GAP Analysis of Catheter-Associated Urinary Tract Infections (CAUTI)

Quality Gap Analysis
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Systemic Problem
One of the most common hospital-acquired/associated infections is catheter-associated urinary tract infections (CAUTI). The infection results when bacteria and other harmful microorganisms enter the urinary tract through the catheter (Werneburg, 2022). It may affect any section of the urinary tract, including the urethra, bladder, kidneys, and ureters. Several cases would trigger the occurrence of the infection. Prolonged use of the catheter is the leading cause of CAUTI (Werneburg, 2022). Secondly, poor tube handling during insertion exposes it to bacteria. For instance, failure to appropriately handwash using the World Health Organization's (WHO) steps before touching the patient or performing the procedure (Atkins et al., 2020). Another case is when the urine drainage bag needs to be emptied adequately. Additionally, the infection may occur when the urine flows back into the bladder.
CAUTI leads to adverse quality and safety problems, including a heavy healthcare burden on the patient. Hollenbeak and Schilling (2018) state that when the infection occurs, the patient may be forced to stay in the hospital longer, which accounts for bills and psychological burdens for conscious patients and their caregivers. CAUTI also increases the rate of antibiotic resistance since treating it calls for consistent and frequent antibiotic use, especially when the catheter is indwelling over the long term (Werneburg, 2022). Most CAUTIs are usually asymptomatic and may therefore take longer before diagnosis. When the problem is not addressed, the patient may develop life-threatening symptoms and advanced infections. These include fever, severe acute pyelonephritis, urethritis, and renal scarring (Werneburg, 2022). If the infection remains untreated when the patient has a long-term indwelling catheter, it may lead to urosepsis and eventual death.
Proposed Specific Practice Changes
Currently, CAUTIs are propagated by several factors. These include long-term indwelling catheters, healthcare staff with little knowledge of Infection Prevention Control (IPC) protocols, inadequate healthcare professionals, and poor communication and collaboration among the interprofessional team. These factors lead to increased infection transmission, compromising the quality of care and safety (Hollenbeak & Schilling, 2018). Therefore, appropriate measures should be implemented to address these gaps and reduce the risk of CAUTI.
One proposed practice change is minimizing indwelling catheters and removing them as soon as it is medically indicated. Assessment of the catheter should be done daily and considered for removal. Healthcare workers can also opt for alternative urine drainage strategies such as intermittent catheterization (Werneburg, 2022). They may also opt for external catheters instead of indwelling catheters. For men, condom catheters may be used. To reduce the use of indwelling catheters and keep the patient clean and at low risk of developing a CAUTI, the nurse administrators can advocate for improved infrastructure and staffing. They should also plan for routine and continuous professional development education on minimizing the risk of CAUTIs, including standard IPC strategies. In these platforms, aseptic insertion and drainage techniques should be taught (Werneburg, 2022). The procedure for effective hand hygiene should be followed before and after the catheter is inserted. Communication and interprofessional collaboration should be enhanced by switching to efficient and smart electronic medical records. EMRs would capture and document the catheter insertion process, the appropriate removal date, indications, and removal reminders. The adoption of EMRs would significantly improve communication and interprofessional collaboration. Since these proposed changes are targeted toward addressing the core problem, they will drastically reduce the risk and incidence of CAUTIs, improving quality and safety outcomes.
Prioritization of Proposed Changes
In relation to quality, safety, and organizational outcomes, the most significant changes include minimizing the use of indwelling catheters, improving the infrastructure and staffing, and routine and continuous professional development education on ways to minimize the risk of CAUTIs, including standard IPC strategies. Minimizing indwelling catheters should be prioritized since it is a first-line strategy that can easily be adopted in a healthcare setting (Werneburg, 2022). Improving the infrastructure and staffing should also be prioritized since the organization will need more staff and equipment to improve the situation and alleviate the problem. Professional education on minimizing the risk of CAUTIs, including IPC strategies, should als...