Catheter Associated Urinary Tract Infection as a Nursing Practice Problem

This article discusses catheter associated urinary tract infection as a nursing practice problem. It includes a literature review on the topic, a quality improvement process, and a tool used for basis in CAUTI. The article also provides recommendations on how to reduce the rate of infections.

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Catheter associated urinary tract infection as a nursing practice problem
Name of author
Institutional affiliation

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INTRODUCTION
Catheter-associated urinary tract infection is regarded to be among the most common hospital-
acquired infection. This is a major problem since there was an increase from one infection last
year to five infections this year. It is a preventable problem since nurses can assess the need of
inserting an indwelling catheter, use of an aseptic technique and aftercare of an indwelling
catheter. According to (International Federation of Infection Control,2016) use of indwelling
catheters increases the risk of bacteriuria at a daily rate of 5% and by 100% by four weeks. In an
untreated infection progresses to septicemia, cystitis, and pyelonephritis. A patient who has an
indwelling catheter in place for an entire day on recognition of urinary tract infection and at least
fever, suprapubic pain, costovertebral pain, urgency, dysuria, and a positive urine culture
qualifies to be a catheter-associated urinary tract infection (Bucci,2016).
There is need to address rise in catheter-associated urinary tract infection. (Scott,2009) states
complications such as endocarditis and meningitis cause discomfort to the patient, prolonged
hospital stays and increased mortality. This superimposes more unnecessary conditions to the
patient and resistance to antibiotics if managed inappropriately. It is important to address the rise
of such infections to avoid unnecessary costs in treatment and to advocate for the patient against
unnecessary catheter insertion. The purpose of this paper is to address indication of indwelling
catheters and reduce the rate of infections from five to zero which occurred in the hospital by
proper nursing care and quality improvement process.

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LITERATURE REVIEW
(Dogra,2015) undertook a research to determine knowledge of doctors and nurses regarding
indication for catheterization and preventing catheter-associated urinary tract infection in a
hospital. The data was collected via questionnaires given to 54 doctors and 105 nurses. The
findings indicated that only 57% could identify steps to prevent catheter-associated urinary tract
infection. The doctors were had better knowledge on indication for inserting a catheter compared
to their counterparts in nursing. This indicates need for imparting knowledge on catheter use
among healthcare professionals.
(Drekonja,2014) engaged a research to ascertain nurses’ attitudes and knowledge regarding
indications for using a catheter and how to prevent associated infections in Minnesota. This was
done via an internet survey containing scale questions on the indications for catheter insertion
and measures to prevent catheter-associated infections. The results indicated high level of
knowledge on need to remove foley catheter to prevent infection. However, there was concern on
other aspect of catheter knowledge. This information if imparted would make a difference in
catheter care in hospitals
(Park,2018) conducted a study on factors associated with hospital-acquired catheter urinary tract
infections. The methods used in identification of such factors are decision trees. The results
identified were nurses with specialty certifications working under such clients reduced
occurrence of catheter-associated urinary tract infections. Also, if a catheter is left in situ for
more than 48 hours there are higher chances of infections. The findings also suggest more
nursing hours with patient results to positive outcomes.

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(Nicolle,2014) investigated antimicrobial resistance and infection control in regard to catheter-
associated urinary tract infections. Methods used was cohort studies across Quebec. The findings
regarding the study was use of an indwelling catheter was associated with an increased
occurrence of urinary tract infection and morbidity from noninfectious causes. There was
evidence limiting use of catheters and removal of catheters while not in use would go a long way
in prevention of infections. Asymptomatic urinary infections would require biofilm resistant
catheters.
(Givens,2014) conducted a research to investigate the excess morbidity and costs related to
catheter-associated urinary infections in surgical patients. This was conducted via case matched
and controlled study. The findings were the patient’s stay was increased by three days and
hospital costs by 558 dollars per patient. The recommendations included removal of the catheter
as soon as the patient was able to ambulate.

