...PREVENTING CATHETER ASSOCIATED URINARY TRACT INFECTION Elizabeth Quartey Abstract According to the CDC estimates in 2002 there were 1.7 million Healthcare-Associated Infections (HAI), and 99,000 HAI- associated deaths in the hospital. The report stated that the four largest categories of HAI, responsible for more than 80% of all reported HAI, are central line-associated bloodstream infections (CLABSI, 14%), ventilator-associated pneumonia (VAP, 15%), surgical site infections (SSI, 22%), and catheter-associated urinary tract infections (CAUTI, 32%). HAI are a great financial costs to health care facilities. The Centers for disease Control and Prevention (CDC) estimates the medical cost of HAI in the U.S. hospitals as $6.65 billion in 2007, and that number has increased to almost $10 billion a year currently. Statement and Significance of the Problem One in 20 patients who are admitted to a hospital will be a victim to an infectious agent they are exposed to during their hospitalization according to the Centers for Disease Control (CDC) (Goodman, Brenda, 201, Hospital-Acquired Infections cost $10 Billion a year). The five most common infections are surgical site infections, infections associated with the use of devices like central lines, catheters, ventilators and clostridium dificile are costing the health care System in the USA almost $10 billion a year to treat. In the article Vitamin D has the potential to reduce the risk of Hospital-Acquired...
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...m e dic i n e Clinical Practice Caren G. Solomon, M.D., M.P.H., Editor Urinary Tract Infections in Older Men Anthony J. Schaeffer, M.D., and Lindsay E. Nicolle, M.D. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors’ clinical recommendations. From the Feinberg School of Medicine, Northwestern University, Chicago (A.J.S.); and the University of Manitoba, Winnipeg, Canada (L.E.N.). Address reprint requests to Dr. Schaeffer at the Feinberg School of Medicine, Northwestern University, 303 E. Chicago Ave., Tarry Bldg. 16-703, Chicago, IL 60611, or at jschaeffer@ a northwestern.edu. N Engl J Med 2016;374:562-71. DOI: 10.1056/NEJMcp1503950 Copyright © 2016 Massachusetts Medical Society. An audio version of this article is available at NEJM.org 562 A 79-year-old community-dwelling man presents with urinary frequency, dysuria, and fever. Culture reveals extended-spectrum beta-lactamase Escherichia coli. He had a similar infection several months ago, with the same organism isolated, and he had a response to nitrofurantoin treatment. How would you further evaluate and manage this case? U The Cl inic a l Probl em rinary tract infection in men without indwelling catheters is uncommon among men younger than 60 years of age, but the incidence increases...
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...Catheter associated urinary tract infection (Author’s name) (Institutional Affiliation) Catheterization is a frequently part of care for various surgical procedures. The study confirmed that patients lacked knowledge in catheterization and most of the patients were limited in decision making on when the catheter was to be removed. The clinical problem and research problem that led to the study being carried in the clinic was that the use of urinary catheter on patients, whom had not vacated the hospital lead to progressive bacterial settlement of the bladder at speed of approximately 5% per day. The increasing threat of the CAUTI infection, in the National Health Service steered to the prevention incorporating one of highly important interventions for the lifesaving initiative. The motive of the study was to reduce chances of the patients who had surgical experience and had been catheterized from being infected with CAUTI. Repetitive placement of a urinary catheter for lengthier period of more than two days after surgery was found to escalate the risk of CAUTI. Most patients lacked the knowledge in the fact that it was more risky for catheter to be routinely placed for more than two days after surgery. If patients had this information, most of CAUTI infections could have been prevented. According to some patients, they had no knowledge in catheters before their surgery; generally it was a new experience for most of...
