File - April D. Beresford, RN

Report
INDWELLING URINARY CATHETERS:
PREVENTION OF CATHETER-ASSOCIATED
URINARY TRACT INFECTIONS (CAUTIS)
Presented By:
April Beresford, Benjamin Kasper, and Kara Elkins
PROBLEM
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Catheter associated urinary tract infections (CAUTI) are the
cause of many hospital acquired infections.
Nearly 25% of hospitalized patients are catheterized annually,
and 10% of these patients develop infections (Oman et al.
2011, p. 1).
40% of all nosocomial infections are due to CAUTIs
(Andreessen et al., 2012, p. 209).
PROBLEM

Patients have increased pain and discomfort due to CAUTIs.
CAUTIs are an unnecessary added
expense to healthcare costs.

EVIDENCE
Article One
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Development of bundle plan to assist nurses in insertion techniques and
maintenance or urinary catheters
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Daily assessment of need by nurse and physician
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Requirement of orders q24 hours to continue catheter use
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Changing practice and adding meticulous computer documentation

Reducing use and duration of catheters
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Percentage of CAUTIs experienced by patients should decrease
EVIDENCE
Article One – Literature Review

The “bundle” that they created to decrease percentage of CAUTI was put
together based on the information gathered in the review of literature
“The strongest predictor for CAUTI is the duration of
catheterization, and catheterization lasting more than
six days increases the risk for CAUTI seven times”
(Andreessen et al. 2012, p. 210).
EVIDENCE
Article One – Hypothesis
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Dependent variable: duration of urinary catheterization
Independent variables: urinary catheter bundle, which included proper
insertion and assessment techniques to be utilized, computerized
documentation, and ordering templates.
The population defined in this case is “acutely hospitalized patients”
(Andreessen et al., 2012, p. 211).
The study was performed using an experimental pretest and posttest
design.
Andreessen et al. performed an evaluation before and after the introduction
of the urinary catheter bundle.
EVIDENCE
Article One – Data Collection

Evaluation of 1,200 charts to collect baseline data over three weeks

Months of collecting data after the urinary catheter bundle and other
policies were put into place

Ended with another three-week post program evaluation and review of
1,385 computerized medical charts to collect the outcome data
(Andreessen et al., 2012, p. 211).

Documentation review was performed by registered nurses, physicians, and
infection control nurses, along with the other members of the research team
(Andreessen et al., 2012, p. 211).
EVIDENCE
Article One – Sample

“The research project took place at a VA (veterans affairs) medical center,
and included patients with acute placement (less than thirty days) of an
indwelling urinary catheter” (Andreessen et al., 2012, p. 211).

Only male patients were included due to patient majority being male at this
VA facility.
EVIDENCE
Article One – Sample

All charts were reviewed for those male, and eighteen and older
(Andreessen et al., 2012, p. 211).

Patients who needed long-term catheterization, or were diagnosed with a
urinary tract infection within 24 hours of admission were excluded from the
study to protect from misinformation in the data collected (Andreessen et
al., 2012, p. 211).
EVIDENCE
Article One – Limitations

Conducted at a single site which causes limitation in the results

“The project also lacked CAUTI rates for comparison because the hospital
had not collected this rate before this project began” (Andreessen et al.,
2012, p. 211).
EVIDENCE
Article One – Conclusion
It was discovered at the end of the study that “the
implementation of a set of guidelines (the urinary
catheter bundle) for catheter use and care resulted in
a reduction of catheter use by 57% and a significant
decrease in catheter duration by 70%” (Andreessen et
al., 2012, p. 216).

EVIDENCE
Article Two

Oman et al directed a study at the University of Colorado in 2011 to
evaluate the effectiveness of nursing interventions at avoiding CAUTI.

“Catheters may be inappropriately retained for days because of
convenience, misunderstanding of their necessity, or lack of clear orders for
removal. Therefore, efforts to reduce CAUTI prevalence must focus on
evidence-based use of IUCs during insertion, maintenance and removal”
(Oman et al, 2011, p. 1).
EVIDENCE
Article Two – Purpose / Framework

Oman et al used a pre/post quasi-experimental design to test incidence rates of
CAUTI in a pulmonary and a general medical surgical unit at a Colorado hospital,
using nurses as champions of change.

