...facility for the insertion of a urine catheter with one licensed professional is as follows: Introducing yourself to the patient, wash your hands, identify the patient by date of birth and first and last name, and informing them of the procedure that is about to take place. The patient lays down in a supine position and legs are spread apart. After opening the kit the sterile gloves are placed on. One hand is placed on the genital area which no is longer sterile, the other hand is used to clean the area with the provided swabs in the sterile box. The urethral area is swabbed three times from the center of the urethral outward. Once cleaned the catheter is then lubricated and placed inside the urinary tract until you see the return of urine. Once you see the return, the balloon is inflated in order to hold the catheter in place. A secure clip is attached to the patient’s leg and bag is hung below the level of the bladder. The current process that is being performed in the facility is a procedure that has been used for the past 50 years but just recently the infection rate has increased drastically that it needs to be changed. An article that was published in Infection Control & Hospital Epidemiology discusses how aseptic techniques were unsuccessful many times. “A total of 81 insertion attempts among 65 patients were observed. Registered nurses attempted to insert 77 catheters (95%); a helper assisted with 64 (79%) of these 81 attempts. Major breaks in aseptic insertion technique...
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...of furniture, unobstructed floor space for walking, medical equipment, cleanliness, proper food storage, compliance with medications and instructions. The practice of proper hand hygiene before and after the visit, client assessment, teaching and education. Proper documentation of the visit was written in detail and a copy provided to the client. The following factors may be considered in all areas of nursing care in any setting: level of self-care, ability for activities of daily living; level of nursing care needed; prognosis; education needs; mental status; level of compliance with instructions from healthcare professionals. Ways in which the nurse adapted care to the home setting are briefly stated in the following: Changing a Foley catheter on a male client, setting up a sterile field while kneeling on the floor as the client was sitting at the edge of the bed; setting up an IV without an IV pole or pump using a clothes hangar and a curtain rod over the bed to attain the necessary gravity flow; writing out new requests for doctor to write orders for special procedures such as toenail trimming to be performed by a podiatrist and requiring a...
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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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...indwelling catheters, with the evidence-based practice and standards of care, UTI’s does still continue to be an ongoing problem today. In one of the large hospitals in my area had recently developed a poster and video approach with special focus on alternatives to urinary catheterization, removing catheters early, and the reinforcement of sterile technique prior insertion and foley catheter care were used to educate nursing staff and improve outcomes. The purpose of this paper is to educate nursing on how to be proactive with this issue and to inform the providers when there is no further need for the catheters to reduce infections in patients. Practice setting problem Urinary tract infections (UTIs) account for approximately 35% of nosocomial infections but are the lowest in mortality and cost (Burke, 2003). Patients with UTIs as a secondary diagnosis have an average length of stay of 9.1 days versus those without a urinary catheter of 4.7 days. As individuals live longer, the probability of them being hospitalized and requiring specialized care services is increased (Hobbs, 2001). Hospitalization of any aged person increases the risk for them to have a urinary indwelling catheter, which predisposes them to a nosocomial urinary tract infection (Saint, 2003).Nurses are responsible for placing and maintaining the indwelling catheters. Often non-licensed staff are being delegated these tasks, without the proper training and education on routine catheter care and catheter insertion...
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...and evidence As discussed earlier nursing practice is in constant change, the latest change I have seen in my Intensive care unit (ICU) was the emphasis on early removal of unnecessary Foley catheters (Urinary catheters) , as many studied has shown its direct coloration with urinary tract infections, (Dr. L. Brusch MD, 2012). Every day the Foley catheter stays. The incidence of catheter associated urinary tract infection (CAUTI) is increased by 3-10%, and about 80% of nosocomial UTI’s is related to urethral catheterization. What kind of evidence where used The evidence used was urine specimens (urinalysis and urine cultures), blood test and clinical presentation. Urine cultures has showed bacterial colonization, meanwhile CBC showed leukocytosis, more over the clinical picture of fever, chills, puss around the site of insertion, pain, redness also supports the diagnosis of CAUTI, (Dr. L. Brusch MD, 2012). Since then the trend in my unit and institution became the early removal of unnecessary urethral catheters. The infection control practitioner rounded every day to ask about the need of the Foley catheter, for example a patient with renal failure and on hemodialysis does not need to be catheterized. Even though he is admitted to the ICU, instead an in/out catheters can be...
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...70 beats per minute. (Back Massage) Complete bed bath given. Patient unable to assist but cooperative with turning. Skin on both legs dry and flaking, complains of severe itching. Bath oil added to bath water. Emollient lotion applied after bath. States itching is less after bath. (Complete or Partial Bed Bath) Perineal care given. Patient unable to assist but cooperative with positioning. No redness, drainage, or open areas noted. Patient complained of mild itching before perineal care. Patient reports reduced itching after perineal care. (Perineal care for Female Pt) Perineal care given. Patient unable to assist but cooperative with positioning. External genitalia show no signs of redness, swelling, or drainage. Indwelling catheter is intact and draining clear amber urine. Patient denies pain but states that he feels “very weak.” (Perineal care for a male Pt) Last BM 5 days ago. C/O abdominal fullness and rectal pressure. Abdomen distended, firm. 1,000-ml soap suds enema given with “mild” abdominal cramping during administration. Solution returned with large amount of dark-brown, soft-formed stool. (Cleansing Edema) States, “I feel better now.” Abdomen soft, nondistended. Resting in bed with side...
