Catheter Associated Urinary Tract Report
Running head: PREVENTION OF CATHETER ASSOCIATED URINARY TRACT INFECTION
Prevention of Catheter Associated Urinary Tract Infection
Prevention of Catheter Associated Urinary Tract Infection
Introduction
Catheter associated urinary tract infection (CA-UTI) is one of the most common hospital acquired infections across the globe. CA-UTI is largely linked to patients that have an indwelling catheter in place for a long period of time (one month or longer) while hospitalized. Catheters are sometimes used on patients that do not absolutely have a need for them, exposing the patient to a higher risk of acquiring an infection. There are an abundance of precautions that could be taken to reduce the risk of infection …show more content…
associated with catheters. This paper will discuss the issues surrounding the topic of CA-UTI, the monetary effects related to the issue, and evidence based guidelines used for prevention of CA-UTI.
Impact of the Issue
Circumstances surrounding the issue Mosby’s Dictionary of Medicine, Nursing and Health Professions defines the urinary tract infection (UTI) as an infection of one or more structures in the urinary system. In the health care setting, patients often times acquire this infection due to the presence of an indwelling catheter. An indwelling catheter is a drainage tube inserted into the urinary bladder through the urethra that is left in place, and is connected to a drainage bag or leg bag. It is also known as a Foley catheter. Having an indwelling catheter long term, as well as catheterizing a patient who does not have a valid need for one exposes the patient to risk for infection. Paul (2005) defines long term as “one that is required for more than a month; is most commonly used either to manage incontinence, particularly in women; or as an intervention for bladder outlet obstruction with retention, more commonly in men”.
Individual/societal impact of the issue Exposure to a urinary tract infection makes the patient susceptible to additional complications affecting their health as a result of possessing a urinary catheter. Complications associated with UTI include but are not limited to falls, delirium, pyelonephritis, urosepsis, and immobility with prolonged duration of use (Blodgett, 2009). The patient could also have decreased desire to be mobile with the use of indwelling catheters for fear of accidental removal and having to be re-catheterized or simply feeling uncomfortable with having one. This could delay the patient with no mobility issues from healing or expose them to the increased risk of pressure ulcers from being unnecessarily immobile.
Monetary impact of the issue In a study carried out by Meddings, Reichert, Rogers, Saint, Stephansky, and McMahon (2012) on the effects of nonpayment for hospital-acquired CA-UTI, 25 of 781,343 hospitalizations suffered from nonpayment for secondary diagnoses hospital acquired CA-UTI in acute care hospitals utilized for the study in Michigan. The dollar impact for nonpayment of the 25 hospitalizations was estimated to be $8700.00, which equals a hospital loss of $132,675 for hospital acquired CA-UTIs (Meddings et al., 2012). Blodgett’s (2009) study states that the estimated cost per case of CA-UTIs is $589.00, with an additional cost of $2800 for UTI related bacteremia. This equals a total annual cost of 424 million for treatment of CA-UTIs. The high incidence and cost of CA-UTIs, Medicaid and Medicare no longer pay for hospital acquired CA-UTIs, causing hospitals to be financially accountable for failing to prevent the infection (Blodgett, 2009).
Evidence Based Nursing Care
Evidence Based Guidelines Not only does the possession of an indwelling catheter increase the risk of CA-UTIs but also the duration of time for which the catheter is used. Bernard, Hunter, and Moore (2012) conducted a study of interventions decrease the duration of indwelling catheters and decreasing the risk of CA-TUIs. Bernard et al. (2012) suggested the use of nurse-led interventions and informatics-led interventions. Nurse-led interventions call for the staff nurses to on a daily basis, in consultation with the physician, to determine whether the patients possessing an indwelling catheter had an ongoing need for the continuation of catheter use according to the indications of proper use (Bernard et al., 2012). These indications may include urinary retention, obstruction to the urinary tract, close monitoring of output for critically ill patients and urinary incontinence that poses a threat to a stage 3 or worse pressure ulcer in the sacral area. Informatics-led interventions use technological information systems to automatically prompt healthcare professionals to take action with specified interventions. The first strategy would involve patients who received indwelling catheters in the emergency department (ED). The indications for the use of the catheter would be put into the computerized system and sent to the admitting physician. The physician would then be prompted to submit one of three orders, 1) to discontinue catheter use, 2) to maintain catheter use for an additional 48 hours, 3) or to leave the catheter in place (Bernard et al., 2012). The second strategy would allow the nurse to discontinue the use of the catheter that no longer had an indication based on assessment and the standing orders (Bernard et al., 2012). These interventions a 42% reduction in the duration of catheterization but showed no reduction in the rate of CA-UTI (Bernard et al., 2012). Nazarko (2009) conducted a study that suggests the use of silver coated catheters. These catheters release silver ions that reduce the number of bacteria able to colonize on the catheter, thus preventing a biofilm from forming. This significantly reduces the contraction of CA-UTIs and if a UTI was contracted it made it much easier to treat because the bacteria do not have a biofilm to protect them (Nazarko, 2009). Hand hygiene immediately before insertion of or handling the catheter is also essential in reducing the rate of CA-UTI (Kilpatrick, Murdoch and Storr, 2012).
