care and monitoring to reduce infection risk.

By examining the existing protocols and measuring outcomes in the form of the number of infections that have occurred, it is possible for an organization to determine if their existing protocols have been successful or if additional monitoring and/or changes are required. This process will demonstrate the importance of recognizing the value of protocol development and routine monitoring in order to determine whether or not patients will receive the type of care that will minimize CAUTI infection risk, and it includes an understanding of the steps that are required to meet expectations and to limit infections and subsequent length of stay for these patients. It is expected that these tools will provide further evidence and support of the development of protocol methods and monitoring tools to support this group of patients on a regular basis. In order to achieve these objectives, it is important to develop a set of methods that will be used to accomplish the needs of this population and to recognize the value of expanded monitoring to promote quality-based improvements.

An evaluation of existing methods is required in order to determine how to best address the needs of this patient population and to be proactive in working towards a set of solutions that will have a positive impact on patient outcomes. Therefore, an examination of different perspectives must be addressed in order to determine the best possible strategies to reduce CAUTI risk for these patients. One approach to this process is to develop a research study that is a pre-post intervention design, which is an important tool in order to examine nurse-led interventions to promote quality improvement, similar to a study conducted by Oman et.al (2011). In a hospital setting, this study design is appropriate because it provides further evidence of the need to examine existing protocols and to recognize how to best manage the conditions under which patients are able to receive continuous care and monitoring with the intent to reduce any risks that are associated with catheter insertion. This process is likely to have a positive impact on the patient population in question and provide further support of the need to improve quality of care and the implementation of protocols that aim to prevent infections for this group of patients. A successful research design will accomplish a number of objectives and support a means of advancing outcomes to improve expectations and health-related outcomes for this group of patients.

An examination of the study population must also be conducted in order to determine which approach will be most feasible in meeting the expectations of the unit and how nurses respond to the call to improve their own methods. This process requires nurses to be proactive in developing a set of protocols that will facilitate a set of positive results for patients that also translate into fewer infections. This process is instrumental in enabling patients to obtain the type of care and treatment that will aim to preserve their health, rather than to depend on circumstances where their health is further compromised for one reason or another. The process of understanding the dynamics of this population must also be addressed and support an expansion of care and treatment that will emphasize quality and the preservation of health and wellbeing above all other priorities.

For the purposes of this study, data collection will be conducted by selecting nurses who work in different units within a large teaching hospital, whereby there are a relatively large number of patients who require urinary catheterization. The survey instrument will be disseminated to nurses who work closely with these patients and who are directly involved in their plans of care, as this will demonstrate the type of knowledge that is required to facilitate successful results in conducting routine monitoring for this patient population. It is important to develop a strategic effort that will have a positive impact on these patients and that will address the type of specific questions that are pertinent in treating this population on a regular basis. As a result, nurses who qualify for and elect to participate in the study will be provided with a questionnaire via email that will be submitted using the Survey Monkey application, where the results are kept confidential and do not require any specific identifiers from each participant. Once the results are collected, they will be evaluated further in order to examine the different perspectives regarding the quality-based intervention that will be conducted.

The Intervention

The role of nurses in improving quality of care as related to patient outcomes regarding urinary catheters is an important step towards the development of quality-based improvements to protect these patients from the risk of catheter-associated urinary tract infections. This process is critical because it reflects a need to evaluate patients and support the development of protocols that will accommodate patients and provide evidence to support the need for improved quality of care. This process will be based upon the need for additional guidance in understanding how prior evidence will impact future directions in reducing the risk of infection for these patients. It is imperative that there must be a greater emphasis on the continued development of methods that will impact patient care and treatment and that will support the ongoing development of factors related to meeting patient needs and expectations at a high level.

A quality-based research intervention method will have a positive and lasting impact on patient outcomes because it is believed that it will translate into positive outcomes and a reduced number of infections for these patients. It is known that “Catheters may be inappropriately retained for days because of convenience, misunderstanding of their necessity/appropriateness, or lack of clear orders for removal. Therefore, efforts to reduce CAUTI prevalence must focus on evidence-based use of IUCs during insertion, maintenance, and removal” (Oman et.al, 2011, p. 1). This process requires an examination of the different perspectives that will be required to ensure that there are sufficient protocol steps in place to protect patients who require urinary catheters from unnecessary risk or harm. It is important for nurses to conduct an intervention that will have a lasting impact on this patient population and which will be supportive of quality-based improvements which are ongoing and consistent in meeting the objectives of the unit.