Dependent variables: incidence rates of CAUTI, catheter duration, LOS, bladder
scanner usage, and product streamlining.

Independent variables: solidified as “nursing interventions” but was broken
down into a series of interventional options presented to nurses who were
participating in the study
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charge nurse rounds
patient-related catheter selections, not nursing preference
daily evaluations of the need for continued catheter use
use of bladder scanners
continuing education for nurses and nurses aids
(Oman et al, 2011, p. 2-3)
EVIDENCE
Article Two – Framework / Data Collection

Study was divided into three phases

PHASE ONE: baseline data on IUC duration and CAUTI rates was obtained

PHASE TWO: intervention begins hospital-wide, including new protocols, updated training
for staff, and product evaluation was performed.

PHASE THREE: interventions targeted the targeted units, including: more education and
journal review with staff nurses, purchase of 2 new bladder scanners and additional
bedside commodes, charge nurse catheter rounds, and posting of flyers throughout the
department outlining facets of evidence based best practice techniques and interventions.
(Oman et al, 2011, p. 2-3)
EVIDENCE
Article Two – Framework / Data Collection

Electronic patient records were used to identify patients with CAUTI and to
determine the length of catheterizations. CAUTIs were reported as an
absolute number and a number of infections per 1,000 catheter-days for
eligible patients.
(Oman et al, 2011, p. 2-3)
EVIDENCE
Article Two – Results

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It was found that nursing based interventions did result in a decrease of
CAUTI within the designated units, although it was beyond the scope of the
study to determine which interventions were most and least effective.
“This project suggests that a focused unit intervention
may be indicated when there is inadequate response
to hospital-wide strategies” (Oman et al, 2011, p. 5)
EVIDENCE
Article Three
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CAUTIs remain an ongoing battle

Guidelines for indwelling catheter use can reduce CAUTIs (Elpern et al.
2009).
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Quality improvement indicators determine CAUTI rates
EVIDENCE
Article Three – Purpose/Framework
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Intervention theory which consisted of the following


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Removal of inappropriate catheters
Assessment for need for catheters
Early removal of indwelling catheters
“This study was a before-and-after evaluation of a low-technology
intervention to reduce duration of urinary catheterization and occurrence of
CAUTIs in an MICU” (Elpern et al. 2009 p. 537).

EVIDENCE
Article Three – Data Collection

Subjects included in this study consisted of all MICU patients during a six
month period
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Data collected during intervention phase

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Duration of catheterization
Appropriateness of catheterization
Reasons for inappropriate catheter use
CAUTI rates based upon surveillance by nurse epidemiologists
Elpern et al. (2009)
EVIDENCE
Article Three – Findings
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Pre – Post intervention data analysis showed a decrease in catheter use

Eleven months previous to intervention, 15 CAUTIs occurred during 3,429
device days
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During the intervention phase, zero CAUTIs occurred in 1,432 device days.
IMPLICATIONS FOR PRACTICE / RECOMMENDATIONS
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Urinary catheterization is necessary in many patient situations
Overuse has been demonstrated to be a significant contributor to increased
infection rates
Questioning attitudes about catheter use assist in CAUTI reduction
Daily reassessment for catheter need
Catheter use based on patient need not nurse preference
Education for proper catheter care
Development of practice policies
REFERENCES
Andreessen, L., Wilde, M., Herendeen, P.,(2012). Preventing Catheter-Associated Urinary
Tract Infections in Acute Care. Journal of Nursing Care Quality. 27(3), 209-217.
Retrieved from
http://www.nursingcenter.com/lnc/JournalArticle?Article_ID=1355891
Burns, N. & Grove S. K. (2011) Understanding nursing research: Building an evidencebased practice. Maryland Heights, MO: Elsevier Saunders.
Elpern, E.H., Killeen, K., Ketchem, A., Wiley, A., Patel, G., & Lateef, O. (2009). Reducing
use of indwelling catheters and associated urinary tract infections. American
Journal of Critical Care, 18(6), 535-541. doi:10.4037/ajcc2009938
Oman, K., Makic, M.B., Fink, R., Schraeder, N., Hulett, T., Keech, T., & Wald, H. (2011).
Nurse-directed interventions to reduce catheter-associated urinary tract
infections. American Journal of Infection Control.
doi:10.1016/j.ajic,2011.07.018

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