CAUTI Literature Review

CAUTI Literature Review The following analysis comprises the literature information that studied the care practices of urinary catheterization in mitigating incidences of catheter-associated urinary tract infections (CAUTIs). A summarized format of the reviewed studies is included in Appendix A. In terms of study design, there was a quasi-experimental, randomized and non-randomized study, a meta-analysis study, and a prospective study. The overall literature review supports the subject of the clinical inquiry. The review covers findings between 2011 and 2014, indicating the importance of further examination of current clinical evidence. The clinical evidence was gathered using CINAHL, MEDLINE, Cochrane, and Embase databases using the following keywords: catheterization, indwelling catheter, care bundle, urinary catheter, catheter-associated urinary tract infection, critical care, and adult-surgical unit, intensive care unit, and CAUTI rates. A total of 90 articles were found during the initial search. However, only five articles met the inclusion criteria that required the final articles to be peer-reviewed journals published between 2010 and 2015 to analyze the research trends in the intermediate period. This was important because the findings would demonstrate how the research topic has been explored within a reasonable and scientifically viable period.  Generally, the studies contained in this review focused on the evidence that CAUTIs prevention strategies are multidimensional. In one of these studies, Marra et al (2011) applied a quasi-experimental design to investigate the effectiveness of multiple interventions in reducing the rates of CAUTIs in adult medical-surgical unit and two step-down units (SDUs). In phase 1 of the study, the evidence-based guidelines recommended by the Centers for Disease Control and Prevention (CDC) on CAUTI prevention were implemented. In phase 2, the bladder bundle recommended by the Institute for Healthcare Improvement was applied to improve the outcomes and comply with CDC’s guidelines. At the same time, the impacts of the intervention were monitored. The incidence of CAUTIs was reported to decline significantly from 7.6/1000 catheter days before the bladder bundle intervention to 5.0/1000 catheter-days. A major limitation of this study is that it investigated a combination of intervention measures in only one medical-surgical unit, which is not representative. The internal validity is further reduced because the study is not specific to the use of indwelling catheter care bundles. In a similar study that evaluated the impacts of a multidimensional approach to CAUTIs control, CAUTI rates were documented before the intervention in thirteen ICUs across ten hospitals in ten different cities in Turkey. The sample size was 4,231 ICU patients who required urinary catheterization. Before the intervention, CAUTI incidence was 10.63/1000 urinary catheter days. This rate reduced to 5.65/1000 urinary catheter days after the intervention. The intervention comprised of catheter care bundle, staff education, surveillance, and feedback on performance (Leblebicioglu et al., 2013). This study achieves the overall objective of the proposed solution in that it considers the indwelling catheter care bundle from a multidimensional perspective. Umscheid et al (2011) did a meta-analysis study to evaluate the percentage of healthcare-associated infections (HAIs) across the U.S. hospitals that can be prevented using evidence-based approaches. Since the use of indwelling catheter care bundles is among the evidence-based approaches supported in clinical literature, the meta-analysis would inform the range of HAIs that could be prevented by implementing the proposed solution. The results showed that current evidence-based approaches can prevent 65-70 percent of CAUTIs and catheter-associated bloodstream infections (CABSIs). CAUTIs emerged as the most preventable among the HAIs. The strength of this study is that it strongly implies cost savings and reduction in mortality and morbidity by implementing EBP. Further, its reliance on studies published since 2000 across patient populations in the U.S. enhances its external validity. The extent to which CAUTIs and CABSIs contribute to HAIs is explored further in a randomized study by Magill et al (2014). In surveys of 11,282 patients across 183 acute care hospitals in the U.S., the researchers noted that CAUTIs and CABSIs contributed 25.6 percent of HAIs in these settings. The internal validity of the study is strengthened by the use of log-binomial regression method to determine the factors that mostly contributed to specific infections. For instance, older age, longer hospital stays, being in a critical care ward, and having a central catheter inserted significantly increased the risk of HAIs. Limitations of the study include its non-representativeness of all acute care hospitals in the U.S. The external validity is weakened by the fact that the researchers could not validate data across the ten Emerging Infections Programs (EIP). In a quasi-experimental study by Blanck et al (2014), the use of a bundled approach in catheter care was investigated to gauge its effects in reducing incidences of CAUTIs within adult medical-surgical units. The guiding question was whether the consistent use of a prevention bundle on adult patients with indwelling catheters ...