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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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...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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...|RM |Isolation |RM |Isolation |RM | |MD |MD |MD |MD |MD | |DX/DATE |DX/DATE |DX/DATE |DX/DATE |DX/DATE | |PMH |PMH |PMH |PMH |PMH | |Allergies |Allergies |Allergies |Allergies |Allergies | |IV |IV |IV |IV |IV | |Activity |Activity |Activity |Activity |Activity | |Neuro AAO x |Neuro AAO x |Neuro AAO x |Neuro AAO x |Neuro AAOX | |RUE RLE LUE LLE |RUE...
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...Disabilities State Operated Community Program SOCP Nurse Tools: http://www.dhs.state.or.us/spd/tools/dd/socp/nurses.html |Foley Catheter Care |Date: | | |Client name: | |DOB: | |House: | | |Site Manager: | |Phone #: | | |Allergies: | | Foley Catheter basics: |What is it? A Foley catheter is a thin rubber tube which is put into your bladder (organ that holds urine). It is used to drain |[pic] | |urine out of your body. A Foley catheter is also called an "indwelling catheter". After the catheter is inserted, its tiny tip can| | |be inflated (filled) with sterile (clean) water to make a small balloon. The balloon holds | | |the Foley in place and keeps it from slipping out of your bladder. A Foley catheter can stay in the bladder for a short or long time. | | ...
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...tube through the urethra and into the bladder. The catheter provides a continuous flow of urine in patients unable to control micturition or those with obstructions.” (Potter, Perry, Stockert, & Hall, 2013, p. 1061) Reasons for long-term indwelling catheterization include “severe urinary retention with recurrent episodes of UTI; skin rashes, ulcers, or wounds irritated by contact with urine; terminal illness when bed linen changes are painful for patient.” (Potter, et al 2013, p. 1061) The indwelling catheter procedure has specific guidelines that should be followed. It is imperative that nurses as well as nursing students follow these guidelines to ensure excellent patient care. This topic was chosen due to a family member who had resided in an assisted living facility for three months postoperative hip fracture surgery and had complications from the indwelling catheter. This particular family member, diagnosed with dementia and at the time of admission, unable to ambulate, led to the necessity for the long-term indwelling catheter. The catheterization did cause the patient to have a catheter-associated...
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...Straight Catheterization Straight catheterization is a task that many patients have to perform themselves after they are discharged home. The main issue with straight catheterization that was recognized was the occurrence of infections, such as urinary tract infections, and patients learning how to straight catheterize themselves once they are discharged home. The teaching project focuses on the actual insertion of the catheters among men and women, tips and tricks, and proper cleaning techniques for both genders. Identification of Clinical Issue Intermittent self straight catheterization is not a common practice for the everyday person therefore it is an important topic to teach patients that require this procedure before they leave the...
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...reason why elimination of wastes is one of the main components nursing care for spinal cord nurses is because bowel and bladder elimination may cause severe illnesses among the spinal injury population if proper management does not exist. One of the few major complications that many Spinal Injury patients face is the possibility of going into Autonomic Dysreflexia. Autonomic dysreflexia (AD) “is a potentially life threatening condition that can be considered a medical emergency. It mainly affects people with injuries at T6 or higher.AD requires quick and correct action. Serious AD can lead to a stroke. AD can be cause from variety of noxious stimulus such as but not limited to: Irritation of bladder wall, urinary tract infection, blocked catheter, overfilled collection bag, over-distended or irritated bowel, constipation/impaction, etc” (Autonomic Dysreflexia, n.d.). For this reason, most basic nursing care for spinal injured patients revolves around the management of wastes elimination. The nursing care around bladder and bowel management in SCI is done in many ways. Nursing collaborate with interdisciplinary team as well as the patients and care givers to develop the best plan to care in assisting the patients...
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...non-for-profit organization that serves many patients with different backgrounds and cultures. The organization is a hospital that is magnet certified and strives to surpass the recommended levels in health care regulatory outcomes such as core measures, patient satisfaction, never events, employee satisfaction, and many other outcomes. Because the organization prides itself in being the best, it is important to attempt to find methods to improve the care provided to the patients. A improvement identified by the staff in a medical surgical unit is portable bladder scanners to help improve catheter associated urinary tract infections, decrease the need for foley catheters, improve patient outcomes, decrease patient days and complications. Bladder Scanner Elpern, E., Killeen, K., Ketchem, A., Wiley, A., Patel, G., & Lateef, O. (2009). Reducing use of indwelling urinary catheters and associated urinary tract...
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...Catheter associated urinary tract infection Introduction: A urinary tract infection is an infection, most commonly caused by E. coli, of either the lower or upper urinary tract. Urinary tract infections are the most common hospital acquired infection and the majority of the urinary tract infections acquired are associated with an indwelling urinary catheter. Recently, hospitals and other healthcare facilities have taken a special interest in the prevention of catheter 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...
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