Catheter-Associated Urinary Tract Infection Assignment Discussion

Catheter-Associated Urinary Tract Infection Assignment Discussion

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A typical hospital acquired infection (HAI) is catheter-associated urinary tract infection (CAUTI). Along with central line-associated blood stream infection (CLABSI), these happen to be some of the most frequent HAIs in an acute care context. Interventions by nurses are essential in ensuring that CAUTI cases are eradicated or maintained to a minimal because the occurrence of CAUTI is a nurse-related quality standard (Davies et al., 2018; Ravi & Joshi, 2019)Catheter-Associated Urinary Tract Infection Assignment Discussion. Sepsis in particular is a more serious consequence of CAUTIs. One of the initiatives that have been shown to be beneficial for decreasing the number of cases of CAUTI in the acute care setting is the deployment of a nurse-led bundled strategy.           The purpose of this paper is to outline a change strategy and its implementation in preventing CAUTI and its complication of sepsis.

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According to Witwer et al. (2019), CAUTIs account for seventy to eighty percent of all urinary tract infections in hospitals and have an incidence of two cases per 1,000 days spent with an indwelling catheter. The avoidance of CAUTI in the acute care environment in any hospital setting is expected to be regarded as an initiative to improve care quality since it is a quality concern. A patient’s hospital stay days will undoubtedly increase if they contract CAUTI while receiving care in the hospital and go on to develop sepsis. Additionally, they will spend more on healthcare as a result. This decreases the standard of care provided in that institution and is not a desired patient result in any type of healthcare facility.

CAUTI and Sepsis

Due to the possibility of sepsis, CAUTI is a serious issue in the acute care setting. It not only raises healthcare expenses by extending hospital stays, but it also ranks as one of the main causes of sepsis-related mortality (Letica-Kriegel et al., 2019). Nursing tasks include caring for indwelling urinary catheters. This indicates that the best treatment for CAUTI and sepsis prevention is nurse preventive actions. Considering that bladder catheterization is practically required for every patient in acute care, CAUTI is an issue that is particularly common in those environments.  According to Tuttle (2017), CAUTIs extend hospital stays for severely ill catheterized patients by at least an additional two to four days. They projected an annual increase in hospitalization expenses of between $400 and $500 million attributable to these extra days Catheter-Associated Urinary Tract Infection Assignment Discussion.

In a study by Barchitta et al. (2020), it was discovered that CAUTIs are linked to serious health effects including sepsis. When bacteria from the urinary tract enter the bloodstream, the result is sepsis. This is a systemic inflammatory illness. According to research monitoring information, sepsis is linked to a rise in morbidity as well as mortality in patients of all ages. The researchers found that although there was no variation in the prevalence of sepsis between clusters, thirty-seven percent of patients with CAUTI went on to acquire sepsis. However, they also noticed that the percentage of patients with CAUTI who developed sepsis rose with longer catheterization days.

To be more precise, sepsis manifested in thirty percent of participants catheterized for no more than five days, thirty-five percent of subjects catheterized for a period of time exceeding five days but fewer than ten days, and 45.6 percent of the individuals catheterized for more than ten days. Uropathogens can potentially breach the tubular epithelial cell membrane and result in sepsis, a serious illness linked to a higher mortality risk, if left unchecked. Consequently, Barchitta et al. (2020) observed that thirty-seven percent of CAUTI patients had sepsis that was making their condition worse, and that this number rose as the length of duration of catheterization extended.

The Change Strategies and their Implementation

According to Letica-Kriegel et al. (2019), approximately 69% of all CAUTI cases are actually preventable and therefore avoidable. What is required is the observation of infection prevention and control measures at all times to begin with. This starts with the simple but effective act of washing hands with soap and water (CDC, 2023; Andriani & Nadjib, 2018)Catheter-Associated Urinary Tract Infection Assignment Discussion. This should be done before touching a different patient and before doing any procedure.