Barriers of Implementation Catheter reminder systems are the most commonly used source of the interventions. According to Blodgett (2009), there have not been enough studies to determine which specific system should be implemented. In Bernard’s et al. (2012) study there was a lack of reported confidence intervals, which reduces the quality of the study and make it difficult to determine the precision of the statistics.
Ethical, Legal and Values-Based Issues In a study conducted by Elpern, Killeen, Ketchem, Wiley, Patel, and Lateef (2009) it is said that the Center for Disease Control and Prevention discourages nursing professionals from the use urinary catheters for convenience or to substitute nursing care for a incontinent patients. I have not seen this in my Intensive Care Unit (ICU) or ED rotation but have heard of this practice being used. Patients have also been known to request the use of a urinary catheter for their comfort or convenience (Elpern et al., 2009). Both of these acts are clearly unethical and expose the values of a nursing professional if utilized. Furthermore, unnecessary catheterization could lead to a healthcare facility being made liable for lawsuits if an infection developed from the use.
Incorporation into Nursing Practice When incorporating prevention of CA-UTIs in to nursing care there are many interventions that could be utilized. As previously mentioned, nurse-led interventions and informatics-led interventions appear to be extremely helpful in decreasing the risk of infection in urinary catheter use. Proper hand hygiene is essential in reducing the spread of infection in all of nursing care. During my rotation in both the ICU and the ED, I witnessed and utilized proper hand hygiene throughout the care provided for the patients. However I did not see any urinary catheter placement or care while in the ED. The ICU personnel consistently utilized proper care of urinary catheters that would decrease the risk of infection, such as daily cleansing of the perineal area. Palese, Buchini, Deroma, and Barbone (2010) suggest that bladder scanners be incorporated into use for determination of urinary retention. Bladder scanners are an easy to use, reliable and non-invasive way to determine if catheterization is necessary.
Future Implications As stated previously there various forms of reminder systems in place at different healthcare facilities. Virtual reminder systems may become a more commonly used intervention as the systems evolve and evidence continues to prove the improvement of adherence of evidence based guidelines related to the prevention of CA-UTI, as well as the reduction of infections related to urinary catheter use (Blodgett, 2009).
Conclusion
Indwelling urinary catheterization is invasive and may lead to serious outcomes affecting patients’ health. The patient should have indications that there is a need for the catheter and proper interventions should be carried out to reduce the potentiality of contracting any infections.
References
Bernard, M. S., Hunter, K. F., & Moore, K. N. (2012). A Review of Strategies to Decrease the Duration of Indwelling Urethral Catheters and Potentially Reduce the Incidence of Catheter- Associated Urinary Tract Infections. Urologic Nursing, 32(1), 29-37.
Blodgett, T.
(2009). Reminder systems to reduce the duration of indwelling urinary catheters: a narrative review. Urologic Nursing, 29(5), 369-379.
Elpern, E., Killeen, K., Ketchem, A., Wiley, A., Patel, G., & Lateef, O. (2009). Reducing use of indwelling urinary catheters and associated urinary tract infections. American Journal Of Critical Care, 18(6), 535-542. doi:10.4037/ajcc2009938
Kilpatrick, C., Murdoch, H., & Storr, J. (2012). Importance of hand hygiene during invasive procedures. Nursing Standard, 26(41), 42-46.
Meddings, J., Reichert, H., Rogers, M., Saint, S., Stephansky, J., & McMahon, L. (2012). Effect of nonpayment for hospital-acquired, catheter-associated urinary tract infection: a statewide analysis. Annals Of Internal Medicine, 157(5), 305-312. doi:10.7326/0003- 4819-157-5-201209040-00003
Myers, Tamara (ed.). (2009). Mosby’s Dictionary of Medicine, Nursing & Health Professions. (8th ed.). St. Louis, MO: Elsevier.
Nazarko, L. (2009). The effective management of catheter-related UTIs. British Journal Of Nursing, 18(10), 597.
Palese, A., Buchini, S., Deroma, L., & Barbone, F. (2010). The effectiveness of the ultrasound bladder scanner in reducing urinary tract infections: a meta-analysis. Journal Of Clinical Nursing, 19(21/22), 2970-2979.
doi:10.1111/j.1365-2702.2010.03281.x
Paul, M. (2005). Long-term urinary catheter-associated urinary tract infection (UTI). Australian & New Zealand Continence Journal, 11(1), 4.
