Variables Conceptual Definition

Variables Conceptual Definition Operational Definition
Institute education power point at annual competencies on CAUTI tool Education sessions, data collection forms with instructions and diagrams, and competency checks after training are required to achieve the level of understanding for this study (Blodgett et. al., 2014). Enrollment, participation, and posttest competency to ensure proficiency of risks and complications of CAUTIs and prevention tool
CAUTI rates six months prior to the tool CAUTI is diagnosed if the patient has an indwelling catheter for more than two days, and at least one of the following signs or symptoms: fever (>100.4 ºF), suprapubic tenderness with no other cause, and costovertebral angle pain or tenderness (Neelakanta
et. at., 2015). Any patient hospitalized with a urinary catheter with signs and symptoms of CAUTI in the six months prior to prevention tool will be included.
CAUTI rates six months after tool is implemented CAUTI is diagnosed if the patient has an indwelling catheter for more than two days, and at least one of the following signs or symptoms: fever (>100.4 ºF), suprapubic tenderness with no other cause, and costovertebral angle pain or tenderness (Neelakanta et. at., 2015). Any patient hospitalized with a urinary catheter with signs and symptoms of CAUTI in the six months after the prevention tool will be included.

Hypotheses
1. The finding will provide a tool that will help decrease the prevalence of CAUTIs in the acute Medical- Surgical care unit.
2. The rate of CAUTIs will decline at a greater rate after the implementation of CAUTI prevention tool compared to the prior six months. Methods The design for this study will be a quasi-experimental design to compare pre-intervention CAUTI incidence rates with post-intervention CAUTI rates.
Quasi-experimental designs assist the pursuit for knowledge and examination of causality in situations in which complete control of a study design is impossible (Grove, Burns, & Gray, 2013). The design is used when randomization is improper and is typically easier to use. Quasi-experimental designs usually allow the researcher to control the treatment (Grove et. al., 2013). The proposal will be submitted to the Institutional Review Boards (IRB) of West Texas A&M University and chosen healthcare system for approval. After approvals are obtained, patients admitted to the acute Medical-Surgical unit with a catheter in place will be screened for eligibility. Patients meeting criteria will be flagged and chart reviewed with data documented by infection control manager. This design will help control as many threats to validity as possible (Grove et. al., 2013).
Ethical Considerations University and Clinical Agency IRB approvals will be attained. No patient names or identification numbers will be collected to ensure patient confidentiality and anonymity. Catheter days and confirmed number of CAUTIs will only be collected and recorded by a hospital trained infection control manager.
Time
Frame This entire study is expected to take one year. After IRB approval, any patient admitted to the acute Medical-Surgical unit with a catheter in place will be screened for study criteria. Data collection and analysis of CAUTI rates prior to prevention tool education will begin and will end six months after CAUTI prevention tool implemented.
Subjects and Setting
All patients admitted with an indwelling urinary catheter will be flagged for review of inclusion criteria. By including all patients admitted with indwelling urinary catheters who did not have a UTI prior to entering the study, selection bias will be eliminated. The patient must be 18 years or older, have an indwelling catheter for more than two days, and at least one of the following signs or symptoms: fever (>100.4 ºF), suprapubic tenderness with no other cause, and costovertebral angle pain or tenderness (Neelakanta et. at., 2015). Patients who are less than 18 years of age, those admitted with a UTI, and those who developed a UTI prior to the two calendar day criteria do not qualify. Furthermore, patients with a suprapubic catheter or intermittent catheterizations were excluded. Sample size will be based on number of catheter days for all patients and the consistent CAUTI incidence rate. Catheter days will be determined by counting the number of patients who had urinary catheters in place each day of the week at the same time of the day; then the days will be added to determine the monthly total.
Procedure
Prior to the initiation of the study, all hospital wide staff that inserts Foley catheters will review a competency power point and take a competency posttest to ensure proficiency of risks and complications of CAUTIs and prevention tool. The staff will have one week to enroll and complete the competency training. Power point content will include current CAUTI incidence rates, research evidence, the components of the prevention tool, and the use of the prevention tool. To ensure the prevention tool is being properly utilized, the patient’s chart will have a red insert on the front page to remind the staff of the precautions. The “algorithm for continuing use and removal of an indwelling catheter” will be part of shift chart checks that will require both the leaving and oncoming RNs signatures. One hour prior to the end of the shift the charge nurse will be responsible to note if the tool was being utilized. If the charge nurse has found the tool has not been implemented, they are to remind the RN to complete. Staff will be presented the results and reminded of goals of prevention during each monthly staff meeting to keep engagement.
Data Collection
The catheter day number will be taken from a patient log maintained by the unit clerk at the beginning of each day shift.
The unit clerk is to record the number of patients on the unit that have a urinary catheter in place. The infection control manager will collect the information each day. Urine cultures will be ordered if a patient has symptoms indicative of a CAUTI. The hospital laboratory will be responsible for reporting positive urine cultures to the infection control manager. The infection control manager then will review the patient data for evidence of CAUTI. The infection control manager will then refer to the NHSN CAUTI definitions for confirmation. Conclusion
Basic nursing care and patient advocacy can ultimately lead to a positive change in patient outcomes. Reviewing policy and procedures and current evidence-based practice CAUTI prevention tool helps guide and remind hospital staff of the importance of CAUTI rates. Implementing training and education on CAUTI tool will decrease the prevalence of CAUTIs in hospitals all over. The study’s goal is not just CAUTI prevention, but rate reduction, cost reduction, and decreased length of stay. Using Lewin’s Change Model to implement, reinforce, and maintain the changes, one believes this study will be
successful.