Evidence-Based Approaches to Reduce and Prevent CAUTIs among Residents of Nursing Homes and Healthcare Centers

Introduction

Catheter-Associated Urinary Tract Infections (CAUTIs) constitute one of the leading issues affecting nursing care in today's healthcare setting. For instance, Saint et al. (2013) suggest that Catheter-Associated Urinary Tract Infections are among the most significant healthcare-acquired infections affecting about1 700 000 patients in the United States of America. Due to the significance of the issue, various studies have been conducted to determine evidence-based approaches to address the problem in all healthcare environments. A urinary catheter consists of a device in hospital centers to assist patients with incontinence problems, usually related to passage of urine. The leading cause of CAUTIs has been attributed to inappropriate use and management of the devices when used in health care centers. In many instances, catheter insertions tend to cause potentially avoidable CUATIs, resulting in much suffering for the patients and increased costs to get further treatments. Multifaceted models and interventions are therefore essential to prevent and reduce problems patients with catheters undergo, especially considering that the problems are preventable in the first place.

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Evidence-Based Approaches to Reduce and Prevent CAUTIs

Various evidence-based approaches have been created by researchers and practitioners to help reduce and prevent CAUTIs. For instance, technical interventions focus on professional development of nurses in relation to urinary catheter utilization, catheter care, antimicrobial stewardship, and maintenance (Mody et al., 2017). Another approach involves a focus on socio-adaptive factors with the aim of empowering healthcare facility teams, on how to deal with emerging challenges in the practice. The intervention further focuses on the provision of solutions to some of these barriers. According to Quinn (2015), the socio-adaptive factors approach promotes a resident safety culture, educates nurses on leadership and team building skills, and encourages the involvement of resident and family members in the caregiving process. Socioadaptive solutions also facilitate an understanding of diverse technical elements associated with the application of catheters to the end-users. The intervention also promotes practitioners to communicate and implement modifications that might improve outcomes in catheter use, workflow and the culture in a healthcare facility.

Overall, a multi-component approach to reduction and prevention of CAUTIs should encompass evidence-based technical aspects and socio-adaptive factors. According to Mody et al. (2017), evidence-based factors include improving catheter maintenance and care, antimicrobial stewardship, and reducing the duration an indwelling catheter remains in use. The socio-adaptive factors should encompass promotion of resident safety culture, leadership engagement, and team building among the healthcare practitioners. Various studies have demonstrated that a combination of these interventions drastically reduces and facilitates preventions of CAUTIs in all healthcare settings. Apart from the costs associated with managing CAUTIs in healthcare settings, the problem causes sepsis, increased hospital admissions, and development of multi-drug resistant organisms due to use of antimicrobial solutions.

Review of Studies on Evidence-Based Interventions for CAUTIs

The various studies reviewed for this paper were all derived from reputable peer-reviewed journals. Additionally, all the studies were empirical, and each focused on more than one approach used to address CAUTIs in healthcare settings. For instance, the study by Purvis et al. (2014) employed an interdisciplinary workgroup to investigate the issue of CAUTI in a hospital. The researchers used various strategies to collect evidence-based information concerning indwelling catheter usage in a medical data and utilized the facility's electronic health record (EHR) system to establish the validity of their information. The study by Parker et al. (2017) focused on a review of indwelling urinary catheter (IDC) insertions based on pre-post control interventions study. The authors used multiple approaches to evaluate pre and post prevalence of CAUTIs in four hospitals, as well the associated results before and after interventions. Data analysis was conducted using various computer applications. For instance, survey data was exported and merged with other digitized information extracted from demographic patient information using statistical the STATA statistical package for data analysis.

The study by Saint et al. (2013) reflected the results of a comprehensive analysis seeking to determine whether the state of Michigan was on track to realize the national goal to cut down CAUTIs by 25% by 2013. Apart from analyzing the evidence-based approaches sampled hospitals in the state used, the study applied national CAUTI-specific standardized infection ratios (SIRs) for the comparisons. Overall, all the reviewed studies employed utilized well-designed research, data analysis, and presentation strategies to reflect their outcomes in relation to prevention and reduction of CAUTIs, whether at the state or institutional level. All the studies utilized appropriate statistical tests and mainly relied on computer applications to process data. Samples were collected depending on the level of the study and particular focus of individual studies.

