...Catheter Associated Urinary Tract Infections (CAUTIs) By: Janelle Davidson & Liz Ellis Picot Question Thesis Preventing catheterization Nursing Initiatives Nursing Initiatives Continued Aseptic Technique Current Practice P: Any catheterized patient in the health care setting. I: Special initiative for prompt catheter removal. C: Versus routine procedure for catheter removal. O: Decrease catheter associated urinary tract infections. T: During the patient's length of hospital stay. Preventing catheterization, aseptic technique, nursing initiatives, and prompt removal are all factors that contribute to the decline of indwelling catheter infections. No clear protocol for catheter placement. Criteria included in the research: -Urinary retention (neurogenic bladder) -Urine Tract Obstruction (blood clots, enlarged prostate, urethral problems) -Close monitoring of urine output of critically ill and immobile patients. -Urinary incontinence that poses a risk for a stage 3 pressure ulcers. -Comfort care for terminally ill patients. Overall reduces the risk for infection Competency Based Training -Wash hands -Don sterile gloves -Maintain sterile technique while cleaning the meatus and upon insertion. Important factors: Keep the tubing unclamped, disinfect the drainage spigot after emptying the bag, and place the bag below the bladder at all times. 1.Concept map for management of urinary retention -Daily checklist was applied to see if the catheter was still needed...
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...associated urinary tract infections (CAUTIs) represent the largest proportion of healthcare associated infections (HAI). Catheter-associated urinary tract infection (CAUTI) increases hospital cost and is associated with increased morbidity and mortality .CAUTIs are considered by the Centers for Medicare and Medicaid Services to represent a reasonably preventable complication of hospitalization. As such, no additional payment is provided to hospitals for CAUTI treatment-related costs.CAUTIs can lead to complications including cystitis, pyelonephritis, gram-negative bacteremia, prostatitis, epididymitis, septic arthritis, endophthalmitis, urosepsis and even death (Centers for Disease Control [CDC], 2009). The Centers for Medicare and Medicaid Services (CMS) considers CAUTI a preventable complication and no longer reimburses for the extra costs of treatment (CMS, 2010). Nursing as a profession has an interest in following the best evidence based practice to improve outcomes and decrease cost, including reducing CAUTIs. The indwelling urinary catheter increases access of micro-organism to the bladder and inhibits complete bladder emptying. The inflated balloon which keeps the catheter in the bladder allows a small amount of urine to remain un-drained. The catheter itself is a direct route of travel for bacteria, on the inside and outside. Bacteria is more likely to become colonized on the outside of the tube from the meatus. CAUSES OF CAUTI 1. Estimated costs and length of stay...
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...Introduction The primary focus of this study is to assess the effectiveness of a simple reminder system to aid clinicians and nurses in remembering that a patient has a urinary catheter can decrease the duration of time that a patient is catheterised and successfully reduce the rates of CAUTIs. The study was completed by a team medical doctors and registered nurses with the aim of confirming the efficacy of this simple reminder intervention. Both the title and the abstract of the article give the reviewer a clear idea of the purpose and intent of the study. Purpose of the study The purpose of this study was to assess whether, if simple interventions were used properly they will reduce the number of catheter associated urinary tract infections. The researchers found that there were a lot of catheter associated urinary tract infections; particularly in the duration of indwelling catheterization was a factor. The researchers found many hospitals in the United States did not monitor the duration of catheter use. Nor were the physicians aware of patients who were catheterised for some duration. The research also notes that there was a cost factor involved with lengthy duration of indwelling catheters. Method - Design and Data collection The study follows a quantitative analysis, using a controlled trial method. A pre intervention and post intervention study was conducted and the data was collected over three time periods. The Pre intervention commenced September 2008 followed...
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...associated urinary tract infections which is likely due to recent healthcare reforms. Facilities will usually have to cover the cost of any hospital acquired catheter associated urinary tract infection, hence why most facilities now have strict guidelines to prevent CAUTI. CAUTI not only is a financial problem for healthcare facilities but it is also a serious problem for the health of their patients. CAUTI increases mortality and morbidity on those who acquire it. The CDC has published a guideline to prevent CAUTI. CAUTI statistics: * Accounts for 36% of all hospital acquired infections * 10% mortality rate with 13000 associated deaths annually * It increases the length of a patient’s stay at the hospital to about 2-4 days on average * Urinary catheters are used on about 60-90% of the patients on an ICU * About 40-50% of urinary catheters do not have a valid indication for use * The risk of getting a UTI while catheterized increases about 3-10% daily, so by day 30 you will have about a 100% chance of getting a UTI * By following your facilities CAUTI prevention guidelines an estimated 69% of CAUTIs can be prevented annually Etiology of CAUTI: The source of most organisms related to CAUTI is either from the patient’s own perineal flora, or bacteria on the hands of personnel. The microbes can enter the bladder through two routes, either extra-luminal, which is...
