A Literature Review on Nurse Effectiveness in Preventing CAUTI

This literature review investigates the effectiveness of nurses in preventing catheter-associated urinary tract infections (CAUTI). It begins by introducing catheterization and the problem of CAUTI, highlighting the increased healthcare costs, patient discomfort, and morbidity associated with prolonged catheter use. The review explores the causes and symptoms of CAUTI, emphasizing the importance of proper catheter insertion and removal procedures, as well as regular cleaning. It then presents a research question focused on nurse effectiveness in CAUTI prevention, outlining the aim and objectives of the research, including assessing nurses' knowledge, perceptions, skills, hygiene levels, and accountability. The methodology involves secondary research, utilizing databases such as PUBMED, CINAHL, BRITISH NURSING DATABASE, and MEDLINE to gather relevant articles based on specific inclusion and exclusion criteria. The review analyzes existing literature, including studies on antimicrobial catheters versus standard catheters, to determine the most effective strategies for nurses to prevent CAUTI and improve patient outcomes.

Running head: LITERATURE REVIEW
LITERATURE REVIEW
Name of the student:
Name of the university:
Author note:

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LITERATURE REVIEW
Part One
Introduction:
Catheterization refers to the procedure where a urinary catheter is placed inside the
bladder of a patient, through the urethra. The process facilitates free drainage of the patient’s
urine from the bladder for collection. The procedure is often performed under circumstances
when patients suffer from urinary incontinence, urinary retention, surgery in the genitals, or
under medical illnesses such as, spinal cord injury and dementia. Although use of catheterization
has irrefutable benefits in medical situation, their prolonged usage is allied with increased
healthcare costs, greater discomfort and morbidity amid the patients (Parientiet al.
2015).Indwelling catheter can be described as the tube that is inserted into the urethra. This tube
helps in draining urine from the bladder into a particular collection bag. Such catheters are
mainly inserted into a patient when they had already undergone a surgery or when the person
does not have control over the bladder function. Catheter related urinary tract infection (CAUTI)
often occurs due to inoculation of organisms by the urethral catheters to bladder, and subsequent
colonization that results in mucosal irritation. CAUTI has been found to be one of the most
common infections that a patient can contract from the healthcare centers. Hence, presence of
urinary catheters are considered as a crucial risk factor that increases the susceptibility of
bacteriuria. Several reasons that result in the onset of CAUTI are namely, (i) contamination of
catheter upon insertion, (ii) failure to empty the drainage bag, (iii) bacteria entry in catheter due
to bowel movement, (iv) backward flow of urine in catheter bag, and (v) unclean catheter. Owing
to the fact that appropriate catheter insertion and removal procedures help in lowering the risks
of CAUTI, and keeping them inserted for long increases the infection risk, nursing professionals
should have adequate knowledge on its usage (Vincitorioet al. 2014). This assignment would

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mainly be focusing on reviews of different literature that shed light on efficiency and expertise of
the nurses in prevention of the CAUTI and provision of safe and quality healthcare that prevent
sufferings and increase satisfaction of patients.Conduction of this literature review would help in
changing the existing behavior among the nursing staff on CAUTI and its prevention. The
collected evidences will also be disseminated, with the aim of increasing awareness among the
staff and hospitalized patients, thereby reducing rates of infection among patients.
Background:
Patients suffering from CAUTI show symptoms like cloudy urine, presence of blood in
the urine, strong odor present in the urine, urine leakage around the catheter. The patients are
also seen to suffer from pressure, pain as well as discomfort in the lower back of the stomach.
They may experience chills, fever, unexplained fatigue as well as vomiting. Therefore, CAUTI
results in preventable sufferings among the patients that affect their quality of life. Such
infection can disrupt the main treatment intervention plans for the patient with the main disorder
that had made them admitted to the healthcare centers (Rea et al., 2018). CAUTI results in
increasing the suffering of the patient in addition to the various disorder symptoms with which
the patient is already suffering from. This has many negative effects. Studies have stated that
preventable infections like CAUTI increases the length of hospital staysas well as readmission
rates along with sufferings of the patient. The patients seem to lose trust over the capabilities of
caring by the healthcare professionals and this creates a rift between the patients and family
memberwith that of the professionals of the hospitals.
It is very important for the nursing professionals to have proper knowledge about the
different ways by which CAUTI can occur among the patients. These would help them to