Nurses must also recognize their responsibility to these patients and to be proactive in working towards a set of objectives that will positively impact patient outcomes. Most importantly, there must be a level of consistency with the chosen intervention and it must demonstrate a level of value and significance that will have positive and lasting implications for patients. This process will also demonstrate that nurses are committed to making changes to their protocols that will positively influence how patients are treated within a given setting and are provided with the tools and resources that will positively impact their health and prevent infection risk. For example, the removal of the catheter must be a critical focus for this group of patients, as this plays an important role in determining what is required to improve quality of care, such as a protocol to remove catheters in a timely manner (Parry, Grant, & Sestovic, 2013). This practice will provide evidence-based support in the development of a program that will have a positive and lasting impact on patients and that will impact their ability to maintain their health at a high level. It is anticipated that this type of approach will have a positive impact on reducing the number of catheter-associated urinary tract infections and in supporting a dynamic that influences quality of care and treatment for these patients.

Prior evidence suggests that patients will benefit from a quality-based intervention protocol in the form of lower infection rates, and this also reflects an opportunity to examine the different approaches to care and treatment that will positively impact outcomes for these patients (Parry et.al, 2013). There must be a significant focus on the continued growth and development of catheter-based protocols that focus on the safety of insertion and proper removal in a timely manner to prevent infection risk over time (Parry et.al, 2013). These factors are likely to play a critical role in shaping the surrounding environment and in supporting a dynamic that will impact quality of care and treatment for patients who already face challenges related to compromised health due to surgery or other serious concerns. With this perspective in mind, it is important for patients to receive the best possible attention and focus from nurses that will positively influence the health of these patients and translate into reduced length of stay and minimized complications for this group.

The Impact

From an outcomes perspective, it is believed that by conducting a nurse-led quality-based intervention involving patients requiring urinary catheters, there will be a greater emphasis on the development of protocol methods that will have a positive impact on patients. This is likely to translate into reduced length of stay, a lower diagnostic rate of infections, and a limited use of antibiotics to treat these infections, thereby translating into reduced cost savings for the hospital environment. This is an important step because it provides further evidence of the need to address quality-based improvements that will influence how nurses are perceived within the hospital setting and the type of care that their patients receive. This is an important step in promoting evidence-based solutions that will have a positive and lasting impact on patients and which will support long-term solutions for these patients that will likely contribute to reductions in length of stay for these patients.

It is expected that these tools will also enable nurses to recognize the importance of developing protocols that will translate into positive and meaningful results in the hospital environment through increased cost savings for patients, greater efficiency in the type of care that is received, and the ability of nurses to recognize how their contributions to patient care will lead to quality-based improvements and other opportunities to improve the nursing unit and the care and treatment of patients who are served. These alternatives will go a long way in supporting a dynamic that will have positive and lasting benefits for the hospital and will expand the body of evidence that is already available in order to enable patients to be treated with the best possible protocols in place to preserve their health and wellbeing, while also reducing the potential risk of infection.

Evaluation

In order to determine if the chosen quality-based intervention has been effective, there must be a greater emphasis on the development of a protocol method that will address quality-based markers and other issues that have a direct impact on patient care quality and subsequent results. Therefore, nurses must be able to recognize the importance of steps such as proper catheter insertion and timely removal, using communication as a primary tool in supporting the desired results. Therefore, continuous contact with physicians must be conducted so that patients are able to receive treatment under the best possible circumstances, while also considering other factors that will determine how they receive care and treatment at a high level to meet the expectations set forth by the organization.

The evaluation method or approach that is identified must be able to capture the essence of this process and support a dynamic whereby there are opportunities for nurses to prove and demonstrate their value when providing direct care and treatment to patients who require urinary catheters. This process also demonstrates the importance of a protocol that emphasizes quality and greater attention to patients in an effort to reduce the number of catheter-associated infections that are identified, along with a reduced length of stay for these patients. It is expected that a nurse-led intervention will be successful if there is evidence to demonstrate that nurses are able to evaluate and monitor patients on a regular basis and administer care and treatment with the intent to reduce infection risk and to improve quality of life for patients who face the potential of developing these infections.

References

Burns, A. C., Petersen, N. J., Garza, A., Arya, M., Patterson, J. E., Naik, A. D., & Trautner, B. 58. (2012). Accuracy of a urinary catheter surveillance protocol.American journal of infection control,40(1), 55-58.

Daniel, J. S., & Michelle Kaiser, C. I. C. Monitoring of Indwelling Catheter Use and Compliance with CDC Guidelines.

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.

Simon, M., Klaus, S. F., & Dunton, N. E. (2009). Using NDNQI data to manage CAUTI. Nursing management, 40(6), 16-18.

Trautner, B. W. (2010). Management of catheter-associated urinary tract infection (CAUTI). Current opinion in infectious diseases, 23(1), 76.