CAUTI Prevention: Patient Education Research Proposal

Introduction and Research Question

Catheter-associated urinary tract infections (CAUTIs) affect timely reimbursement and prolong patient stays in healthcare facilities. Many hospitals strive to find ways to reduce CAUTIs and take specific medical measures to aid patients in recovery and avoid recurrence. These deliberate measures ensure better patient outcomes, improve the quality of patient care, and enhance reimbursement received from insurance providers.

The research seeks to investigate the effect of frequent CAUTI education, conducted over six months, among in-hospital patients with indwelling urinary catheters.

Background and Significance

It is common medical knowledge that urinary catheters have the potential to cause urinary tract infections, known as catheter-associated urinary tract infections (CAUTIs). Indwelling catheters are a part of many plans of care, specifically for emergent and critical care patients within the hospital setting. According to the CDC, more than 12% of acute care infections are caused by CAUTI. The CDC further reports that 12–16% of acute care patients require an indwelling catheter during their hospital stay (Shaver et al., 2018).

The purpose of this study is to investigate the effect of frequent CAUTI education among in-hospital patients with indwelling urinary catheters over six months. Because, as the CDC postulates, as many as 16% of acute care patients require indwelling catheters, there is an urgent need in medical practice to ensure that indwelling catheters benefit patients rather than cause additional harm or infection. The 12% infection rate associated with indwelling catheters is too high, underscoring the urgent need for a multifaceted approach to curbing these infections.

This proposed research is grounded in the premise that CAUTI prevention does not rest exclusively with hospital clinicians but depends greatly on patients themselves implementing the medical guidance they receive from nurses — hence the emphasis on CAUTI education for in-hospital patients. Once the intervention described herein is implemented, UTI cases and their severity among research participants will be observed, and new data will be compared to pre-test outcomes to determine whether a significant difference exists after the intervention and whether that difference can be directly associated with patient education.

Education is an effective way to address gaps in knowledge; nurse educators and clinical nurse specialists serve as the primary educators for these innovations. Providing unit- or facility-specific CAUTI data to clinical staff and then educating them on ways to reduce knowledge gaps can be an effective strategy for reducing CAUTI in acute care patients. CAUTI reduction programs with evidence-based, protocol-driven guidelines communicated to staff are also effective, and there are financial savings to be gained from reducing CAUTI rates (Scanlon, 2017). The education in this study will be nurse-driven but patient-focused. The nurse will strive to impart the requisite knowledge of what CAUTI is and the care and caution the patient must exercise to avoid infection while the indwelling urinary catheter is in place. Patients will be educated on the dry-bag concept and its importance to their health; this will be followed up frequently among intervention participants as described below. Patients will also receive instruction on perineal care practices and catheter maintenance and insertion techniques so they can effectively manage their indwelling catheters both within and outside the hospital setting.

Literature Review

Carr (2017) reviews CAUTI prevention using a nursing intervention bundle — a CAUTI bundle — that all hospitals are encouraged to adopt. The bundle is based on standardized, evidence-based practice and allows for consistent care and maintenance of indwelling catheters. Components of the bundle include medical record review for all patients with an indwelling urinary catheter and daily assessment by nursing staff and the physician to determine the medical necessity of the catheter. For patients with a catheter in place, Foley care is provided every eight hours and as needed, using aseptic technique. Additional bundle interventions include hand hygiene, use of a leg strap for catheter tubing management, and avoiding kinks in the tubing.

Fletcher et al. (2016) conducted qualitative semi-structured interviews and observations at four sites — three academic medical centers and one Veterans Affairs facility. The research focused on the importance of the CAUTI Guide to Patient Safety (GPS) in CAUTI prevention activities across units in different hospitals. Participants from two units within each of the four hospitals were included. Researchers collaborated with nursing staff and interviewed nurse managers using specific questions following completion of the CAUTI GPS tool. Based on the results, they debriefed nursing staff and discussed CAUTI preventive initiatives. Nursing staff agreed that the CAUTI GPS was an effective tool. The study's limitations included a small hospital sample size. Findings included steps to engage physicians, encourage sharing of unit-level performance trend data, and use the GPS as a vehicle for stakeholder discussion to promote CAUTI identification and implementation of treatment and prevention strategies.

Peter, Devi, and Nayak (2018) evaluated the effectiveness of clinical practice guidelines on maintenance of indwelling catheters using an evaluative pre-test and post-test approach with an experimental and control group. The study's objective was to assess both insertion and maintenance practices for indwelling urinary catheters. A quasi-experimental, non-equivalent control group pre-test and post-test design was employed over one year. Demographic data were collected from both nurses and patients. The study found that clinical practice guidelines regarding CAUTI were effective in improving participants' infection control practices and reducing CAUTI occurrence in hospitals. Conclusions underscore the need to support clinical nurses and provide nurse education to aid implementation and monitoring of infection prevention and control standards.

Safdar et al. (2016) present a qualitative study assessing patient perspectives on indwelling urinary catheters using semi-structured interviews. Results indicated that patient awareness and engagement regarding indwelling urinary catheters and the potential risk for CAUTI could be improved in the hospital setting. Recommendations included implementing educational programs that incorporate patient preferences for both healthcare workers and patients, thereby increasing patient involvement in their own care. The study found that 75% of patients perceived that they had not received adequate education about the consequences of indwelling urinary catheters, all patients surveyed reported that alternative methods of excretion had not been discussed, and 65% felt they had not received adequate information about CAUTI risk. The limitations of this study include a small sample size, though the qualitative data provided meaningful opportunities for improvement in patient–provider discussions about indwelling catheters.

Scanlon (2017) used quantitative data collection to measure the success of a healthcare system's CAUTI reduction program by tracking the standardized infection ratio, incidence, and number of catheter days. The research also aimed to demonstrate quality improvement by developing best practices and transferring them across the healthcare organization. Benefits documented included a decrease in catheter days and a reduction in the number of CAUTIs. The primary goal was to reduce hospital ICU catheter days by 25% within 12 months and by 50% within 18 months of implementation.

Shaver et al. (2018) discuss the fact that indwelling catheters are part of many care plans, particularly for emergent and critical care patients. Consistent with CDC data, they note that more than 12% of acute care infections are caused by CAUTI and that 12–16% of acute care patients require an indwelling catheter during their hospital stay. Their intervention involved staff education and the development of Best Practice Champions using a skills checklist. These super-users worked one-on-one with clinical nurses to reinforce appropriate Foley catheter insertion and maintenance techniques.