Evidence-Based Interventions to reduce CAUTI
Summary of Articles
Article 1:
The article’s main setting is in the PICU unit. The rate of CAUTI is high in the unit/ This is despite the unit using CAUTI prevention bundles and adopting the use of sterile techniques when using indwelling catheters. To eliminate and stop the rising cases of CAUTI in the PICU unit, the hospital management asked the nurses and nurse leaders in the unit to design an intervention to improve patient safety and care This is because nurses in the hospital are in charge and responsible for the improvement of patient safety (Schiessler et al., 2019). The team involved adopted the Plan, Do, Check, Act (PDCA) methodology to design the intervention. This means nurses and the PICU unit must plan and find the appropriate time to use an indwelling catheter.
After this, the nurses and the team involved must distinguish indications for catheter necessity of the patients in the hospital. Later, nurses had to check in with the pediatrician to remove or leave the catheter in. From consultation with the physician in charge, then the nurse can act on the consideration.
The unit’s built-in electronic medical record would help eliminate confusion after shift change due to inconsistent discussion for catheter necessary and opinions. The electronic medical record has documented indications and considerations as to why a patient does not need an indwelling catheter (Schiessler et al., 2019). Other complementary interventions, such as education to primary intervention-nurse-driven protocol, were adopted to enhance knowledge on the protocol implemented and the need for CAUTI prevention.
The nurse-driven protocol proved to be a success even at its earliest phase post-intervention. One month post-intervention, the rate of indwelling catheters was being used had decreased by 60%. The rate of CAUTI, the use of CAUTI devices, and catheter days continued to decline one-year post-intervention to zero cases of CAUTI. Catheter devices are only used when need be. After the project, other units in the hospital are to develop their nurse-driven protocol for urinary catheter removal. At the end of the project, the study concluded that using an evidence-based care bundle and sterile technique as aseptic insertion of the indwelling catheter is not enough for CAUTI prevention. The study recommends using nursing autonomy with patients and using situation awareness of the underlying problem by using education programs.
Article 2:
This research aims to prevent CAUTI by appropriate catheter use and maintenance. Evidence suggests that prolonged use of catheters results in CAUTI infection. The study suggests adopting the Urinary Tract Infection bundled protocol (UTIP) of several preventive measures to avoid such cases. The project adopted four key nursing elements and some things from a bladder bundle protocol by Keystone Center for Patient Safety. It combined them to make a comprehensive UTIP bundle that uniquely fits this hospital’s surgical unit (Connor, 2018). A three-month pilot study is conducted concerning preventing CAUTI through the adoption of the UTIP bundle protocol. The study was successful as the catheter days were reduced by 1.5 percent, from 5.3 days to 3.8 days. Also, the compliance rate and acceptance of the UTIP bundle protocol was 100%.
Because the pilot study proved to be a success, the main research started the month after in the surgical unit to zero the rate of CAUTI, unnecessary use of catheter device, and prolonged use time. The initiative was conducted in five non-critical care units with a total of 140 beds. The most affected unit in the initiative was the surgical unit, with higher-than-expected CAUTI incidences. The initiative introduced several evidence-based initiatives to curb these incidents that would help reduce CAUTIs, such as using electronic solutions. Also, the initiative introduced other strategies that will help the surgical unit enhance the safety culture and increase staff accountability around urinary catheters (Connor, 2018). For example, the staff conducted daily reviews of all of the catheters by indicating the catheter being used and the length the patient has stayed with it.
To understand the full measure of the impact of the intervention implemented, A DUR devise was adopted to monitor and measure performance achieved at every phase of the project. The performance and progress made were to be reported monthly to deal with a barrier as they come. The initiative was a success as the initial was to reduce the use of urinary catheter devices by 10%, and it surpassed by 22%. Also, the rate of CAUTI infections decreased significantly from 5% to 3%.
Article 3:
The research occurs in Sheikh Khalifa Medical City (SKMC), with a 560-bed capacity and many patients. The rate of CAUTI infection in the medical center is increased. This is because the staff has failed to comply with evidence-based practices suggestions relevant to the prevention of CAUTI. To ensure the rates of CAUTI reduce, a quality improvement project was formed. The project aims to train and educate frontline staff on the importance of ownership and accountability of CAUTI prevention (Taha et al., 2017). This means that each of the team must pledge to comply with CAUTI preventive measures. The research aims to decrease the CAUTI rate per 100 Cauti days to zero in one year.
Live surveillance of the electronic medical record is used to identify CAUTI cases. Before the initiation of the intervention, the CAUTI measurement was at 6.8% per 1000 catheter days, which was interpreted as 3 cases of CAUTI per 441 days. This measurement is marked as the baseline measurement for the project. Staff and groups involved in CAUTI prevention conducted a brainstorming session to find suitable strategies to prevent CAUTI and identify the most affected areas (Taha et al., 2017).
The strategies implemented in the project were dispensed in three cycles depending on the problems identified in relevance to CAUTI prevention. In the first cycle, CAUTI rates per 1000 catheter days reduced from 6.8 to 5.0 in May 2015. In the second cycle, CAUTI rates per 1000 catheter days decreased from 5.0 to 3.64 in August 2016. The rates went on decreasing even in the third cycle to 2.41 in January 2016. In the last cycle, the CAUTI rates per 1000 catheter days reduced from 2.14 to zero in April 2016. The project accomplished the objective and goals of the project. Although it took long for the frontline to buy in the initiatives suggested, the project was a success. The frontline staff eventually accepted to use the interventions recommended and committed to the project to the end. Overall, the project was a success, and other units adopted the interventions in the hospital
Conclusion
The evidence-based practice used in the articles is Nurse Driven Protocol, Urinary Tract Infection bundled protocol (UTIP), and Education programs as an evidence-based practice to reduce CAUTI infections. Nurse-driven protocols are medical rubrics that nurses use as a basis to make autonomous care decisions. The UTIP bundle is a set guideline to reduce CAUTI. Education programs create awareness of the existing programs and how to prevent the problem. Adopting evidence-based interventions suggested in the articles in quality improvement projects will be effective as it decreases patient risks for developing CAUTIs. All the interventions yielded the same result: the staff became conscious of CAUTI, and how to prevent it, the rate of CAUTI decreased to zero, the number of CAUTI days and use of catheter devices decreased too
References
Connor, B. (2018). Best practices: CAUTI prevention. American Nurses Association. Retrieved from https://www.myamericannurse.com/wp-content/uploads/2018/02/ANT_BestPractices_CautiPrevention.pdf
Taha et al., (2017). Improving Catheter-Associated Urinary Tract Infection Rates in the Medical Units. BMJ quality improvement reports, 6(1), u209593.w7966. https://doi.org/10.1136/bmjquality.u209593.w7966
Schiessler, M., Darwin, L., Phipps, A., Hegemann, L., Heybrock, B., & Macfadyen, A. (2019). Don’t Have a Doubt, Get the Catheter Out: A Nurse-Driven CAUTI Prevention Protocol, Pediatric Quality and Safety: 4: 4 – p e183 https://journals.lww.com/pqs/fulltext/2019/07000/don_t_have_a_doubt,_get_the_catheter_out__a.4.aspx