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...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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...in place the risk of developing a CAUTI increases 3%-7% (Kahnen, Flanders, & Magalong, 2011 ). Although indwelling urinary catheters are widely used in hospitalized patients and can provide an appropriate means of therapeutic management, they are often used without clear indications putting the patient at a risk for complications during their hospitalization. Complications related to a urinary catheter include physical and psychological discomfort to the patient, bladder calculi, renal inflammation and most frequently CAUTI (Bernard, Hunter, & Moore, 2012, 32(1)). Not only does the urinary catheter cause complications to the patient and put them at a higher risk for morbidity and mortality they also increase the hospital costs. Therefore CAUTIs are considered by the Medicare and Medicaid Services to represent a reasonably preventable complication of hospitalization and as such will not provide any additional payment to hospitals for CAUTI treatment (American Association of Critical Care Nurses, 2012). A great amount of attention has been placed on improving quality of care and minimizing preventable harms that are occurring in the healthcare setting. With the passage of the Deficit Reduction Act of 2005 and the implementation of the Final Rule in October 2008 the CMS, Centers for Medicare and Medicaid Services, will no longer pay hospitals for the additional cost of care resulting from hospital-acquired conditions such as CAUTI (Palmer, Lee, & Wroe, 2013,...
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...CAUTI is the most frequently acquired healthcare-associated infection in the nation. Urinary catheter use averages one in every five patients admitted to an acute care hospital Cite. Catheter use is great among Medicare patients and infection occurs more frequently after urinary catheter have been placed. The longer a catheter remains the greater chance there is to increase their incidence of bacteriuria, which can be asymptomatic and does not always requires treatment. Because CAUTI infections are common, costly and preventable CMS no longer reimburse hospitals or receive any additional payments to compensate for additional cost for treatment. By Collaborating with nursing efforts to reduce and prevent CAUTI by simply minimizing the unnecessary use of urinary catheters when not needed and facilitating early catheter removal can help to improve care...
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...urinary tract infection (CAUTI): Relationship to stroke diagnosis Abstract Background: Eighty percent of hospital-acquired urinary tract infections are associated with urinary catheters (Joint Commission Resources, 2011). Catheter-acquired urinary tract infections (CAUTI) continues to be at the forefront of the fight against hospital-acquired infections (HAI). Despite ongoing efforts to decrease the incidence of catheter-acquired urinary tract infections (CAUTI) in the acute care setting, overall standardized infection rates (SIR) for CAUTI have decreased only 7% since 2009 (Centers for Disease Control and Prevention (CDC), 2013). Purpose: The purpose of this study was to compare patients with a diagnosis of stroke to patients without a primary diagnosis of stroke to determine if patients diagnosed with stroke had a higher incidence of CAUTI infection. A secondary aim was to examine use of antibiotics, steroids, length of hospital stay, catheter days, and ICU length of stay in both stroke and non-stroke patients. Methods: The study method is a retrospective chart review analysis uses data from an 874-bed large teaching hospital located in the Southeastern United States from 2011 and 2012. After approval from both the Nursing Scientific Advisory Committee and the Institutional Review Board of the institution, analysis of data began. Results: 600 patients were potential candidates for analysis. Of the 600 patients, 23 developed a CAUTI in the two-year period....
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...There are numerous current prevention and improvement initiatives taking place in the healthcare system to reduce the occurrence of catheter associated urinary tract infections (CAUTIs). One of the most prominent initiatives is to decrease the number of catheters being inserted and remove the catheters as quickly as possible. Stamford Hospital located in Connecticut, USA, implemented a CAUTI reduction project after noticing that education-based approaches and handwashing efforts had not decreased the incidence of CAUTIs. They implemented a nurse’s checklist for justified use of catheters and timely removal of urinary catheters as well as added a specific catheter charting module in the electronic health record, and held biweekly meetings with...