Evidence-based practice, or EBP, is built on peer-reviewed academic research. The goal of this change initiative’s interventions is to prevent sepsis as a result of CAUTI, and this serves as the justification (Melnyk & Fineout-Overholt, 2019). In this particular instance, the evidence required for the suggested remedies listed below is provided by a variety of recent scholarly sources. A major clinical issue in nursing practice, CAUTI causes unnecessary morbidity and mortality. It is a quality improvement issue since it is avoidable, and its rates act as an indicator of quality or standard.

Four evidence-based interventions are given below. They will utilize interprofessional considerations to ensure successful implementation by adopting a multidisciplinary approach. Almost all the scholarly sources are unanimous that these interventions should be used together as a bundle for maximum effectiveness. Also, the interventions and adherence to the CAUTI prevention bundle need to be nurse-led.

The process of bladder catheterization must always be carried out in pairs by two nursing staff members. One of them utilizes a list of instructions while doing this to ensure the other nurse performs the processes exactly as they should be (Fletcher-Gutowski & Cecil, 2019). It has been demonstrated that this safety measure lowers the frequency of CAUTIs. As expensive infections, CAUTIs raise the expense of hospitalization. However, according to a study by Hollenbeak and Schilling (2018), the cost varies significantly depending on the patient’s level of acuity. This study found that the expense of a CAUTI is higher for patients in critical care facilities. Therefore, it should be a top goal to lower this cost through easy actions like using the aseptic technique and washing your hands.

For patients undergoing major surgery, extended surgery is a risk factor for the occurrence of a CAUTI (Letica-Kriegel et al., 2019). This indicates that bacteria use the length of time of stasis to their advantage to colonize the urinary system. During lengthy procedures, it would be crucial to make an evidence-based clinical decision regarding whether to continually clean the meatus or cleanse the urinary tract. Last but not least, CAUTI is either caused by or predisposed to by late catheter removal for surgically treated patients following surgery. According to Rimmer et al. (2020), this was especially true for patients who had undergone hysterectomy. The preventative bundle should therefore include the removal of indwelling catheters as soon as is practical. Catheter-Associated Urinary Tract Infection Assignment Discussion

Data Table

References

Andriani, Y., & Nadjib, M. (2018). The importance of implementation of hand hygiene practice in reducing healthcare-associated infections: A systematic review. The 2nd International Conference on Hospital Administration (KnE Life Sciences),135–145. https://doi.org/10.18502/kls.v4i9.3565

Barchitta, M., Maugeri, A., Favara, G., Riela, P.M., La Mastra, C., La Rosa, M.C., San Lio, R.M., Gallo, G., Mura, I., & Agodi, A. (2020). Cluster analysis identifies patients at risk of catheter-associated urinary tract infections in intensive care unit: Findings from the SPIN-UTI network. Journal of Hospital Infection, 107(0), 57-63. https://doi:10.org/1016/j.jhin.2020.09.030

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Centers for Disease Control and Prevention [CDC] (2023, April 28). Hand hygiene in healthcare settings. https://www.cdc.gov/handhygiene/

Davies, P.E., Daley, M.J., Hecht, J., Hobbs, A., Burger, C., Watkins, L.… & Brown, C.V.R. (2018). Effectiveness of a bundled approach to reduce urinary catheters and infection rates in trauma patients. American Journal of Infection Control, 46(7), 758–763. https://doi.org/10.1016/j.ajic.2017.11.032

Fletcher-Gutowski, S., & Cecil, J. (2019). Is 2-person urinary catheter insertion effective in reducing CAUTI? American Journal of Infection Control, 47, 1508-1509. https://doi.org/10.1016/j.ajic.2019.05.014

Hollenbeak, C.S., & Schilling, A.L. (2018). The attributable cost of catheter-associated urinary tract infections in the United States: A systematic review. American Journal of Infection Control, 46, 751-757. https://doi.org/10.1016/j.ajic.2018.01.015

Letica-Kriegel, A.S., Salmasian, H., Vawdrey, D.K., Youngerman, B.E., Green, R.A., Furuya, E.Y., Calfee, D.P., & Perotte, R. (2019). Identifying the risk factors for catheter-associated urinary tract infections: A large cross-sectional study of six hospitals. BMJ Open, 9(2), 1-7. https://doi.org/10.1136/bmjopen-2018-022137

Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice, 4^th ed. Wolters Kluwer.