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develop detailed knowledge about the specific initiatives that they need to undertake during
insertion of catheters for prevention of the occurrence of the infection. Firstly, the catheter might
become infected upon insertion and secondly, the drainage bag might not be emptied often
enough that may become the source of infection (Pickard et al., 2012). Third, bacteria from the
bowel movement might also enter the catheter. Fourth, urine that remains present in the catheter
bag might flow backward into the bladder. Fifth, the catheter might not also be regularly cleaned
for prevention of infection. These factors might result in development of CAUTI among the
patients.
However, the prevalence of CAUTI in the nation of UK is quite high.. urinary tract
infection is one of the most important cause of morbidity as well as mortality in the healthcare
settings and even accounts for about 19% of all the nosocomial infections. Out of them, data
suggests that about 43 to 56% of the cases are cases of CAUTI. When inadequately treated,
CAUTI situations in patients might progress to cases of bacteraemia and even consequent
urosepsis syndromes. This contributes to the multiplication of the risks of the extended hospital
stays and even mortality (Peter et al., 2018). Due to the high-level prevalence of CAUTI,
economical analysis of different collected data shows that the economic implications of CAUTI
are quite high costing an estimated of about £1968 per patient episode as well as that of about
£99 million annually to the NHS (Barry et al., 2017). Therefore, it is highly significant to learn
how effective are the nurses in preventing such infections and accordingly develop strategies and
interventions to help nurses develop skills by which such infection can be prevented. This would
not only prevent occurrence of CAUTI among patients and reduce their suffering, but would also
help in managing the healthcare resources on more crucial treatment modalities.
Literature review question:

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The literature review question would be “How effective are nurses in preventing catheter
related urinary infections?”
Aim of the research:
 To explore the knowledge and efficacy of nursing professionals in preventing catheter
related urinary tract infections among patients.
Objectives of the research:
 To determine the idea harbored by nurses regarding CAUTI
 To understand the perception of the nurses about prevention of CAUTI among patients
 To assess the presence or absences of skills and knowledge that need to be harbored by
nurses for preventing CAUTI
 To explore the hygiene levels maintained by nurses
 To determine the attributes that make nurses accountable for preventing CAUTI
Methodology:
The study was based on secondary research that involved a comprehensive collation,
summary and synthesis of already existing scientific evidences. This methodology was in clear
contrast with primary research approach in that the latter involves data generation, while the
former takes into account primary scholarly articles for data analysis. The steps involved in the
methodology are given below:
 Formulation of the research question
 Searching for relevant scientific literature
 Screening articles for inclusion

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 Assessing the quality of the extracted primary studies
 Extraction of data
 Analysis of data
The research question was formulated with the use of the PEO framework that is a
commonly used criteria for framing and defining the clinical question of qualitative nature.
This framework comprises of three components namely, (i) population and their problems
(P), (ii) exposure (E), and (iii) outcomes or themes (O). The framework used for this
literature search is provided below:
P Nursing staff
E Knowledge, awareness, efficacy
O Catheter related urinary tract infection (CAUTI)
prevention
Table 1- PEO components
Search strategy:
The structure of this literature review was based on elaboration of the research question,
outlining the eligibility criteria for selection of prospective scholarly literature, extracting
articles, and detailed analysis. Four electronic databases namely, PUBMED, CINAHL, BRITISH
NURSING DATABASE, MEDLINE were used for extracting the articles.The search terms and
key phrases that were fed into the databases were namely, “effectiveness of nurses to prevent
CAUTI”, “prevention of CAUTI”, “skills of nurses and CAUTI”, “ways or prevention for
CAUTI”, “efficiency of nurses and CAUTI”, “perception or awareness and CAUTI”. Use of
boolean operators helped in combining the search terms in certain ways, thereby broadening or