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...(2013). Prevention and management of catheter-associated urinary tract infections (CAUTI) in a regional WA hospital - utilising clinical practice improvement principles to optimise practice. Australian & New Zealand Continence Journal, 19(4), 105-106 2p. Prevention and management of catheter-associated urinary tract infections (CAUTI) in a regional WA hospital - utilising clinical practice improvement principles to optimise practice. There is available evidence based knowledge on prevention of Urinary tract infection related to urinary catheter. The institution implemented a protocol to guide insertion and removal of urinary catheter. This resulted to a 42% decrease on catheter insertion while Catheter Associated Urinary Tract Infection (CAUTI) rate decreased from 14 CAUTI/ 1000 catheter days to 1.6 CAUTI/ 1000 catheter days. These findings support the proposed change (Hake, M., Auret, K., van Gessel, H., & Sinclair, C....
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...trend of CAUTI infection, its impact on patient care outcome, morbidity, mortality and related treatment cost. Different studies reveal that use of a protocol guiding insertion, care and prompt discontinuation of urinary catheter has the ability to reverse the current trends. Catheter Associated Urinary Tract Infection (CAUTI) accounts for 70-80% of all urinary tract infections. The risk of developing a urinary tract infection increase by 3% for each day the urinary catheter is left...
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...An APIC Guide 2008 Guide to the Elimination of Catheter-Associated Urinary Tract Infections (CAUTIs) Developing and Applying Facility-Based Prevention Interventions in Acute and Long-Term Care Settings About APIC APIC’s mission is to improve health and patient safety by reducing risks of infection and other adverse outcomes. The Association’s more than 12,000 members have primary responsibility for infection prevention, control and hospital epidemiology in healthcare settings around the globe. APIC’s members are nurses, epidemiologists, physicians, microbiologists, clinical pathologists, laboratory technologists and public health professionals. APIC advances its mission through education, research, consultation, collaboration, public policy, practice guidance and credentialing. Look for other topics in APIC’s Elimination Guide Series, including: • • • • Catheter-Related Bloodstream Infections Clostridium difficile Mediastinitis MRSA in Long-Term Care Copyright © 2008 by APIC All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission of the publisher. All inquires about this document or other APIC products and services may be addressed to: APIC Headquarters 1275 K Street, NW Suite 1000 Washington, DC 20005 Phone: 202.789.1890 Email: APICinfo@apic.org Web: www.apic.org ISBN: 1-933013-39-7 ...
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...Introduction Catheter associated urinary tract infections (CAUTIs) are a common problem found in patients who endure long-term indwelling urinary catheterization. However, some research has started to prove that the use of clean intermittent catheterization (CIC), and or the use of adult briefs can decrease the incidence of CAUTIs in acute care settings by reducing the use of indwelling catheters. CAUTIs are known the be caused by the buildup of bacteria around the urinary catheter due to improper hygiene, and or its long-term use. The use of clean intermittent catheterization in patients with urinary retention will reduce the number of unnecessary long-term indwelling catheters, which will in turn reduce the number of CAUTIs. Also, for patients who are incontinent of their bladder functions, it is proven that the use of adult briefs will reduce the number of catheter associated UTIs. It is thought that with the use of alternative methods such as...
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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 catheter-associated urinary tract infection (CAUTI) leading to more difficulties including further deterioration of her mental function that may have been a result of the CAUTI. Ultimately, this family member never recovered from the hip injury and passed just shortly after admission to the facility. Procedure Guidelines In searching for guidelines and standards regarding preventing CAUTIs, multiple sources were discovered. JCAHO (The Joint Commission on the Accreditation of Healthcare Organizations) is one such organization that develops standards of practice for quality healthcare and safety for patients. JCAHO institutes standards on preventing nosocomial infections including CAUTIs. Along with JCAHO, the CDC, The Association for Professionals in Infection Control and Epidemiology (APIC), many hospitals, and also several professional nursing associations including The American Nurses Association have also instituted practices concerning safety in terms of such infections. CAUTIs are a significant problem in the healthcare setting in this day and time, which is the reason for publishing specific standards regarding the best evidence practice in the procedure of urinary catheterization. Reducing the rates of healthcare-associated infections should be at the forefront of the minds of all healthcare workers. In 2009, The Joint Commission revised the previously outlined National Patient Safety Goals in preventing CAUTIs due to the high incidence of mortality and morbidity...
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