Ravi, P.R., & Joshi, C. (2019). Role of “bladder care bundle” and “infection control nurse” in reducing catheter-associated urinary tract infection in a peripheral hospital. Journal of Marine Medical Society, 20(2), 116-121. Doi: 10.4103/jmms.jmms_8_18.

Rimmer, M.P., Henderson, I., Keay, S.D., Khan, K.S., & Al Wattar, B.H. (2020). Early versus delayed urinary catheter removal after hysterectomy: A systematic review and meta-analysis. European Journal of Obstetrics & Gynecology and Reproductive Biology, 247, 55-60. https://doi.org/10.1016/j.ejogrb.2020.01.011

Tuttle, J.C. (2017). Cutting CAUTIs in critical care. Journal of Clinical Outcomes Management, 24(6). https://www.mdedge.com/jcomjournal/article/145872/infectious-diseases/cutting-cautis-critical-care

Witwer, M., Dobbins, G., Uher, C., & McFarren, M.D. (2019). Auditing CAUTI best practices bundle adherence in a 24-bed neurovascular/cardiovascular/intensive care unit. American Journal of Infection Control, 47(6), S30. https://doi.org/10.1016/j.ajic.2019.04.062 Catheter-Associated Urinary Tract Infection Assignment Discussion

Guiding Questions: Change Strategy and Implementation

This document is designed to give you questions to consider and additional guidance to help you successfully complete the Change Strategy and Implementation assignment. You may find it useful to use this document as a pre-writing exercise, as an outlining tool, or as a final check to ensure that you have sufficiently addressed all the grading criteria for this assignment. This document is a resource to help you complete the assignment. Do not turn in this document as your assignment submission. Catheter-Associated Urinary Tract Infection Assignment Discussion

Develop a data table that accurately reflects the current and desired states of one or more clinical outcomes.

• Does your data table clearly and accurately reflect the current state of one or more clinical outcomes?
  • If applicable, have you appropriately citied the source for this data?
  • Is your data HIPAA compliant?
• Does your data table clearly and accurately reflect the desired state of one or more clinical outcomes?
  • Have you based your desired state on best practices, guidelines, or regulations?
    • Have you cited the relevant sources of evidence that you used to set your desired outcome state?
    • Is your data HIPAA compliant?
  • Are the data and outcomes in your table relevant to a specific care setting, case study, or other clearly defined condition or issue?
  • Are the data and the outcomes relevant and appropriate for the change strategy you will be proposing?

Propose change strategies that will help to achieve the desired state of one or more clinical outcomes.

• What change strategies do you propose implementing to help achieve your desired outcomes?
• How will you implement the change strategies to help achieve your desired outcomes in the context of the care setting or case study you are using for this assignment?
  • What other implementation considerations do you need to take into account to ensure that the change strategy is successful?
  • What implementation challenges or hurdles might exist and how might you deal with them?
• How could the efficiency and effectiveness of the care system be evaluated to see if the desired outcomes are met? Catheter-Associated Urinary Tract Infection Assignment Discussion

Justify the specific change strategies used to achieve desired outcomes.

• Why is each change strategy you have chosen to implement relevant and appropriate for achieving one or more of your desired outcomes?
  • What evidence (literature, best practices, professional guidelines, et cetera) supports your reasoning for implementing a chosen change strategy in the context of the care setting, case study, or desired outcomes you are considering for this assignment?
    • How does the evidence support your reasoning and proposed implementation? Be specific. Catheter-Associated Urinary Tract Infection Assignment Discussion

Explain how change strategies will lead to quality improvement with regard to safety and equitable care.

• Which change strategy (or strategies) will most likely lead to quality improvements in the area of patient safety?
  • How will it contribute to quality improvements in this area?
• Which change strategy (or strategies) will most likely lead to quality improvements in the area of equitable care?
  • How will it contribute to quality improvements in this area?
• How might the strategy (or strategies) lead to other improvements related to the Quadruple Aim?

Explain how change strategies will utilize interprofessional considerations to ensure successful implementation.