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narrowing down the extracted hits. The using of the Boolean operators of “AND” helped in
narrowing down our researches and the using of the “OR” broadened the search by combining
different synonyms for covering the research question that was being explored. Determination of
the inclusion and exclusion criteriabeforehand facilitated selection of appropriate articles that
aligned with the phenomenon under investigation.
Inclusion criteria Exclusion criteria
Articles that are published in the English language Articles that are containing non-English language
Articles that had been published on or after 2008 Articles that are published before 2008
Articles that mainly emphasize on nurse’s
perception about skills and knowledge required to
prevent CAUTI or contain measurement of their
skills or expertise
Articles that focus on other healthcare associated
infections should be avoied
Primary research articles would only be chosen Secondary research articles
Articles that are published in the peer-reviewed
journals only needs to be chosen
Manuscripts as well as clinical guidelines should
be avoided
Table 1- Inclusion and exclusion criteria
Finally, the most reliable, per reviewed articles that aligned with the inclusion criteria and
helped in solving the literature review question were selected for the assignment.
Part Two
Literature review:
The article provided bySingha, Locklin & Handa (2017) had put focus on an interesting
aspect of the cause of the CAUTI among different hospitals. The authors are of the opinion that

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the major cause for the development of CAUTI is the bacteria travelling up to the bladders and
thereby causing infections. One of the main reasons for the occurrence of this event can be
attributed to the utilization of the different non-ideal material in the fabrication of the urinary
catheters. It has been found by them that such types of materials allow for the colonization of the
microorganisms that lead to bacteriuria and even the infection depending on the severity of the
symptoms (Royet al. 2018). They are of the opinion that the catheter should be made up of
materials that should be biocompatible, antifouling and antimicrobial.
Over many years, it has been found that many of the professionals have often argued
about the use of antimicrobial catheters in comparison to that of the standard polytetrafl
uoroethylene (PTFE) catheterization. Many of the nursing professionals had been seen to believe
that antimicrobial catheters are indeed helpful in obstructing the growth of microbes in the
catheters or prevent the chance of development of microbes at the entry site of the catheters into
the urethra (Saini, 2018). However, not much fruitful effect had been yet established that make
antimicrobial catheters the gold practice to prevent CAUTI. However, Pickard et al. (2012) have
conducted randomized controlled trail to test the efficiency of the antimicrobial catheters over
the normal use of the standard polytetrafl uoroethylene (PTFE) catheterization. The results of
this outcome had showed that although many experts support the use of anti-microbial catheters,
but its efficiency to prevent CAUTI is quite low (Krein et al. 2017). The interpretation of their
findings showed that levels of benefits obtained from using the antimicrobial catheters are so low
that bringing changes in practice would not bring out successful outcomes in prevention of
CAUTI. One of the best parts of the study was that the author did not only use one type of
antimicrobial catheter while comparing with the standard polytetrafl uoroethylene (PTFE)
catheterization. This is because only one type of antimicrobial agent failing to bring out positive

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results in prevention of CAUTI could not have represented same result by other antimicrobial
agents (Rhee et al. 2016). Therefore, the best part as the study was that they used two types of
antimicrobial catheters like that of the silver alloy catheter and that of the nitrofural-impregnated
catheters. It was found that the efficiency of silver-coated catheters was found to be not more
than that of the control showing that it does not have additional benefits in prevention of CAUTI.
It proved to be entirely failure in providing extra protection against bacteria. Another one is the
nitrofural-impregnated catheters which although showed a slight better efficiency than that of the
control but the number was not high enough to bring successful extraordinary outcomes when
implemented in practices.
The paper as written by McClurg et al. (2018) has given insights into the physical as well
as the psychological impacts on the health of persons who engages in habit of using clean
intermittent self-catheterization. This study showed that as habit of using this form of
catheterization normalized with the frequency of uses, many of people showed positive feelings
about their quality of life. However, many of the participants also stated that this habit often
seemed a burden on the life of people preventing them from participating in potential activities
of lives and hence seem as burden to them. They even try to reduce their water intake for getting
the chance if issuing this procedure less. Moreover, urinary tract infections are also found to be
quite common among the people using this mode of catheterization. Many of them have stated
that development of such infections due to use of catheters often acted as burden to lifestyle,
working as well as social life mainly within those who experienced them more than one month
(Purvis et al. 2017). This paper is therefore very useful to the nursing professionals to understand
about the feelings and perceptions about the patients suffering from long term bladder problems
and using clean intermittent self-catheterization. Another important aspect of this study was the