Ethical Practices Used in the Reviewed Studies

Although not all studies involved direct contact with the patients, those that did utilize various approaches to protect participants from any form of harm, stigma, or exploitation during the studies. For instance, Parker et al. (2017) sought ethical approval from the local health district and regional authorities. Additionally, all the participants signed consent forms indicating that their information could be used in the study. Furthermore, various protocols were followed by the research team to ensure the safety of both patients and their medical information. Purvis et al. (2014) also sought informed consent from the relevant authorities, although the authors do not give much information on how they protected patient data. The study by Saint et al. (2013) was different in that it did not focus on data from individual patients, but outcomes of hospitals within and outside the state of Michigan. Subsequently, the researchers only sought authorization for the project and proper consent from the hospitals involved in the study. Overall, studies that used individual participants met all the ethical requirements necessary to protect the patients and their information.

Strengths and Limitations of the Research Articles

Despite the thorough nature of the selected studies, some of them manifested limitations in relation to structure, coverage, and outcomes. For instance, the study by Saint et al. (2013) was prone to bias from multiple perspectives. First, the research was biased in that the researchers did not receive 100% response rate from the sampled hospitals. Additionally, the data used could not be verified but relied on self-reports from first infection preventionists from the sample hospitals. Finally, the researchers did not have information did not have direct access to patient-level details, indicating that they could not verify the authenticity of the responses they got from the individual hospitals.

The study by Mody et al. (2017) highlights other limitations that affected research conducted at the hospital level. For example, the study was restricted to nursing homes, whereby the environment can differ from that of hospital settings despite the provision of healthcare services. Additionally, the study was purely based on voluntary participants. Hence the results cannot be generalized as a representation of the effectiveness of evidence-based interventions in the reduction and prevention of CAUTIs in nursing homes. Also, since the researchers did not conduct any randomized controlled trials, their results could have been fuddled by an unmeasured variable. Overall, all the studies were affected by one or more forms of bias, ranging from inadequate samples and lack of standardized measures of outcomes to scope errors.

Implications for Practice

All the reviewed studies explore some aspects of how to reduce or prevent cases of CAUTIs in healthcare settings. Overall, the studies indicate that various evidence-based interventions, mainly comprised of technical and socio-adaptive approaches have a positive impact on the reduction of CAUTIs in hospitals and nursing homes. The results from these studies contribute to the evidence-base on CAUTIs through augmenting the understanding of various interventions to reduce the problem. Additionally, the studies outline implementation strategies that enable more straightforward replication of the reviewed interventions and implementations tactics. The use of mixed studies encompassing the hospital and national levels provides a framework for an in-depth analysis of any barriers or enablers to progress towards elimination of CAUTIs in healthcare settings. Ultimately, the studies facilitate the improvement of patient safety in healthcare facilities, through the implementation of rigorous evaluation of clinical practice and change. The reviewed research contributes towards an ongoing process seeking to eradicate or at the least minimize cases of catheter associated urinary tract infections in hospitals and other healthcare facilities.

References

Mody, L., Greene, M., Meddings, J., Krein, S., McNamara, S., Trautner, B., & ... Saint, S. (2017). A national implementation project to Prevent Catheter-Associated Urinary Tract Infection in nursing home residents. JAMA Internal Medicine, 177(8), 1154-1162.

Parker, V., Giles, M., Graham, L., Suthers, B., Watts, W., O'Brien, T., & Searles, A. (2017). Avoiding inappropriate urinary catheter use and catheter-associated urinary tract infection (CAUTI): a pre-post control intervention study. BMC health services research, 17(1), 314-323.

Purvis, S., Gion, T., Kennedy, G., Rees, S., Safdar, N., VanDenBergh, S., & Weber, J. (2014). Catheter-associated urinary tract infection: A successful prevention effort in employing a multipronged initiative at an academic medical center. Journal of nursing care quality, 29(2), 141-148.

Quinn, P. (2015). Chasing zero: A nurse-driven process for catheter-associated urinary tract infection reduction in a community hospital. Nursing Economic, 33(6), 320-325.

Saint, S., Greene, M., Kowalski, C., Watson, S., Hofer, T., & Krein, S. (2013). Preventing catheter-associated urinary tract infection in the United States: A national comparative study. JAMA internal medicine, 173 (10), 874-879.