Amy Lecuona
Grand Canyon University: NRS-433V Introduction to Nursing Research
4/26/13

Introduction “Urinary tract infections (UTI’s) are common hospital-acquired infections and account for up to 40% of the 2 million nosocomial infections reported each year” (Yin-Yin, C., Mei-Man, C., Yu-Chih, C., Yu-Jiun, C., Shin-Shang, C., & Fu-Der, W., 2013). Urinary tract infections also happen to be the most common nosocomial infection reported. Of all of the UTI’s reported, 80% of them are caused by the use of indwelling urinary catheters. Improper use and duration of indwelling catheters put patients at unnecessary risk for complications, longer hospital stays, and cause a financial burden on the health care system. Although there are set guidelines for placement and retention of these indwelling catheters that are supposed to be followed, the incidence of these catheter acquired urinary tract infections (CAUTI’s) is still relatively high. This could be because many times catheters are left in for unnecessary reasons whether it’s just an oversight by the physician or nurse or it’s for convenience, either way it puts patients at risk for infection. (Yin-Yin, C., Mei-Man, C., Yu-Chih, C., Yu-Jiun, C., Shin-Shang, C., & Fu-Der, W., 2013).
Background of Study There is a direct correlation between the duration of indwelling urinary catheters and the incidence of CAUTI’s. The purpose of the research article being reviewed is to determine if the use of a criteria based reminder system would help reduce the use indwelling urinary catheters and reduce the incidence of CAUTI’s. This study is significant to nursing because it will help determine whether or not a reminder system can improve patient outcomes.
Methods of Study In this quantitative study, 278 patients were randomly selected from 2 separate respiratory intensive care units in a controlled trial. Patients that had a urinary catheter for more than 2 days in the months of April to November were randomly assigned either the control group (131 patients, no reminder system) or the intervention group, (147 patients, with the use of a reminder system). The intervention group used a criteria-based reminder system that prompted the nurse to remove the catheter no later than the 7th day. Removal was contingent on the absence of: urinary obstruction, urinary retention, strict intake and output on critically ill patients, urological surgery, surgery on contiguous structures, incontinence in patients with open wounds in the pelvic or sacral regions, or neurogenic bladder dysfunction. (Yin-Yin, C., Mei-Man, C., Yu-Chih, C., Yu-Jiun, C., Shin-Shang, C., & Fu-Der, W., 2013).
Results of Study This study reviled that the use of a criteria-based reminder system decreased the utilization of indwelling catheters by 22%, the incidence of CAUTI’s by 48%, and the success rate for removing the catheters by the 7th day was a whopping 88%. There is clearly a benefit to implementing a reminder system for the use of indwelling catheters. Patient outcomes are improved and it would in turn reduce financial burden on the healthcare system due to preventable infections. Implementing a reminder system would have a large impact on nursing practice. It would change the way nurses assess the need for indwelling catheters in their patients and make them more accountable for leaving in a catheter for reasons deemed unnecessary. This system would greatly improve patient safety and outcomes.
Ethical Considerations Although demographic information, age, sex, and health conditions were used in the study, none of those things were revealed in the article, therefor there was no way of identifying any of them in any way. Patient confidentiality and safety was of upmost importance, and the overall goal was to improve patient safety and outcomes. In this writers opinion the study was ethically sound.
Conclusion
In conclusion, improper use of indwelling catheters and the incidence of CAUTI’s is a big problem and has been for some time. Evidence shows that there is an increased risk of CAUTI’s the longer the catheter is in place, therefor removal of the catheter as soon as possible is necessary to reduce the incidence of these infections. Although there are guidelines already in place for placement and retention of indwelling catheters, they are not always being implemented properly and patients are left with indwelling catheters longer than necessary putting them at unnecessary risk.
This study revealed that with the use of a criteria-based reminder system, catheters are removed sooner 88% of the time and the incidence of CAUTI’s can be decreased significantly. This reminder approach should be considered in all acute care settings to enhance the safety and patient outcomes, as well as reduce the unnecessary cost of catheter acquired urinary tract infections.

References

Yin-Yin, C., Mei-Man, C., Yu-Chih, C., Yu-Jiun, C., Shin-Shang, C., & Fu-Der, W. (2013). Using a criteria-based reminder to reduce use of indwelling urinary catheters and decrease urinary tract infections. American Journal of Critical Care, 22(2), 105-114. doi:10.4037/ajcc2013464

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