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QUALITY IMPROVEMENT PROCESS AND TOOL USED FOR BASIS IN CAUTI
Quality improvement process refers to the act of improving the needs and healthcare of targeted
patients groups in a manner that can be evaluated. According to (Batalden,2014) quality
improvement involves combined efforts of healthcare workers, patients, and their families,
researchers to yield better outcomes and care. This process involves forming a team that looks
into the desired change, whether it is measurable, whether the staff is able to undertake the
changes and the models that will be used. The use of data is a guideline in the need of quality
improvement process. The formation of quality improvement team is important as it spearheads
the whole process with the main focus being the patient. The team establishes the changes to be
met according to the data, sets the objectives to be met, implements the objectives via teamwork
from all the healthcare providers and evaluates if there is any difference. In addressing catheter-
associated urinary tract infections quality improvement process would be applied right from
handwashing, insertion of catheter, daily assessment, and cleaning and prompt removal of the
catheter.
The quality improvement tool that will be used is the plan-do-study-act cycle in catheter-
associated urinary tract infections. Plan-do-Study-Act cycle is a quality improvement tool which
involves determining needed improvement and changes required, implementing changes,
analyzing data to note any improvement and finally evaluating the changes(Spath,2013).There is
deeper insight after every repetition of the cycle and there easy assessment of mistakes by the
team.(Spath,2013).According to(Bell,2014) science improvement draws conclusions from tools
such as plan-do-study-act. This would involve implementing changes at each step of catheter

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insertion, drawing of urine samples and removal of the catheter. This will be monitored to assess
if there is a reduction in the occurrence of the catheter-associated urinary tract infections. If there
is an improvement the actions can then be implemented at a large-scale level by repeating the
cycle
During my clinical rotation, the third week mainly involved taking actions according to the Plan-
do-study-act cycle to reduce the number of catheter-associated urinary tract infections. A
performance improvement team was formed to review data, establish areas of improvement and
monitor improvement. Another action was nurse-driven protocol to remove foley, for example,
the nurse had the autonomy to remove a catheter in a surgical patient who was ambulatory.
Nurse performed perineal care aseptically. There was continuing medical education regarding the
handling of the catheters. Nurses were taught that catheters should be below the bladder level,
the urine bag should not be on the flow, change of catheter before obtaining a urine culture if it
has been in place more than five days. The nurses were challenged to engage the doctors on the
indications of indwelling catheter.

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REFERENCES
Batalden, P. B., & Davidoff, F. (2014). What is “quality improvement” and how can it
transform healthcare?.
Bucci M. (2016). Understanding outcome measures: catheter-associated urinary tract
infections and CDI.
Drekonja DM, Kuswoski MA, Johnson JR. (2014). Internet survey of foley catheter practices
and knowledge among Minnesota nurses.
Givens, C. D., & Wenzel, R. P. (2014). Catheter-associated urinary tract infections in
surgical patients: a controlled study on the excess morbidity and costs. The Journal of
urology, 124(5), 646-648.
International federation of infection control (2016).Catheter associated urinary tract
infections. Retrieved from www.who.int>CAUTI_student-handbook.
Jain, M., Dogra, V., Mishra, B., Thakur, A., & Loomba, P. S. (2015). Knowledge and
attitude of doctors and nurses regarding indication for catheterization and prevention
of catheter-associated urinary tract infection in a tertiary care hospital. Indian journal
of critical care medicine: peer-reviewed, official publication of Indian Society of
Critical Care Medicine, 19(2), 76.
Nicolle, L. E. (2014). Catheter associated urinary tract infections. Antimicrobial resistance
and infection control, 3(1), 23.

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Park JI, Bliss DZ, Chi CL, Delaney CW, Westra BL. (2018). Factors associated with
healthcare-acquired catheter-associated urinary tract infections
Scott, R. D. (2015). The direct medical costs of healthcare-associated infections in US
hospitals and the benefits of prevention.
Spath, P. (2013). Introduction to healthcare quality management (3rd ed.). Chicago IL:Health
Administration Press.
Taylor, M. J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D., & Reed, J. E. (2014).
Systematic review of the application of the plan–do–study–act method to improve
quality in healthcare. BMJ Qual Saf, 23(4), 290-298.