Catheter associated urinary tract infection

Catheter associated urinary tract infection (Name) (Course) (Instructor’s Name) (Date) PICOT Statement and Question Ms. X is a critically ill patient who has been in the ICU for almost a month. She was unconscious upon admission due to an occurrence of a stroke while she was at home. Upon admission to the ICU, an indwelling catheter was placed and has not been replaced since. P – Critically-ill patients in the intensive care unit I – Prolonged use of a catheter C – Decreased use of a catheter O – Cause urinary tract infection T – In a span of 1 month PICOT Clinical Question In the intensive care unit, does prolonged use of a catheter compared to the decreased use in critically-ill patients cause an increase in urinary tract infection in a span of 1 month? Catheter associated urinary tract infection Urinary catheterization is a treatment used to empty the bladder. Healthcare providers may recommend this for short or long-term use for patients experiencing urinary incontinence, urinary retention, surgery and other medical conditions. The occurrence for long-term use of urinary catheters can usually be observed in the intensive care unit (ICU). This is because most of the patients in the ICU are unconscious and critically-ill. It is indicated for diagnostic or therapeutic purposes. Its diagnostic use includes urine specimen collection, urine output monitoring and urinary tract imaging. The therapeutic use of urinary catheterization includes acute urinary retention, chronic obstruction, initiation of continuous bladder irrigation, intermittent decompression for neurogenic bladder and hygienic care for bedridden patients. Nosocomial or hospital-acquired urinary tract infection (UTI) is a significant contributor in the prevalence in nosocomial infections (Bennet & Brachmann, 1986). The use of a urinary catheter is a major predisposing factor in the occurrence of nosocomial urinary tract infections. Approximately 80% of nosocomial UTI is associated with the use of a urinary catheter (Mandell, Douglas & Bennet, 1990). Identifying the Problem Knowing the risk factors for catheter-associated urinary tract infection (CAUTI) is one way to lessen its prevalence. The duration of catheter use is the major risk factor for the occurrence of CAUTI. The occurrence of CAUTI increases by 5% to 10% for each day that the catheter remains in place. Patients with a long-term catheter almost always develop CAUTI. Other risk factors include sex, age and the ability to maintain a closed drainage system. Females are more prone since their urinary tract is shorter than males. This makes for easy access of the bacteria from the outer part of the catheter. Elderly patients are more prone since they have a compromised immune system due to their age. The urine collection bag is a pool for microorganisms that is why proper handling can help reduce the risk for infection. Impact of CAUTI The occurrence of any nosocomial infections reflects the level and quality of healthcare the patient is receiving. Since the insertion of a urinary catheter should be done in a sterile technique, maintaining its sterility is dependent on the healthcare provider who is placing the catheter. Nosocomial UTI is a significant cause of mortality and morbidity (CDC, 1982). CAUTI is a very preventable condition according to the Centers for Medical Services (CMS). That is why the CMS has announced that they will no longer allow the reimbursement of healthcare institutions for care associated with preventable conditions such as CAUTI. This brings about an increase in extra expenses since it causes prolonged hospital stay, additional hospital costs and complication to the recovery of a critically-ill patient (Alavaren, Lim, Antonio-Velmonte & Mendoza, 1993; Stokowski, 2009). Solutions to Prevent CAUTI Although not all CAUTI can be prevented, it is believed that a large part can be prevented with the proper handling of the catheter. The maintenance of the sterility in the process of placing a urinary catheter should be given more focus and monitored closely. The proposed solution to address the occurrence of CAUTI includes the following: proper insertion and management techniques, lessen unnecessary catheter use, prompt removal of urinary catheters, adequate availability of nurses and patient and nurse education (Stokowski, 2009). References: Alavaren, H., Lim, J., Antonio-Velmonte, M. & Mendoza, M. (1993). Urinary Tract Infection in Patients with Indwelling Catheter. Philippine Journal of Microbiology and Infectious Disease, 22(2), 65-74. Bennet, J.V. & Brachmann, P.S. (1986). Nosocomial Urinary Tract Infection. Hospital Infection, 2nd ed, 375-384. CDC. (1982) Guidelines for Prevention of Catheter. Related UTI. In: Guidelines for Prevention and Control of Nosocomial Infection. Atlanta: Center for Disease Control. Mandell, G., Dolin, R. & Bennett, J. (1990). Mandell, Douglas and Bennett’s Principles and Practice of Infectious Diseases, 3rd ed, 2205-2215. Stokowski, L. (2009). Catheter-Associated Urinary Tract Infections. Retrieved August 24, 2011 from /viewarticle/587464 Sources of Literature Article #1 Gentry, H. & Cope, S. (2005). Using silver to reduce catheter-associated urinary tract infections. Nursing Standard, 19(50), 51-54. This article states that catheter insertion is linked to the occurrence of hospital acquired urinary tract infections (UTI). It is also the source for unnecessary prolonged hospital stay which causes additional hospital costs. Specifically, 80% of all urinary tract infections are associated with the insertion of a urinary catheter. The estimated additional costs the National Health Service spends yearly for hospital acquired UTIs is at least £124 million. A patient with a hospital acquired UTI can incur an additional £1,327 in hospital bills. 8.5% of bacteremia cases are attributed to catheter associated urinary tract infection (CAUTI) and 30% of those patients die. This study proposes the use of a silver alloy hydrogel-coated catheter which reduces the incidence of CAUTIs by 33.5% upon its introduction. Article #2 Gould, C.V., Umscheld, C.A., Agarwal, R.K., Kuntz, G. & Pegues, D.A. (2009). Guideline for prevention of catheter-associated urinary tract infections 2009. Atlanta, Georgia: Centers for Disease Control and Prevention (CDC). This is a guideline done by the National Guideline Clearinghouse (NGC) for the prevention of catheter-associated urinary tract infection (CAUTI). The guideline has developed certain recommendation regarding CAUTI. One major recommendation is the appropriate use of the urinary catheter. Another recommendation is proper techniques in the insertion of the catheter. Proper technique for urinary catheter maintenance is also recommended. Quality improvement programs should also be utilized and administrative infrastructure should also be implemented. Lastly, surveillance of CAUTI patients and facilities is recommended to improve the quality of patient care. Article #3 Madeo, M. & Roadhouse, A.J. (2009). Reducing the risks associated with urinary catheters. Nursing Standard, 23(29), 47-55. Urinary catheterization is a common intervention in the healthcare setting. According to the Hospital Infection Society, an estimated 31% of all inpatients have a urinary catheter, but its frequent use is not a confirmation of its safety. It has been indicated that an estimate of 8.5-10% of all patients who have an indwelling catheter develops CAUTI. The use of evidence-based guidelines and technological innovations are developed to reduce the risk for infection, to instil in the healthcare providers to implement the best practice at all times and to improve patient outcomes. Article #4 Pratt, R. & Pellowe, C. (2010). Good practice in management of patients with urethral catheters. Nursing Older People, 22(11), 25-29. The use of an indwelling urinary catheter in older patients is common in the hospital. They are prone to increase risk for infection due to their compromised immune systems. The occurrence of urinary tract infections (UTIs) in older patients bring about serious consequence...