Nursing Home and Infections

Deficiency: Catheter Care Insufficient urinary catheter care is a cause for concern among nurses working in the senior care environment. Catheter-cased urinary tract infections account for more than a third of all health care associated infections in the United States (Fink, Gilmartin, Richard, et al., 2012). To reduce the number of infections in a nursing home, staff need to reduce the number of unnecessary catheterizations performed and remove unnecessary catheters. When catheters are necessary, nurses need to practice evidence-based catheter maintenance. Catheter maintenance is relatively straightforward. Wilson, Wilde, Webb et al.

(2009) found that there are several effective methods to reduce the risk of catheter-based urinary tract infections including daily cleansing of the meatus using soap and water or an appropriate cleanser and maintenance of a closed urinary drainage system. Other methods of infection prevention include wearing gloves, hand washing, maintaining a sterile barrier, and using the "no-touch insertion technique," (Fink, Gilmartin, Richard, et al., 2012, p. 715).

Staff education is critical to preventing urinary tract infections and other problems like skin infections that are associated with unnecessary catheterization, prolonged catheterization, or improper catheter care. The first step in nurse training at a nursing home would be to reduce the total number of catheterizations, by limiting their use only to situations in which they are absolutely necessary. Research shows that limiting catheter use reduces the instances of urinary tract infections, without any deterioration in nursing satisfaction (Rothfeld & Stickley, 2010). Unfortunately catheters are sometimes used unnecessarily.

When catheters are necessary, nurse leaders and nursing home administrators can use an alarm or alert system to schedule catheter removal. An alert system can be designed differently depending on the nursing home organization. In some organizations, portable electronic devices might provide optimal alert systems for nurses. In other organizations, a shift leader might provide the reminders to nursing staff. Reminders and stop orders on catheters using alert or alarm systems reduce the number of urinary tract infections caused by catheters (Meddings, Rogers, Macy & Saint, 2010).

Therefore, the administration needs to put in place a systematic method of alerts. There are some outmoded practices that recent literature has found ineffective in reducing the prevalence of catheter-caused urinary tract infections.

Those include the following: the use of a sterile technique for catheter insertion, the use of antiseptic solutions or ointments during routine meatal care, the use of a 2-chambered urinary drainage bag, the use of antiseptic filters incorporated into a urinary drainage bag, bladder or catheter irrigation, frequent changes of the urinary drainage bag, and the placement of an antiseptic solution in the urinary drainage bag (Willson, Wilde, Webb, et al., 2009).

Nursing home administrators should monitor nurse practitioners to ensure that some of these outmoded practices are set aside in favor of evidence-based practices. In addition to ongoing staff education and recurrent reminders to remove catheters, nurse leaders need to carefully monitor staff for proper catheter insertion. The most up-to-date catheter equipment, such as silver-coated catheters, may also be helpful in reducing the frequencies of infections among patient populations in the nursing home (Fink, Gilmartin, Richard, et al., 2012). Moreover, the nursing home policy should prohibit unnecessary catheterization.