Preventive Strategies for Lowering Catheter Associated UTI Risks

This essay critically appraises two quantitative articles that are based on preventive strategies for lowering catheter associated UTI risks.

Running head: NURSING
Quantitative Research Critique
Name of the Student
Name of the University
Author Note

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Introduction- Urinary tract infection (UTI) refers to an infection that occurs in a
segment of the urinary tract, predominantly due to infestation by Escherichia coli bacteria.
The common signs and symptoms of this condition encompass burning sensation at the time
of micturition, vaginal discharge, pain, pyelonephritis, nausea and vomiting (Gratzke et al.,
2015). Time and again it has been found that urinary catheters increase the likelihood of
suffering from UTI and the risk of bacteriuria, or presence of bacteria in urine does not
decrease with the administration of prophylactic antibiotics (Flores-Mireles, Walker, Caparon
& Hultgren, 2015). However, on using aseptic techniques for catheter insertion, risks of
catheter associated UTI (CAUTI) can be reduced. This essay will critically appraise two
quantitative articles that are based on preventive strategies for lowering CAUTI risks.
Background- The article by Yasuda (2017) was based on the problem of intravascular
catheter colonization, and aimed to compare the efficacy of three antiseptic solutions [10%
aqueous povidone-iodine (PVI) and 0.5%, and 1.0% alcohol/chlorhexidine gluconate (CHG)]
for preventing it. The purpose was significant to nursing since use of intravascular catheter is
imperative in contemporary clinical practice, predominantly in ICUs (Daubenspeck & Kacha,
2019). Nonetheless, use of central venous catheters contribute to catheter-related infections.
However, the purpose of the quasi-experimental study by Menegueti (2019) was to assess the
effect of executing a healthcare workers (HCWs) informative program and a day-to-day list
for indwelling urinary catheter signs. Its purpose is accredited to the fact that indwelling
catheter is generally in ICU patients, for collection of urine.
Support to nursing practice- The two articles will prove beneficial in providing
answers to the PICOT question owing to the fact that the question focused on identifying
strategies like appropriate catheter insertion and removal, training and education, and
antiseptic technique application that will help in lowering the incidence rate of CAUTI
among adult hospitalized patients, within a time frame of six months. Time and again it has

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been found that yeast and bacteria, particularly those that are naturally present in the human
biome have the capacity to grow long urinary catheter surface, thus resulting in bladder
infection (Tiwari, Hui & Rai, 2015). According to Khan, Baig and Mehboob (2017) CAUTI
has been associated to several health complications such as, epididymitis,
prostatitis, and orchitis among males, and pyelonephritis, cystitis, gram-
negative bacteremia, endocarditis and septic arthritis. Records from the United States suggest
that roughly 449,334 CAUTI events occur each year and each event is related with a medical
expenditure of $758 (CMS Hospital Compare, 2018). This calls for the need of identifying
strategies that can help in preventing the onset of CAUTI, and/or its management, in order to
reduce the chances of related health complications. The intervention in the RCT were three
types of antiseptic solutions namely, 0.5%, and 1.0% alcohol/chlorhexidine gluconate (CHG),
and 10% aqueous PVI (Yasuda 2017). This was in contrast to healthcare routine training
intervention in the quasi-experimental study (Menegueti 2019). Both of these are relevant to
the PICOT question since the RCT was based on antiseptic intervention, and the latter was
based on educational program.
Methodology- Both the articles selected for critical analysis were based on
quantitative research design, thereby highlighting that the researchers tried to quantify the
issue of CAUTI, and used statistical or numerical data for assessing the defined variables
(incidence of CAUTI). The article by Yasuda (2017) was a RCT, thus suggesting that the
subjects were randomly allocated to one of the three treatment groups, in order to determine
the antiseptic technique that was most effective. Following randomization procedure helped
in the removal of selection bias between the three groups of patients, thus preventing the
allocation results from getting compromised. This is in contrast to the research by Menegueti
(2019) was a quasi-experimental one that generally encompasses the modification of an
independent variable, which is not accompanied by random allocation of study participants to

