CAUTI-Catheter-Acquired Urinary Tract Infections) Identify a Work-Setting

¶ … CAUTI-catheter-Acquired urinary tract infections)

Identify a work-setting problem.

• Describe a problem or issue that needs a solution.

Basic infection prevention along with antimicrobial stewardship is necessary to investigate due to the global need for interventions that will impact HAIs, including urinary tract infections. "The basics of infection prevention and control are the necessary underpinnings of programs, policies, and protocols that impact HAI" (APIC, 2008, p. 5). One aspect that specifically needs continual focus is formation of antimicrobial stewardship programs. Antimicrobial stewardship has a chance of generating positive outcomes through minimization of potential adverse outcomes of occurrences like CAUTIs. The reason for this is the development of colonization, biofilms, and asymptomatic bacteriruria, and symptomatic urinary tract infections which are typical in regards to urinary catheter use.

What often occurs in a health care setting where CAUTIs have a chance of forming are inappropriate choice and utilization of antimicrobials. Not only does the misuse of antimicrobials lead to well-documented effects like multidrug resistance, it can also lead to ineffective treatments and persistent infections within patients and residents in a healthcare facility. The main problem lies in mismanagement of drugs along with lack of supervision and monitoring. As previously mentioned in another essay, most of the CAUTIs occur because of untimely removal of the catheters resulting in increased rates of infection.

• Provide support that the problem or issue is an important one to solve.

"Since the earliest days of national nosocomial infection reporting, UTIs have been shown to occur more frequently than other infections associated with healthcare, accounting for 36%of all HAIs in the United States" (APIC, 2008, p. 5). Because CAUTIS are 100% acquired after 30 days of catheterization, it is of the utmost concern to resolve this issue. Research indicates regardless of antimicrobial and hygienic protocols, bacteria, especially in women (due to their shorter urethras) will have to deal with a CAUTI merely based on prolonged use of catheters. When an issue becomes a certainty, there must be actions taken to prevent further infections, further misuse of antibiotics and so forth. Healthcare, especially in the U.S. faces constant re-budgeting with funds not being allocated to meet the increasing demands of infection control. The more affordable option of prevention of CAUTIs not only saves healthcare facilities from any unnecessary and additional expenses, but will also prevent resurgence of other more costly consequences like antibiotic resistant bacteria.

• State a project objective that is specific, realistic, and measureable.

Implement a monitoring program in conjunction with an antimicrobial stewardship program that will deal with effective and quick removal of catheters in order to decrease and prevent CAUTIs. Both of the programs can be taught to the hospital staff and patients, allowing both parties to actively know and participate in checking for appropriate time for removal of catheters. The typical rate of infection to reach 100% certainty is after 30 days with infections starting in as little as 6 days. Thus removal of catheter after 6 days must be mandatory.

• Describe briefly the proposed solution and the way in which it will solve the problem or issue.

The proposed solution: prompt removal of catheters after certain time limits, normally 6 days, will and has been proven to be an adequate solution to CAUTIs. Not only does it remove the certainty of infection, it also prevents misuse of antibiotics by preventing infections altogether. Simply evaluating patient time with catheter and then prompt removal saves money, time, and decreases risk of infection. Implementation of routine hygiene protocols can also help by removing additional bacteria within the patient environment.

Complete Section B: Solution Description.

Develop a description of the proposed solution

• Describe the proposed solution.

Although hospitals have adapted an implementation strategy similar to other hospital-acquired infections, like central line-associated blood stream infection (CLABSI), many CAUTI prevention strategies are resource intensive and fail to meet the demands of increasing infection rates, exhausting the budget of the healthcare facility and failing to change or improve the habits of the medical staff. Instead, it is imperative to prioritize actions that will best help in preventing CAUTIs. The proposed solution: strategies to encourage prompt removal of catheters. Hospital staff should be taught what to look for in patients who no longer need catheters. The actions needed to remove catheters can often take time. If a method is implemented to shorten this process, thus shortening time for removal of catheter, then infection rates will decrease.

• Describe the way(s) in which the proposed solution is consistent with current research knowledge.

Information, extracted from chapter 9 of the book: Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices, Meddings et al. (2013), shares the problems associated with swift catheter removal and relates the need for the process to become streamlined to avoid additional unnecessary days of catheter use:

In most hospitals, four steps are required to remove a urinary catheter: (1) a physician recognizes the catheter is in place, (2) the physician recognizes the catheter is no longer needed, (3) the physician writes the order to remove catheter, and (4) a nurse removes the catheter. Thus, by default, hours and sometimes days may pass before an unnecessary catheter is recognized and removed (Shekelle, Wachter, & Pronovost, 2013, p. 211)