• Which proposed change strategy (or strategies) will best leverage interprofessional considerations and strategies?
  • How will it help ensure successful implementation across interprofessional or multidisciplinary teams?
  • How does your change strategy address the well-being of health care professionals? Catheter-Associated Urinary Tract Infection Assignment Discussion

Communicate a change plan in a way that makes the data and rationale easily understood and compelling.

• Is your data table clearly presented?
• Are the links between your data table, desired outcomes, and change strategy and implementation clear and justified?
• Is your writing clear and professional?
• Is your writing free from errors?
• Is your submission 3–5 pages (not including the title page and reference list)?
  

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Integrate relevant sources to support assertions, correctly formatting citations and references using current APA style.

• Did you use 3–5 sources in your assignment?
  • Are the sources you used no more than five years old?
• Are your sources cited in APA format throughout the assignment?
• Have you included an attached reference list?
• Did you use the APA Paper Template for the proper formatting and to include a running head and title page?
  • No abstract is needed for this assignment. Catheter-Associated Urinary Tract Infection Assignment Discussion

Professional Context
One area in health care that it is necessary to consider is the environment in which nurses work. It is important that this environment evolves and changes so that all patients are adequately supported. For this assignment, you will develop a change strategy to improve the health care environment. These changes can be rooted in a desire to improve clinical outcomes and data related to assessment accuracy, drug administration, or disease recovery rates. A key skill for master’s-level nurses is to be able to evaluate clinical data and create a change plan to help drive improvements in the data to reach set goals.

Scenario
Consider a current environment. This could be your current care setting, the care setting presented in the Vila Health scenario Concept Maps as Diagnostic Tools, or a care setting in which you are interested in working. For the setting that you choose you will need to have a data set that depicts sub-optimal outcomes related to a clinical issue. This data could be from existing sources in the course, a relevant data set that already exists (a data set from the case study you used as a basis for your Week 3 Concept Map assignment, or from your current place of practice), or an appropriate data set that you have created yourself. (Note: if you choose to create your own data set, check with your instructor first for approval and guidance.)

After you have selected an appropriate data set, use your understanding of the data to create at least one realistic goal (though you may create more) that will be driven by a change strategy appropriate for the environment and goal.

Potential topics for this assignment could be:

Consider ways to help minimize the rate of secondary infections related to the condition, disease, or disorder that you focused on for your Week 3 Concept Map assignment. As a starting point, you could ask yourself, “What could be changed to facilitate safety and minimize risks of infection?”
Consider how to help a patient experiencing traumatic stress or anxiety over hospitalization. As a starting point, you could ask yourself, “How could the care environment be changed to enhance coping?”
Once you determine the change you would like to make, consider the following:

What data will you use to justify the change?
How can the team achieve this change with a reasonable cost?
What are the effects on the workplace?
What other implementation considerations do you need to consider to ensure that the change strategy is successful?
How does your change strategy address all aspects of the Quadruple Aim, especially the well-being of health care professionals?
Once the change strategy is implemented, how would you evaluate the efficiency and effectiveness of the care system if the desired outcomes are met?
Instructions
Your assignment submission should include a data table that illustrates the current and desired states of the clinical issue you are attempting to improve through your application of change strategies. Additionally, you will need to explain the rationale for your decisions around your chosen change strategies, as well as how the change strategies will be successfully implemented. The bullet points below correspond to the grading criteria in the scoring guide. Be sure that your change strategy addresses all of them. You may also want to read the Change Strategy and Implementation scoring guide and Guiding Questions: Change Strategy and Implementation [DOC] to better understand how each grading criterion will be assessed.

Develop a data table that accurately reflects the current and desired states of one or more clinical outcomes.
Propose change strategies that will help to achieve the desired state of one or more clinical outcomes.
Justify the specific change strategies used to achieve desired outcomes.
Explain how change strategies will lead to quality improvement with regard to safety and equitable care.
Explain how change strategies will utilize interprofessional considerations to ensure successful implementation.
Communicate the change plan in a way that makes the data and rationale easily understood and compelling.
Integrate relevant sources to support assertions, correctly formatting citations and references using current APA style.