Abstract
This paper concerns the issue of indwelling catheters being able to lead to urinary infections in acute care settings. This issue affects a great number of people and the pain caused by such reactions makes them a significant problem that requires research. The purpose of the study is to find a possible solution that would lead to a reduction in the occurrence rate of infections. The primary method of study for this paper is a literature review. Four articles with strong evidence were found during the data collection process. The first article showed that antimicrobial-impregnated indwelling catheters are not significantly effective in infection prevention and their use is not recommended. The second article examines the financial issue of the problem, and its results suggest that Medicare did not have a significantly negative effect on the issue despite changes in hospital practices. The third article suggested that one of the main issues is insufficient sterilization that nurses perform. Therefore, a proposed solution is an organization of training courses that would focus on this issue and the significance of urinary infections. The last article proposed that simple solutions such as cleaning the patient with soap and water may be the most beneficial for the reduction of urinary infection occurrence rate. These results were then summarized, and the creation sterilization and cleaning-focused training courses were chosen as the most beneficial solution to the issue. The insignificance of more complex catheter solutions is surprising but is likely due to the outside factors affecting urinary infections.
Introduction
Indwelling urinary catheterization in the acute care setting can lead to urinary tract infections. It is a relatively common problem in hospitals and an important subject to discuss because it can have dire consequences for both the patient and family as well as the institution of care. Urinary tract infections (UTI) are a well-known Hospital Acquired Infection (HAI) that can lead to increased length of stay, complications, and loss of profit for the institution (Moola & Konnos, 2010). The issue of catheter-related UTI’s is significant because it makes up for 40% of HAI’s and evidence declares that it is indwelling Foley catheters that account for 80% of UTIs acquired in the hospital (Moola & Konnos, 2010). Both the hospital and patient are affected negatively because the patient’s condition deteriorates further and there is a financial and reputable loss for the healthcare establishment. The question of emphasis based on the subject of urinary catheters and infection is: What are the strategies used to prevent UTI’s for patients in the acute care setting who have indwelling Foley catheters? This question also yields the clinical significance of such interventions. A literary search was conducted with the goal of finding research information that can reflect better practice outcomes and studies that produce major findings which may facilitate better care by Registered Nurses.
Problem Statement
The problem statement of the paper is the issue of urinary tract infections being possibly caused by indwelling urinary catheterization. The PICOT question for this paper consists of the following. The population it concerns is patients that require indwelling urinary catheterization. The intervention is the use of different types of catheters and sterilization technics instead of the standard solution. Its effects are compared to standard catheter options utilized by hospitals. The desired outcome is the reduction of urinary tract infection occurrence rates. The timeframe is dependent on the amount of available information. Overall the purpose of this study is to find a possible solution to the issue of urinary infections caused by indwelling catheters.
Methods
A literary search was conducted on CINAHL Complete within Ebsco Host database using Boolean terms “indwelling urinary catheters” and “hospital-acquired infections” that yielded eighteen results. A search on PubMed which houses journals based on biomedical literature, resulted in 753 articles and studies based on the search terms and phrases of “hospital-acquired infection,” “Foley catheters,” and “prevention.” On the Medline database, an authoritative database of medical information, the phrases “indwelling foley” and “hospital acquired infection” returned only one result whereas the narrowing of “foley catheter” gave 16 results, four of which touched the subject of infection related to indwelling catheter devices.
Data Analysis
The data analysis of the examined information would be based on the outcomes described in the examined literature and studies. The most significant elements of the publications would be the results and methods by which they were achieved. It is important to make sure that the methods used by the researchers are effective and involve a large enough group of participants if the publication is a research study. Based on the effectiveness of methods, a judgment of the evidence’s strength could be made. If the examined article showcases elements of bias or interprets its results in a fashion that does not appear genuine under close examination, it would not be used in the results section of the paper. However, articles with strong evidence and relevant focus would be used to showcase the most effective results on this topic. The methods used for this paper resulted in four articles being chosen for the review. All of the selected articles have proven to be valid in their approach to the subject. The research performed by their authors utilizes an adequate number of participants to produce convincing data. The results gained by these articles are consequential and can be used to determine a possible solution to the problem of urinary infections being caused by indwelling catheters.