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...for candidemia. The reason for this being, many of the antibiotics like beta-lactams and vancomycin used in the wards and intensive care unit (ICU) settings lead to the depletion of normal bacterial flora resulting in fungal overgrowth. The increasing use of oral vancomycin in the ICUs results in the depletion of anaerobic bacterial flora of the gut. 1.2.2 Intravascular Catheters and Central Venous Catheters Intravascular catheters are also one of the important risk factors in the acquisition of candidemia. Candida species adhere avidly to materials used in intravascular catheters and provide a potential nidus for infection. Some species like Candida parapsilosis are especially implicated in intravascular catheter-related infections in neonates and in the paediatric age group. The role played by intravascular catheters in perpetuating candidemia has implications for its management. Removal of vascular catheters has been advocated as an adjunctive strategy for treating patients with catheter-related candidemia. However, there is some controversy regarding the benefits and risks of removal of vascular catheters in management of candidemia....
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...prescribe them as the traditional drug of choice for urinary tract infections and sexually transmitted diseases. Currently, the new development of antibiotics to combat illnesses caused by bacterial resistant strains and have limited the usefulness of Sulfa medications. Objectives Upon successful completion of this presentation you should be able to: • Understand and communicate your knowledge of Sulfonamides mode of action and bacterial resistance • Identify and understand the contra indications, common signs and symptoms of allergic reactions to Sulfonamides. • Identify 3 common trade names for sulfonamides and select indication for use between different patient population. Type and class of Pathogen Sulfonamides have been in use since the 1930's , these drugs are effective against both gram- negative and gram - positive bacteria. Sulfonamides are know as broad spectrum antimicrobial drugs; they are effective against a wide variety of microorganisms most Enterobacteriaceae, Chlamydia trachomatis, Nisseria, Haemophilus influenzae,, Norcardia, E.Coli , P. mirabilis some staphylococci, and many streptococci (with exception of Enterococcus faecalis). They are used for treatment of Protozoan such as Toxoplasma gondii, and mycobacterial. Sulfonamides are use for treatment and prophylaxis of Pneumocytis carinii and Shigella small bowel infections. Mode of Action Sulfonamides are bacteriostatic...
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...Evidence-Based Practices in Nursing Evidence-based practice can be defined as any research done whose findings enhance the ability to make better decisions regarding health care. (effective healthcare) There have been countless studies done on a multitude of topics. All of this research has led to more effective treatment and better outcomes for patients. An example of an evidence-based project performed in 2014 is one on catheter associated urinary tract infections.(Clagg) This is an immense problem in hospital and nursing home settings. There are many ways we can examine this study to see how the nurses involved with these particular patients can decrease the risk of these infections. Patients admitted in the hospital are much easier to do this type of evidence based research on due to availability of data. In the hospital, the nurse can monitor the patient’s intake and output, the color of the patient’s urine, and whether or not it has any odor or sediment.(Clagg) This research may also be done in a nursing home setting with twenty-four hour nursing care. This type of research would be difficult in the patient who was at home with a Foley catheter without having a home health nurse multiple times per day. The steps of the nursing process closely relate to evidence-based practice. This is because the nursing process is designed to deliver complete care. The nurse taking care of the patient must evaluate the patient’s needs based on subjective and objective data, develop...
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...The definition of evidence-based practice (EBP) is “practice based on the best available evidence, patient preference, and clinical judgement.” (Schmidt & Brown, 2012, p. 480). Catheter associated urinary tract infections (CAUTI) are the most common hospital acquired infections in America. Only in certain cases are health care workers aloud to insert a foley catheter, and when they do, strict guidelines are used to prevent CAUT. This would include things like providing adequate fluid intake, avoiding bladder irritants, and cleaning the bladder two to three times a day and after every bowel movement. When left untreated, CAUTI can lead to things such as renal abscesses, epididymitis, periurethral glad infections, bacteremia, and possibly even death (Lewis et al., 2014, p. 1066). Although hospitals are required to pay for any medical attention and further hospital stay needed due to a CAUTI, this does not lessen the burden and pain it puts on the patient. The current best evidence used to prevent CAUTI was...