Prevention of Catheter Associated Urinary Tract Infection
Prevention of Catheter Associated Urinary Tract Infection
Introduction
Catheter associated urinary tract infection (CA-UTI) is one of the most common hospital acquired infections across the globe. CA-UTI is largely linked to patients that have an indwelling catheter in place for a long period of time (one month or longer) while hospitalized. Catheters are sometimes used on patients that do not absolutely have a need for them, exposing the patient to a higher risk of acquiring an infection. There are an abundance of precautions that could be taken to reduce the risk of infection …show more content…
associated with catheters. This paper will discuss the issues surrounding the topic of CA-UTI, the monetary effects related to the issue, and evidence based guidelines used for prevention of CA-UTI.
Impact of the Issue
Circumstances surrounding the issue Mosby’s Dictionary of Medicine, Nursing and Health Professions defines the urinary tract infection (UTI) as an infection of one or more structures in the urinary system. In the health care setting, patients often times acquire this infection due to the presence of an indwelling catheter. An indwelling catheter is a drainage tube inserted into the urinary bladder through the urethra that is left in place, and is connected to a drainage bag or leg bag. It is also known as a Foley catheter. Having an indwelling catheter long term, as well as catheterizing a patient who does not have a valid need for one exposes the patient to risk for infection. Paul (2005) defines long term as “one that is required for more than a month; is most commonly used either to manage incontinence, particularly in women; or as an intervention for bladder outlet obstruction with retention, more commonly in men”.
Individual/societal impact of the issue Exposure to a urinary tract infection makes the patient susceptible to additional complications affecting their health as a result of possessing a urinary catheter. Complications associated with UTI include but are not limited to falls, delirium, pyelonephritis, urosepsis, and immobility with prolonged duration of use (Blodgett, 2009). The patient could also have decreased desire to be mobile with the use of indwelling catheters for fear of accidental removal and having to be re-catheterized or simply feeling uncomfortable with having one. This could delay the patient with no mobility issues from healing or expose them to the increased risk of pressure ulcers from being unnecessarily immobile.
Monetary impact of the issue In a study carried out by Meddings, Reichert, Rogers, Saint, Stephansky, and McMahon (2012) on the effects of nonpayment for hospital-acquired CA-UTI, 25 of 781,343 hospitalizations suffered from nonpayment for secondary diagnoses hospital acquired CA-UTI in acute care hospitals utilized for the study in Michigan. The dollar impact for nonpayment of the 25 hospitalizations was estimated to be $8700.00, which equals a hospital loss of $132,675 for hospital acquired CA-UTIs (Meddings et al., 2012). Blodgett’s (2009) study states that the estimated cost per case of CA-UTIs is $589.00, with an additional cost of $2800 for UTI related bacteremia. This equals a total annual cost of 424 million for treatment of CA-UTIs. The high incidence and cost of CA-UTIs, Medicaid and Medicare no longer pay for hospital acquired CA-UTIs, causing hospitals to be financially accountable for failing to prevent the infection (Blodgett, 2009).
Evidence Based Nursing Care
Evidence Based Guidelines Not only does the possession of an indwelling catheter increase the risk of CA-UTIs but also the duration of time for which the catheter is used. Bernard, Hunter, and Moore (2012) conducted a study of interventions decrease the duration of indwelling catheters and decreasing the risk of CA-TUIs. Bernard et al. (2012) suggested the use of nurse-led interventions and informatics-led interventions. Nurse-led interventions call for the staff nurses to on a daily basis, in consultation with the physician, to determine whether the patients possessing an indwelling catheter had an ongoing need for the continuation of catheter use according to the indications of proper use (Bernard et al., 2012). These indications may include urinary retention, obstruction to the urinary tract, close monitoring of output for critically ill patients and urinary incontinence that poses a threat to a stage 3 or worse pressure ulcer in the sacral area. Informatics-led interventions use technological information systems to automatically prompt healthcare professionals to take action with specified interventions. The first strategy would involve patients who received indwelling catheters in the emergency department (ED). The indications for the use of the catheter would be put into the computerized system and sent to the admitting physician. The physician would then be prompted to submit one of three orders, 1) to discontinue catheter use, 2) to maintain catheter use for an additional 48 hours, 3) or to leave the catheter in place (Bernard et al., 2012). The second strategy would allow the nurse to discontinue the use of the catheter that no longer had an indication based on assessment and the standing orders (Bernard et al., 2012). These interventions a 42% reduction in the duration of catheterization but showed no reduction in the rate of CA-UTI (Bernard et al., 2012). Nazarko (2009) conducted a study that suggests the use of silver coated catheters. These catheters release silver ions that reduce the number of bacteria able to colonize on the catheter, thus preventing a biofilm from forming. This significantly reduces the contraction of CA-UTIs and if a UTI was contracted it made it much easier to treat because the bacteria do not have a biofilm to protect them (Nazarko, 2009). Hand hygiene immediately before insertion of or handling the catheter is also essential in reducing the rate of CA-UTI (Kilpatrick, Murdoch and Storr, 2012).
