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"Urinary tract infections are the most common type of healthcare-associated infection, accounting for more than 30% of infections reported by acute care hospitals. Virtually all healthcare-associated UTIs are caused by instrumentation of the urinary tract. Catheter-associated urinary tract infection (CAUTI) has been associated with increased morbidity, mortality, hospital cost, and length of stay." (CDC, 2009) I chose this topic to research due to the prevalence within the hospital. Important interventions required to prevent catheter associated urinary tract infections are tasks which are often delegated to unlicensed nursing aids. Nurses must be experts in these tasks to ensure their nursing aids are performing the tasks correctly.

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What is the issue?
Catheter associated urinary tract infections (CAUTI). THe CDC states a CAUTI is "a UTI where an indwelling urinary catheter was in place for >2 calendar days on the date of event, with day of device placement being Day 1*, AND an indwelling urinary catheter was in place on the date of event or the day before." (CDC, 2019).

Who is affected?
Any patient who has an indwelling urinary catheter in place is at risk for a CAUTI. Patient populations which commonly require indwelling urinary catheter placement includes: surgical patients, females, elderly patients, patients with long term foley catheters, patients with urinary retention, immobile patients and patients with pelvic or hip fractures (CDC, 2019). "CAUTIs are the most frequent healthcare associated infection, accounting for 30 % to 40% of infections in hospitalized patients according to data from the Centers for Disease Control and Prevention." (ANA, 2013)

How?
Indwelling urinary catheters act as a vector for bacteria to enter the bladder, which is a sterile environment, causing infection.

Where?
This can occur anywhere. Patients have indwelling urinary catheters in place within the acute care setting, rehab or skilled nursing facilities and long term foley catheters at home. .

When?
Unnecessary or increased use of indwelling urinary catheters as well as sub-par catheter cleansing allow for bacteria to travel upwards to the bladder. Prolonged use of an indwelling urinary catheter is the highest risk factor developing a catheter associated urinary tract infection (CDC, 2019).

Why?
As stated above, indwelling urinary catheters act as a easy pathway for bacteria to enter the bladder leading to infection.

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What is the nurse doing or not doing in relation to the issue?
The nurses' current role is to prevent CAUTIs from occurring using standard nursing bundles containing evidenced based guidelines. These nursing bundles include things such as catheter care every shift, proper hand hygiene prior to catheter care, sterile techniques during placement and patients voiding within an allotted time limit on discontinuation of indwelling urinary catheters (CDC, 2015). Nurses also administer treatment when urinary tract infections do occur.

Improving or exacerbating the issue?
Nurses contribute to both improving and exacerbating the issue of catheter associated urinary tract infections. When following evidence based guidelines, the rate of CAUTIs drastically decreases (Meddings et al., 2017). Unfortunately when nurses fail to abide by the catheter bundle policies within their hospital system CAUTI incidences tend to increase.

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How the nurse's involvement helps resolve or improve the selected issue?
One of the most important jobs of a nurse is to be a patient advocate. Nurses are at the forefront of healthcare, providing one-on-one care to patients every day and are often the first to recognize adverse events occurring in our patients. Nurses' recognition and early detection of catheter associated urinary tract infections protects our patients from worsening conditions including UTI related sepsis. (ANA, n.d.) The constant monitoring and prevention of CAUTIs protects hospital systems from spending funds on hospital acquired injuries allowing those funds to be spent elsewhere. "Hospital-acquired conditions (HACs) are a major threat to patient safety with costs estimated to be $33 billion." (ANA, n.d.)

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ANALYSIS: Challenges & Barriers for Nurse's Involvement 

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ANALYSIS: Challenges & Barriers for Nurse's Involvement 

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🏥Requirement of Medical Doctor order prior to removal
Often nurses recognize that all criteria has been met for discontinuation of a patient's indwelling urinary catheter but can not discontinue until a MD order has been placed. These orders may be delayed, leaving urinary catheters in place for a longer period of time, increased the risk for a CAUTI.

🏥Patients and patient family members requesting urinary catheter placement
Patients who require increased assistance for ADLs or their family members may request a long term indwelling urinary catheter placed because they believe it may provide the patient with increased independence. It is important for nurses to thoroughly explain the qualifications and risks of a urinary catheter to their patients and patient family members. (Krein et al., 2014).