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...A hospital-acquired infection (HAI) or nosocomial infection is an infection whose development is favored by a hospital environment, such as one acquired by a patient during a hospital visit or one developing among hospital staff. In the United States, the Centers for Disease Control and Prevention estimated roughly 1.7 million hospital-associated infections, from all types of microorganisms, including bacteria, combined, cause or contribute to 99,000 deaths each year. In Europe, where hospital surveys have been conducted, the category of Gram-negative infections are estimated to account for two-thirds of the 25,000 deaths each year. Nosocomial infections can cause severe pneumonia and infections of the urinary tract, bloodstream and other parts of the body. Many types are difficult to attack with antibiotics, and antibiotic resistance is spreading to Gram-negative bacteria that can infect people outside the hospital. HAI is sometimes expanded as healthcare-associated infection to emphasize that infections can be correlated with health care in various settings (not just hospitals). Nosocomial infections are commonly transmitted when hospital officials become complacent and personnel do not practice correct hygiene regularly. Also, increased use of outpatient treatment in recent decades means that a greater percentage of people who are hospitalized today are likely to be seriously ill with more weakened immune systems than in the past. Moreover, some medical procedures bypass...
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...Improvement Strategies (Vol. 6: Prevention of Healthcare–Associated Infections)" under the head Quality Improvement and Patient Safety What is Accountability? In Fundamentals of Nursing it says “The ability and willingness to assume responsibility for ones’ actions and accepting the consequences of one's behavior.” Accountability of nursing professional is a legal obligation; for a professional nurse it is relating to ethics and moral responsibility. Within the kingdom of professional accountability, there are many factors. The American Nursing Association (ANA) states in its code that the nurse will assume accountability for nursing judgment and actions. A professional nurse has the responsibility to take decisions and practice within the scope of care, calling upon his/her information and skills to make judgments in favor of the patient. A professional nurse is accountable to their profession, their patients, employer, and other health care team members and to themselves. Nurses are accountable to provide safest care for their patient based on evidence based practice and safe nursing interventions. Nursing profession as a whole is build up on accountability, unselfishness, integrity and social justice. A professional nurse who take decisions and practice on the basis of those ethical values will always be in favor of the patient, no matter what is his/her professional level. Methods The Healthcare-associated infections. In a patient care situation as a nursing professional...
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...This assignment reflects on one day’s care delivered to a patient during my practice as a healthcare support worker (HSW). It presents anatomy and physiology of the urinary system and focuses on the patient’s catheter use, urinalysis, regular intake of medication and legal issues associated with delivery of care to the patient without mental capacity to make crucial decisions in his life. For the purpose of this care study, I use the pseudonym Chris for the patient in order to protect his identity and maintain confidentiality (NMC, 2008). There is also a legal obligation under Data Protection Act (1998) not to disclose patient’s personal details. Chris is a 73 year old male, who I worked with in a residential home for people with learning disabilities and challenging behaviour, where he was residing. Chris has been diagnosed with a learning disability (LD), which means that he has significantly. reduced ability to understand new or complex information and learn new skills (Department of Health, 2002). He has a reduced ability to cope independently due to recent leg amputation and the LD. Amputation is the surgical removal of a limb or body part (Mosquera, 2010). It was performed on Chris’s right leg above the knee to relieve the recurring pain caused by a severe case of peripheral artery disease (PAD). The PAD is a form of peripheral vascular disease in which there is partial or total blockage of an artery, caused by deposits of fat built up along its walls (Patient UK...
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...RACE/ETHNICITY: CULTURAL CONSIDERATIONS: Caucasian None RELIGION/SPIRITUAL CONSIDERATIONS: Unknown OCCUPATION/HOBBIES/RECREATIONAL ACTIVITIES: Retired LIVING SITUATION/WITH WHOM: (home, assisted living, LTC, etc) Lives with daughter. SOCIAL HISTORY: (tobacco, ETOH, illicit drugs, family dynamics) Quit smoking many years ago, no history of ETOH or drug use. NURSING CARE PLAN ADMITTING MEDICAL DIAGNOSIS: Client's principal admitting diagnosis was leukocytosis. Definition: (from Taber’s) “An increase in the number of leukocytes (usually above 10,000/mm3) in the blood. It occurs most commonly in disease processes involving infection, inflammation, trauma, or stress, but it also can result from the use of some medications” (Venes, 2009, p. 1327). Etiology/pathophysiology: ( NOT from Taber’s or Wikipedia) Etiology: Causes of leukocytosis are infection, inflammation, tissue damage, immune reaction, bone marrow problems, medications, and stress (Drug Information Online, 2011). Pathophysiology: “Leukocytosis can be a reaction to various infectious, inflammatory, and, in certain instances, physiologic processes (eg, stress, exercise). This reaction is mediated by several molecules, which are released or regulated in response to stimulatory events that include growth or survival factors (eg, granulocyte colony-stimulating factor, granulocyte-macrophage colony-stimulating factor, c-kit ligand), adhesion molecules (eg, CD11b/CD18), and various cytokines (eg, interleukin-1, interleukin-3...