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positive perception of the people in using low dose antibiotics in management of their tract
infections. However, such low dose antibiotics were only taken after the recommendation of
healthcare professionals and decision were taken based on three factors. These were utility,
gravity of need and perceived efficacy.
Clayton (2017) had discussed some of the important information that the nursing
professional need to keep in mind for the effective prevention of CAUTI. Prevention of CAUTI
mainly begins with the avoiding of the nursing professionals in the unnecessary use of catheters.
Policies need to be developed for the insertion as well as the maintenance of the catheters along
with the proper election of the appropriate catheter, instituting surveillance of CAUTI and even
catheter use. The researchers are of the opinion that implementation of the facility wide CAUTI
protocol not only results in the reduction of the incidence of CAUTI (Teal et al. 2017). This
protocol can help in the improvement of the plan of care for the patients by ensuring that the care
can successfully meet different established criteria for the insertion of the catheters along with
adherence to standardized catheter guidelines along with prompt early removal of the catheters.
Protocols would also help the nursing professionals in improvement of the documentation of
dates of catheter insertion as well as removal, type of catheter, reason for insertion and even
justification of necessary. Every nursing professionals need to develop good knowledge about
every aspect of the CAUTI protocols successfully so that they can prevent the disorders
successfully.
Study conducted by Meddings et al. (2014) had supported the previous study and their
findings were much similar to that of the study conducted by Clayton. The study conducted by
them had provided various important interventions regarding reduction of the chances of the
occurrence of CAUTI. One of them is the proper use of the reminder system for removing the

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catheters at the right time (Mody et al. 2016). The other one is the unnecessary use of catheters
like in cases where it can be avoided thereby stopping such orders of insertion of catheters. Some
of the other CAUTI prevention strategies that can be well used for the reduction of the
prevalence is the aseptic insertion along with effective catheter maintenance. Many of the other
strategies are the use of the antimicrobial urinary catheters and even effective application of the
bladder bundle implementation.
Hutton et al. (2018) had published an important article that focused on the economic
evaluation of the implementation of CAUTI prevention programs in the nursing homes. This
paper is selected as it has a randomized control trial that provide level 2 evidence to readers
regarding the reliability as well as applicability of the information. The program that was
implemented was a 3 year targeted infection prevention multimodal program called the TIP
(Pashnik et al. 2017). The interventions that included in the program were mainly a structured
interactive educational program for the NH staff along with hand hygiene promotion, preemptive
barriers precautions for the CAUTI along with the infection preventionist supporting monthly
data feedback. The outcomes were then economically evaluated. The authors are of the opinion
that a 120 bed healthcare center would have around a program costs of $20279 in each year
(Richards et al. 2017). This would help in reducing the cost of the treatment of CAUTI by
$54,316 per year. This would result in a net cost savings of $34,037. The most of the savings as
found by the authors would come directly from the reduced number of hospitalization due to
CAUTI for about $39180 along with the savings of 15136 from CAUTI care within the
healthcare center. Even the authors had shown that this program would result in gaining of about
0.197 quality-adjusted life-years (QALYs). The best part of the study was that the authors were
the first to conduct an economic analysis and thereby developed a program that can be helpful

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for the trainers to train nurses and develop their knowledge and skills over the prevention of
CAUTI.
Another very interesting article depicting an innovative concept for the prevention of
CAUTI by the nurses had been found. Kathleen et al. (2018) had been innovative in a way, as
she had introduced technological perspective for the first time to help nurses become more
competent in their services towards patients and prevention of CAUTI. The initial stage of the
experiment included nurse champions to first evaluate evidence based catheter associated urinary
tract infection prevention practices with the help of the manual and paper-based feedback. This
process helped in the reduction of the rates of CAUTI in the hospitals over about 18 months.
However, the main issues with the program was that it was resource intensive (Mody et al.
2015). Following this, the cloud based software technology was also introduced for replacement
of the paper. After the new intervention was introduced, four important components were
selected which were satisfaction of the nurse champion, indwelling urinary catheter utilization,
catheter associated urinary tract infection and also prevention practices and then they were
compared with before and after the technology intervention (Brown, 2017). Nurse Champion’s
satisfaction rate was higher with the cloud-based technology and indwelling urinary catheter
utilization rate was lower for the later intervention. However, no considerable changes in the
rates of catheter-associated urinary tract infection rates were found. This is one of the best
articles as it had successfully applied the innovative concept of cloud-based technology
overcoming the traditional system of controlling CAUTI. It provided one of the most innovative
ways by which they can control the CAUTI in hospitals. Reduction in the utilization of the
catheters would help in reducing the prevalence of CAUTI successfully.