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👍🏼Hospital systems (i.e. Sentara Healthcare and Bon Secours) should require bi-yearly education on CAUTI prevention and treatment. The most important part of CAUTI prevention is caregiver knowledge. The American Nurse's Association has a CAUTI Prevention Tool which lays out prevention strategies. (ANA, n.d.)

👍🏼Hospital systems (i.e., Sentara Healthcare and Bon Secours) should acknowledge and provide recognition to hospital units when there is a period of little to zero CAUTIs on the unit. Recognition helps to encourage nurses to continue the level of care they have been providing.

👍🏼An alert system should be present within the electronic medical record system (i.e. EPIC) used within hospital systems, skilled nursing facilities, etc. to alert nurses and unlicensed personnel when it is time for urinary catheter care as well as removal.

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In conclusion, catheter associated urinary tract infections are one of the most common hospital acquired injuries. I chose this topic for my capstone project because of the prevalence it has as well as how many patients I have taken care of during my time at SCOHS. CAUTIs are preventable and the risk of them should be taken seriously by all healthcare professionals. Nurses play a major role in patient safety and advocacy everyday within the acute care and long term settings. Nurses have the power to make the change and prevent these very much preventable injuries for our patients. Thank you.

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Reducing catheter-associated urinary tract infections in hospitals

💉Step-wedged randomized controlled study within three large Australian hospital systems over a 32 week time frame examining methods to provide more cost effective urinary catheter care.
💉This study examined the effects of chlorhexidine (1%) vs  normal saline (0.9%) on the meatal area prior to insertion.
💉 The goal of this study is to better prevent catheter associated urinary tract infections and provide higher quality patient safety while decrease hospital costs.
(Mitchell et al., 2017)

Reminder systems to reduce catheter-associated urinary tract infections and urinary catheter use in hospitalized patients

🚑Meta-Analysis focusing on 14 studies which implemented reminder systems and stop orders for patients with indwelling urinary catheters.
🚑5 of the studies used stop orders to discontinue catheter orders while 9 studies utilized reminder systems to ensure all catheter care was achieved.
🚑"In summary, interventions to routinely prompt physicians or nurses to remove unnecessary urinary catheters significantly decrease the rate of CAUTI, and no evidence indicates that these interventions increase the need for recatheterization." (Meddings et al., 2010).
(Meddings et al., 2010)

Nursing catheter care bundles to reduce CAUTIs within the nursing home resident population

💊Systematic review of 19 studies which collected data of adult patients within short-term and long-term care facilities.
💊The use of standardized nursing care bundles in the prevention of CAUTIs was analyzed.
💊The use of standardized nursing care bundles was proven to be effective in the reduction of catheter associated urinary tract infections.
(Meddings et al., 2017)

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📚Patient Advocacy & Patient Safety
One of the most prominent concepts we learned throughout nursing school is to be an advocate for our patients. " The American Nurses Association (ANA) believes that advocacy is a pillar of nursing." (ANA, n.d.) Often patients lack knowledge or are unable to understand concepts which are important for their health and safety. As a member of that patient's healthcare team, it is vital that we as nurses protect our patients always having their best interest at heart. Gaining confidence in our knowledge and being an active member in our patients' healthcare teams has prepared us for leadership roles once transitioned into professional roles.

📚Infection Control & Proper Urinary Catheter Care
One of the fundamental concepts of nursing, dating back Florence Nightingale, is infection control. With urinary catheters the highest risk for an infection control issue is during insertion as well as the cleanliness while it remains inserted. Foley catheter insertions using sterile technique as well as proper foley catheter care are both concepts learned in nursing fundamentals. Although they are basic concepts to us at this point in our nursing school career, they both are very important to perform correctly for the health and safety of our patients. Infection control and urinary catheter care concepts have allowed us a student nurses to assume leadership roles by giving us opportunities to educate our peers and patients on the importance of handwashing and proper hygiene. These concepts have also given us the opportunity to delegate tasks to other members of the healthcare team.