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the CAUTI. The benefit of RCT is that one intervention is unswervingly compared to
alternatives, with the aim of establishing superiority. Furthermore, RCT also makes causal
inference about the intervention (Creswell & Creswell, 2017). However, power calculation
needs enormous sample and needs clinical equipoise. In contrast, quasi-experimental
research helps the researchers to gain influence over the variables and helps in determining
what is best for the target population. However, it is subject to human error and the personal
bias of the researchers might encroach during the research (Lebo & Weber, 2015).
Results- The findings of RCT by Yasuda (2017) suggested that 70% of the 1132
catheters that were randomized were allocated to the complete analysis set and the incidence
of catheter-tip colonization was found to be 3.9, 3.7, and 10.5 incidents/ 1000 catheter days,
for 1% CHG, 0.5% CHG, and PVI groups, respectively (p = 0.03). On conducting a pairwise
comparison, significantly increased risk of catheter colonization was found in PVI group
(0.5% CHG vs. PVI: HR 0.33 [95% CI 0.12–0.95], p = 0.04; 1.0% CHG vs. PVI: HR 0.35
[95% CI 0.13–0.93], p = 0.04). Results presented by Menegueti (2019) highlighted a
reduction in catheter utilization rate from phase I to phase IV (73.1%, 74.1%, 54.9%, and
45.6%, respectively). Furthermore, a reduction was also observed in CAUTI incidence phase
I to phase IV (14.9, 7.3, 3.8, and 1.1 per 1000 catheter-days, respectively). The implications
of the research findings are that it confirmed the effectiveness of 0.5% and 1.0% alcohol
CHG antiseptic agents for the successful prevention of catheter colonization, thus
highlighting the need of implementing this strategy for enhancing health outcomes. It also
illustrated that routine education and training programs help in increasing awareness among
healthcare professionals about the harmful impact of catheter use, thus facilitating them to
decrease CAUTI occurrence amid their patients.
Outcomes comparison- The anticipated outcome for the PICOT question is that use of
antiseptic techniques and/or training the healthcare workers will prove effective in reducing

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the incidence of CAUTI. Thus, the outcomes of the articles were in accordance to the
anticipated consequences.
Conclusion- To conclude, UTI is a common disease that affects hospitalized critically
ill patients, particularly in the ICU, and increases with the use of catheter. However, aseptic
techniques must be used during the insertion of the catheters in order to lower of incidence.
Hospitals must focus on the use of antiseptics such as, 0.5% and 1.0% CHG for prevention of
CAUTI. Likewise, routine evaluation and HCWs education must also be imparted for
effectively lowering CAUTI rates among the patients.

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References
CMS Hospital Compare. (2018). National Healthcare Safety Network (NHSN) Catheter-
associated Urinary Tract Infection (CAUTI) Outcome Measure. Retrieved from
https://www.hospitalsafetygrade.org/media/file/CAUTI.pdf
Creswell, J. W., & Creswell, J. D. (2017). Research design: Qualitative, quantitative, and
mixed methods approaches. Sage publications.
https://www.academia.edu/29084454/_John_W._Creswell_Research_Design_Qualitat
ive_Q_BookFi_
Daubenspeck, D., & Kacha, A. (2019). Intravascular Devices in the ICU. In Difficult
Decisions in Cardiothoracic Critical Care Surgery (pp. 135-148). Springer, Cham.
https://doi.org/10.1007/978-3-030-04146-5_11
Flores-Mireles, A. L., Walker, J. N., Caparon, M., & Hultgren, S. J. (2015). Urinary tract
infections: epidemiology, mechanisms of infection and treatment options. Nature
reviews microbiology, 13(5), 269. https://doi.org/10.1038/nrmicro3432
Gratzke, C., Bachmann, A., Descazeaud, A., Drake, M. J., Madersbacher, S., Mamoulakis,
C., ... & Gravas, S. (2015). EAU guidelines on the assessment of non-neurogenic
male lower urinary tract symptoms including benign prostatic obstruction. European
urology, 67(6), 1099-1109. https://doi.org/10.1016/j.eururo.2014.12.038
Khan, H. A., Baig, F. K., & Mehboob, R. (2017). Nosocomial infections: Epidemiology,
prevention, control and surveillance. Asian Pacific Journal of Tropical
Biomedicine, 7(5), 478-482. https://doi.org/10.1016/j.apjtb.2017.01.019
Lebo, M. J., & Weber, C. (2015). An effective approach to the repeated cross‐sectional
design. American Journal of Political Science, 59(1), 242-258.
https://doi.org/10.1111/ajps.12095

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Menegueti, M. G., Ciol, M. A., Bellissimo-Rodrigues, F., Auxiliadora-Martins, M., Gaspar,
G. G., da Silva Canini, S. R. M., ... & Laus, A. M. (2019). Long-term prevention of
catheter-associated urinary tract infections among critically ill patients through the
implementation of an educational program and a daily checklist for maintenance of
indwelling urinary catheters: A quasi-experimental study. Medicine, 98(8).
doi: 10.1097/MD.0000000000014417
Tiwari, V., Hui, M., & Rai, M. (2015). Incidence of Candida Species in Urinary Tract
Infections and Their Control by Using Bioactive Compounds Occurring in Medicinal
Plants. Medical Mycology: Current Trends and Future Prospects, 79. Retrieved from
https://www.taylorfrancis.com/books/e/9780429088940/chapters/10.1201/b18707-8
Yasuda, H., Sanui, M., Abe, T., Shime, N., Komuro, T., Hatakeyama, J., ... & Seo, R. (2017).
Comparison of the efficacy of three topical antiseptic solutions for the prevention of
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