EBP: Catheter-Associated Urinary Tract Infection (CAUTI)

Catheter-Associated Urinary Tract Infection (CAUTI)
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Abstract
This proposal focuses on the problem of Catheter-Associated Urinary Tract Infections (CAUTIs). At the moment, there is a high rate of CAUTI cases in my acute care hospital. Specifically, there are 14 cases per 1,000 catheter-days, which is very high. The consequences include the prolonged length of stay, increased patient morbidity and mortality rates, and additional hospital costs. Various researchers have found out that in patients with CAUTIs, the estimated mortality is as high as ten percent. Treating a Catheter-Associated Urinary Tract Infection costs a hospital about $600. Nonetheless, this figure rises to about $2,800 if there is an associated bloodstream infection. The solution entails the adoption of a bundle of interventions for preventing CAUTIs. The bundle of interventions includes several interventions, which include limiting the utilization of urinary catheters, finding an alternative to indwelling urinary catheters, using aseptic techniques for inserting and maintaining the catheters, and following infection control protocols of the hospital. The budget for implementation is $30,000. The implementation is to take place over a period of 6 months.
Catheter-Associated Urinary Tract Infection (CAUTI)
Section A: Problem Description
The identified problem is the occurrence of Catheter-Associated Urinary Tract Infection (CAUTI) in the hospital. It is worth mentioning that these infections are the most common sorts of healthcare-associated infections. CAUTIs are mostly avoidable. Urinary tract infections are infections that involve any part of the patient’s urinary system, such as kidney, ureters, bladder, and urethra (Centers for Disease Control and Prevention, 2018). The incidence of CAUTIs is very high at the acute care hospital in which I work. Catheters are utilized in draining urine from the bladder of the patient into a bag that is located outside the patient’s body. Health professionals insert indwelling catheters in the body of the patient. These catheters at my hospital are often utilized for individuals who are recovering from a surgical operation; who experience urinary retention, that is, patients who are not able to urinate; and patients who experience urinary incontinence.
Urinary Tract Infections at this hospital account for nearly 43% of all infections reported at the healthcare organization and an estimated 89% of all Urinary Tract Infections are linked to the presence of an indwelling urinary catheter. These infections have significant economic and clinical consequences for the healthcare organization. CAUTIs increase hospital cost as the acute care hospital spends about $52,000 annually in treating CAUTIs alone. They are also linked to increased patient mortality and morbidity. Every year, more than five patients die as a result of these nosocomial infections. The Centers for Medicaid and Medicare Services (CMMS) considers CAUTIs at the hospital as reasonably preventable complications of hospitalization. For this reason, it does not provide extra pay for CAUTI treatment-related expenses (Meddings, Rogers & Macy, 2014). The rate of CAUTI at the hospital is 14 cases per 1,000 catheter-days, which is very high.
In this acute care hospital, urinary catheters are utilized in fifteen to twenty-five percent of all the hospitalized patients. The urinary catheters are sometimes placed for unsuitable indications. In many instances, the hospital does not monitor the patients that have been catheterized. Also, duration and discontinuation are often not monitored. The pathogenesis of these infections might take place late by capillary action or early at insertion, or may happen because of contamination of urine collection bag or a break in the closed drainage tubing. The source of the organisms has been often exogenous through contaminated hands of the nurses and other healthcare workers during insertion of the catheter or while they manipulate the collecting system, or endogenous for instance through vaginal or rectal colonization (Saint, Kaufman & Rogers, 2016). Senior leadership at this acute care hospital need to support the design as well as the execution of appropriate measures aimed at the prevention of CAUTIs.
Section B: Literature Support
In the United States, CAUTIs have become a significant public health concern, accounting for about one-third of all healthcare-associated infections (HAIs) (Tambyah & Maki, 2015). CAUTI is a major cause of secondary bloodstream infections leading to increased mortality and morbidity, increased length of stay by two to four days, about 13,100 attributable patient deaths each year, as well as increased costs of healthcare with extra costs of $1300 to $2500 for every case (Taha et al., 2017). These infections cause up to 4 percent of all secondary bloodstream infections. The single most significant risk factor for developing this healthcare-associated infection is the duration of urinary catheterization. Overusing indwelling urinary catheters contributes very much to the frequency of hospital-associated UTIs. Indwelling urinary catheters are used in 15% to 20% of patients who have been hospitalized (Taha et al., 2017).
Researchers have reported that during hospitalization, about fifteen to twenty-five percent of all hospitalized patients in the United States would have a urinary catheter implanted into their body at some time, indicating that many people are at risk of developing CAUTIs (Weber, Sickbert-Bennett & Gould, 2014). These infections are linked to substantial morbidity. About fifteen percent of nosocomial bacteremias, as Tambyah and Maki (2015) pointed out, are attributed to the urinary tract. CAUTIs are also known to bring about the increased hospital length of stay as well as additional healthcare spending. Various scholars have found out that in patients with CAUTIs, the estimated mortality is as high as ten percent (Warren, 2015; Nicolle, 2013). Treating a Catheter-Associated Urinary Tract Infection costs a hospital about $600. However, this figure rises to about $2,800 if there is an associated bloodstream infection. Every year in American hospitals, more than 150,000 CAUTIs are diagnosed and treating them costs over $145 million (Warren, 2015).