Barriers of Implementation Catheter reminder systems are the most commonly used source of the interventions. According to Blodgett (2009), there have not been enough studies to determine which specific system should be implemented. In Bernard’s et al. (2012) study there was a lack of reported confidence intervals, which reduces the quality of the study and make it difficult to determine the precision of the statistics.
Ethical, Legal and Values-Based Issues In a study conducted by Elpern, Killeen, Ketchem, Wiley, Patel, and Lateef (2009) it is said that the Center for Disease Control and Prevention discourages nursing professionals from the use urinary catheters for convenience or to substitute nursing care for a incontinent patients. I have not seen this in my Intensive Care Unit (ICU) or ED rotation but have heard of this practice being used. Patients have also been known to request the use of a urinary catheter for their comfort or convenience (Elpern et al., 2009). Both of these acts are clearly unethical and expose the values of a nursing professional if utilized. Furthermore, unnecessary catheterization could lead to a healthcare facility being made liable for lawsuits if an infection developed from the use.
Incorporation into Nursing Practice When incorporating prevention of CA-UTIs in to nursing care there are many interventions that could be utilized. As previously mentioned, nurse-led interventions and informatics-led interventions appear to be extremely helpful in decreasing the risk of infection in urinary catheter use. Proper hand hygiene is essential in reducing the spread of infection in all of nursing care. During my rotation in both the ICU and the ED, I witnessed and utilized proper hand hygiene throughout the care provided for the patients. However I did not see any urinary catheter placement or care while in the ED. The ICU personnel consistently utilized proper care of urinary catheters that would decrease the risk of infection, such as daily cleansing of the perineal area. Palese, Buchini, Deroma, and Barbone (2010) suggest that bladder scanners be incorporated into use for determination of urinary retention. Bladder scanners are an easy to use, reliable and non-invasive way to determine if catheterization is necessary.
Future Implications As stated previously there various forms of reminder systems in place at different healthcare facilities. Virtual reminder systems may become a more commonly used intervention as the systems evolve and evidence continues to prove the improvement of adherence of evidence based guidelines related to the prevention of CA-UTI, as well as the reduction of infections related to urinary catheter use (Blodgett, 2009).
Conclusion
Indwelling urinary catheterization is invasive and may lead to serious outcomes affecting patients’ health. The patient should have indications that there is a need for the catheter and proper interventions should be carried out to reduce the potentiality of contracting any infections.
References
Bernard, M. S., Hunter, K. F., & Moore, K. N. (2012). A Review of Strategies to Decrease the Duration of Indwelling Urethral Catheters and Potentially Reduce the Incidence of Catheter- Associated Urinary Tract Infections. Urologic Nursing, 32(1), 29-37.
Blodgett, T.
(2009). Reminder systems to reduce the duration of indwelling urinary catheters: a narrative review. Urologic Nursing, 29(5), 369-379.
Elpern, E., Killeen, K., Ketchem, A., Wiley, A., Patel, G., & Lateef, O. (2009). Reducing use of indwelling urinary catheters and associated urinary tract infections. American Journal Of Critical Care, 18(6), 535-542. doi:10.4037/ajcc2009938
Kilpatrick, C., Murdoch, H., & Storr, J. (2012). Importance of hand hygiene during invasive procedures. Nursing Standard, 26(41), 42-46.
Meddings, J., Reichert, H., Rogers, M., Saint, S., Stephansky, J., & McMahon, L. (2012). Effect of nonpayment for hospital-acquired, catheter-associated urinary tract infection: a statewide analysis. Annals Of Internal Medicine, 157(5), 305-312. doi:10.7326/0003- 4819-157-5-201209040-00003
Myers, Tamara (ed.). (2009). Mosby’s Dictionary of Medicine, Nursing & Health Professions. (8th ed.). St. Louis, MO: Elsevier.
Nazarko, L. (2009). The effective management of catheter-related UTIs. British Journal Of Nursing, 18(10), 597.
Palese, A., Buchini, S., Deroma, L., & Barbone, F. (2010). The effectiveness of the ultrasound bladder scanner in reducing urinary tract infections: a meta-analysis. Journal Of Clinical Nursing, 19(21/22), 2970-2979.
doi:10.1111/j.1365-2702.2010.03281.x
Paul, M. (2005). Long-term urinary catheter-associated urinary tract infection (UTI). Australian & New Zealand Continence Journal, 11(1), 4.