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...As people age, they can face more difficulties in caring for themselves, therefore they need help with washing, dressing, eating ,drinking and walking. When we look at James’s case study we can see that this client lost his vision and he needs daily support with personal hygiene. Every morning James needs assistance in washing and dressing. We should ask him if he wants a bed bath, a shower or bath to give him a choice. Washing and bathing is an intimate procedure so it is very important to remember about privacy and person’s dignity. The client can feel embarrassed, helpless, resistant or even aggressive. We have to always give him a choice and independence if it is possible. James also has to be allowed the time to wash whatever he could...
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...Nosocomial Infections By princessbec76 | Studymode.com Section 1: Infections in Healthcare Settings Essay. Nosocomial infections, hospital acquired infections, are an on-going concern to healthcare professionals. These infections are one of the major causes of death in hospitalised patients and are a significant burden on not only the patient’s and the public’s health (as organisms causing nosocomial infections can be transmitted to the community through discharged patients, staff and visitors) but also the economy. A nosocomial infection is an infection acquired at least 72 hours after being admitted into hospital for any reason other than the infection or one which develops amongst hospital staff. Infections are also identified as nosocomial if they appear in a patient within 30 days after their discharge from hospital. Non nosocomial infections, community acquired infections, are infections acquired anywhere other than the hospital. The most common places where non nosocomial infections occur are schools, day care centres and sports facilities. They are spread through skin to skin contact, cuts and grazes, overcrowding and poor hygiene. The illnesses or infections can be the same, for example, pneumonia or gastroenteritis but it is the setting that they are contracted in which differentiate the two infections. Nosocomial infections occur worldwide and affect both wealthy, developed countries as well as the poorer ones with scarce resources. A survey conducted by the World...
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...treated in time, can quickly lead to organ failure and death. Approximately one third of people diagnosed with sepsis die from it. The role of emergency departments throughout the country has become vitally important to the early detection and treatment of sepsis. With the implementation of sepsis protocols in the emergency department the mortality of patients with sepsis admitted through the ED is significantly lower. The word sepsis is commonly used to diagnose patients, but the debate continues as to the true definition. The word sepsis comes from the Greek meaning decay or to putrefy.” (A). Sepsis is a general term that is applied to patients that develop clinical signs of infection. Unlike other diseases sepsis is not diagnosed by the location or type of microbe involved in the infection. Some of the criteria used to diagnose sepsis are abnormalities of body temperature, pulse, respirations, and white blood cell counts. Some symptoms that are common in septic patients are fever, hypothermia, heart rate greater than 90 beats per minute, altered mental status, swelling of the extremities, and high blood glucose in diabetic patients. Sepsis is considered severe when there is organ dysfunction involved. Some examples of this kind of dysfunction are low oxygen level, low urine output; high levels of creatnine in the blood, absent bowel sounds, and low...
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...A lot of research has been recorded trying to figure out the issue between workload of nurses and mortality of patients. A study of 168 Pennsylvania hospitals in 1999 found that one additional patient added to a hospital staff nurse’s workload is associated with a seven percent increase in hospital mortality. A study of 799 hospitals in eleven states found a higher chance of infections when the nurses’ workload was high (Welton 4). The New England journal of Medicine published a study examining the association between mortality and day-to-day variations in unit level staffing and found that the risk of death is increased two percent each time a patient is exposed to shifts with below target RN staffing ("Safe-Staffing" 3). Researches that have been done have suggested that hospitals can avoid many deaths each year by raising staffing levels to those in the twenty-five percent best hospitals (Aiken 63). Linda...
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