In many instances, urinary catheters are placed for unsuitable indications, and medical professionals are usually not aware that their patients have catheters thus resulting in prolonged needless catheter use (Warren, 2015). About 60 percent of all CAUTIs is avoidable, so long as a healthcare facility implements the recommended evidence-based infection-prevention practices. There is a 3% to 7% likelihood of the occurrence of bacteriuria for each day that an indwelling urinary catheter remains inserted in the patient. After this device has been inserted for four weeks, the risk for the development of bacteriuria is almost 100% (Nicolle, 2013).
Starting October 2008, the CMMS stopped reimbursing healthcare organizations for the costs of CAUTI treatment in addition to other sorts of healthcare-associated infections. This has, in turn, incentivized healthcare facilities to come up with strategies and measures for reducing their incidences of CAUTIs. A big decrease in the incidences of these infections is possible given that preventing 65% to 70% of all CAUTIs has been demonstrated to be feasible (Weber, Sickbert-Bennett & Gould, 2014). These infections would resolve spontaneously when the catheter is removed. In high-risk patients, infections may occasionally result in complications like gram-negative bacteremia, cystitis, prostatitis, pyelonephritis, and epididymitis. Gram-negative bacteremia is particularly linked to higher death rates, although it arises in just less than 1% of all catheterized patients (Hola, Peroutkova & Ruzicka, 2014).
Escherichia coli or E-coli is the main organism that causes CAUTI in Intensive Care Patients. E-coli belong to the family of pathogens known as Enterobacteriaceae. Besides this, other organisms that are also known to cause such infections to include Candida spp, Klebsiella pneumonia, Pseudomonas aeruginosa and Enterococci (Weber, Sickbert-Bennett & Gould, 2014). The micro-organisms that bring about a catheter-associated urinary tract infection are often found in the perineum of a patient. They usually move alongside the external surface of the indwelling urethral catheter and then go into the urethra. Compared with the movement of the micro-organisms alongside the outside surface, their movement alongside the catheter’s inner surface typically takes place a lot less frequently (Djeribi et al., 2013). As soon as an indwelling urethral catheter has been inserted, the organisms create a biofilm comprising an extracellular matrix and the organisms themselves alongside the surfaces of the indwelling urethral catheter tubing, both the outer and inner surfaces. The organisms utilize the biofilm in facilitating their movement into the urethra (Djeribi et al., 2013). Researchers have found that the presence of the biofilm serves to decrease the effectiveness of antimicrobial agents given that they are not able to properly go into the biofilm and the organisms comprising it are inclined to have a decreased rate of growth (Hola, Peroutkova & Ruzicka, 2014). Owing to these characteristics, Hola et al. (2014) stated that the biofilm decreases the effectiveness of antimicrobial agents.
Regarding the risk factors for the development of CAUTI, women and older patients aged 50 years and above are at a higher risk. Some scholars have also reported that diabetic patients also have a high risk of developing these infections (Taha et al., 2017). Also, people who are on systemic antimicrobials tend to have a lower risk. Risk factors for bacteremia have also been found in bacteriuric people. Some of those risk factors include patients who engage in tobacco smoking, people who have known malignancy, as well as people who are on immunosuppressant drugs (Djeribi et al., 2013). Also, renal disease, that is, serum creatinine > 2mg/dL increases a person’s chances of developing CAUTI. Additionally, severe underlying illness and malnutrition are also known to increase the likelihood of developing these infections (Djeribi et al., 2013).
On the whole, however, an extended and protracted period of catheterization is the main risk factor for the development of CAUTI. As such, Nicolle (2013) stated that limiting the utilization of indwelling urethral catheters to situations of true necessity and taking them out the moment they are no longer required is of utmost importance. Regrettably, though, many medical doctors are usually not aware of which of their patients have been inserted into an indwelling catheter (Nicolle, 2013). Unsurprisingly, this lack of awareness could lead to a long-drawn-out catheterization period. Furthermore, there are also other modifiable risk factors that contribute to the development of these infections, for instance, when the indwelling catheter is inserted into another location other than an operating room, and when health professionals do not adhere to aseptic catheter care.
Moreover, the risk for CAUTI is also increased by the presence of a urethral stent (Warren, 2015). The risk factors linked to the development of secondary bloodstream infections brought about by CAUTI are renal impairment, neutropenia, as well as the male gender. Failure to maintain closed drainage also increases the patient’s likelihood of developing CAUTI.
Section C: Solution Description
The high incidence of Catheter-Associated Urinary Tract Infections at my acute care hospital calls for appropriate clinical prevention initiatives. CAUTI prevention is widely recognized as a high priority patient safety issue (Weber, Sickbert-Bennett & Gould, 2014). The suitable solution involves adopting a bundle of interventions for preventing CAUTIs. The interventions are evidence-based. Through the use of these interventions, CAUTIs at the acute care hospital would be effectively prevented resulting in improved patient health. Prevention of CAUTIs will also decrease potential patient harm. The bundle of interventions includes the following interventions:
Limit the utilization of urinary catheters
The main risk factor for healthcare-associated Urinary-Tract Infections is indwelling urinary catheters and prolonged catheterizatio...