Problem
Cather-associated urinary tract infections (CAUTIs) are the main causes of secondary infection in the blood stream, making up around 76% of all UTIs, due to the wrong use of urinary catheter (Kuriyama et al., 2017). There are three types of catheters, as indicated by the World Health Organization [WHO]: indwelling, external, and short-term (2018). Indwellling which include urethral and subrapubic, external catheters recommended for men with severe cognitive impairment, and short-term catheters for use over a short duration of time, for example, after surgery. The duration of using urinary catheterization is the main determinant of developing CAUTI.
Setting
Urinary catheters are mainly used on bed-ridden patients; hence their presence is higher in intensive care units at 60% while the rest consists of other divisions. Based on the different types of urinary catheters, other than the ICU, it is evident that residential institutions and medical wards are places where one can find patients with CAUTIs. Urinary catheters are ideal for use during surgery or when one has urinary retention or a condition that requires an accurate attainment of urinary output (Hu et al., 2018). Nonetheless, individuals receiving home-base care and with the aforementioned conditions also warrant urinary catheter use.
Description
CAUTIs account for 34% of all health-care associated infections, as highlighted by Hu et al (2018). Hu et al. (2018) further indicate that these catheters tend to be inappropriately used on the elderly even when they do not have a medical indication. Taha et al. (2017) state that while urinary catheters are inserted for the wrong reasons, healthcare providers are not aware of the catheterization. Sequentially, there is prolonged use which is unnecessary and bound to have a negative effect on the health of a patient. 60% of the CAUTIs can be prevented in the correct guidelines are followed. As a result, there should be clear indications for the need of a urinary catheter which should be well-maintained and removed in a timely manner.
Effects
CAUTIs have negative implications on the social and economic aspects of a patient’s life along with their physical health. While it results in patient discomfort and serious comorbidities such as endocarditis, urinary tract trauma, and sepsis, 13, 000 deaths in the United States are due to UTIs acquired from healthcare (Letica-Kriegel et al., 2019; Wooller et al., 2018). These infections are comorbidities that arise as an individual receives care within a health facility and are not the main diagnosis. CAUTIs cause 13,000 estimated deaths yearly, increase the length of hospital stays by 2 to 4 days, and escalate healthcare costs for each individual by $1200 to $2400 (Taha et al., 2017). These effects sequentially affect one’s quality of life negatively and drain an individual’s as well as the society’s resources.
Significance
The issue of CAUTIs is important to nursing because at least 69% of these infections can be avoided if the right measures are applied. Healthcare workers need to be educated on the appropriateness of urinary catheter use because wrong indications have been seen in an estimated 50% of indwelling catheters (Kuriyama et al., 2017; Safdar et al., 2016). Gaps in practice should be identified with the help of a multidisciplinary team periodically and training provided to healthcare workers to attain efficacy and efficiency in practice.
Solution
Collaboration among healthcare workers in different departments and on-job training are useful system interventions that could help ameliorate the problem. The implementation of a multidisciplinary team in a study by Taha et al. (2017) and an evidence-based paper by Pérez et al. (2017) yielded positive outcomes as the players are able to highlight issues within the system, leading to collective decision-making. Such a process is effective in resolving all of the issues bound to thwart the successful implementation of urinary catheter guidelines compared to a focus on a single department.
References
Hu, F. W., Shih, H. I., Hsu, H. C., Chen, C. H., & Chang, C. M. (2018). Dynamic changes in the appropriateness of urinary catheter use among hospitalized older patients in the emergency department. PloS One, 13(3). Web.
Kuriyama, A., Takada, T., Irie, H., Sakuraya, M., Katayama, K., Kawakami, D., Iwasaki, H., Fowler, K. E., Tokuda, Y., & Saint, S. (2017). Prevalence and appropriateness of urinary catheters in Japanese intensive care units: Results from a multicenter point prevalence study. Clinical Infectious Diseases, 64(suppl_2), S127–S130. Web.
Letica-Kriegel, A. S., Salmasian, H., Vawdrey, D. K., Youngerman, B. E., Green, R. A., Furuya, E. Y., Calfee, D. P., & Perotte, R. (2019). Identifying the risk factors for catheter-associated urinary tract infections: a large cross-sectional study of six hospitals. BMJ Open, 9(2), e022137. Web.
Pérez, E., Uyan, B., Dzubay, D. P., & Fenton, S. H. (2017). Catheter-associated urinary tract infections: challenges and opportunities for the application of systems engineering. Health Systems, 6, 68–76. Web.
Safdar, N., Codispoti, N., Purvis, S., & Knobloch, M. J. (2016). Patient perspectives on indwelling urinary catheter use in the hospital. American Journal of Infection Control, 44(3), e23–e24. Web.
Taha, H., Raji, S. J., Khallaf, A., Abu Hija, S., Mathew, R., Rashed, H., Du Plessis, C., Allie, Z., & Ellahham, S. (2017). Improving catheter associated urinary tract infection rates in the medical units. BMJ Quality Improvement Reports, 6(1). Web.
Wooller, K. R., Backman, C., Gupta, S., Jennings, A., Hasimja-Saraqini, D., & Forster, A. J. (2018). A pre and post intervention study to reduce unnecessary urinary catheter use on general internal medicine wards of a large academic health science center. BMC health services research, 18(1), 642. Web.
World Health Organization [WHO]. (2018). Advanced infection prevention and control training: prevention of catheter-associated urinary tract infection (CAUTI): A student handbook. Web.