Review of Relevant Literature
A research study involving two different types of indwelling urinary catheters was conducted. It sought to compare antimicrobial-impregnated (Nitrofurazone) indwelling urethral catheter with the standard, most commonly used polytetrafluoroethylene (PTFE) coated latex indwelling urethral catheters (Lam, Omar, Fisher, Gillies, & MacLennan, 2014). The study found that the Nitrofurazone-impregnated catheter displayed a better outcome for the patient rather than the classically used catheter. It showed that it is useful in the prevention of UTI’s as well as the incidence of bacteriuria; 84% reduction and 71% reduction, respectively. However, the degree to which it makes a significant difference was unremarkable. In addition, the Nitrofurazone-impregnated catheter is more expensive than the standard, and there were more patient complaints of discomfort and pain compared to the standard (Lam, Omar, Fisher, Gillies, & MacLennan, 2014). This study suggests that it is not worth using antimicrobial-impregnated indwelling catheters because they are not economically reasonable since there is no profound difference in infection incidence and lead to increased spending.
Medicare, in an effort to stop the rampant incidence of catheter-associated urinary tract infections (CAUTI), implemented a policy that would hurt hospitals financially. Beginning October 1, 2008, hospitals would no longer receive payment for hospital-acquired infections (Peasah, McKay, Harman, Al-Anin, & Cook, 2013). This would force hospitals to put forth serious and consistent efforts for the prevention of urinary tract infections in patients with indwelling Foley catheters. A study was implemented designed to compare the incidence of hospital-acquired CAUTI’s pre and post policy implementation using discharge information from the Florida Agency for Healthcare Administration from the years of 2007 to 2011 (Peasah, McKay, Harman, Al-Anin, & Cook, 2013). The study found that before the policy, “0.12% of admitted patients were diagnosed with CAUTI; of these, 32% were HA-CAUTI. Post-policy, the study showed that 0.16% of admissions were CAUTIs; of these, 31% were HA-CAUTI”. The results of this study show that there is no statistically significant finding with the decline of HA-CAUTI’s despite Medicare policy intervention that threatens hospitals in the financial realm.
Urinary catheter infections lead to exorbitant hospital expenses and morbidity in especially vulnerable patient populations. A retrospective cohort study was conducted with the subjects of a systematic random sample of 388 admitted patients in which 1 of 4 underwent indwelling Foley catheter insertion (Lobão & Sousa, 2017). It was found that 36.5% of these patients with the indwelling Foleys did not meet clinical criteria that required insertion (Lobão & Sousa, 2017). In other words, no evidence and no true reasons were found that justified the need to insert the indwelling Foley catheter. Along with this relationship, 71% of the patients who did develop a CAUTI did not meet the criteria for the indwelling catheter. The study also found that 66.7% of the patients with CAUTI were first introduced to the catheter insertion at the Emergency Department before being admitted to the internal medicine department. This suggests that there should be practice and quality improvement efforts in the Emergency setting. Perhaps the nurses should undergo re-training for sterile technique and participate in a meeting that recalls the importance of maintaining sterility along with a refresher on the appropriate procedure during insertion.
A systematic review that analyzed six randomized control trials retrieved evidence that showed certain management techniques helped to prevent catheter-associated urinary tract infections (Moola & Konnos, 2010). Moola and Kronnos (2010) further discuss the comparison of immediate versus delayed catheter removal and state that the earlier removal times displayed reduced incidence of CAUTI’s. Another study supported this evidence by stating that the most imperative modifiable risk factor involved with indwelling urinary catheters is the time in-situ (Parida & Mishra, 2013). This study declares that “by the 30th day of catheterization, infection rates are about 100%” (Parida & Mishra, 2013, p. 372). As for genital cleansing, “there was no additional benefit from specific meatal care other than standard daily personal hygiene and removal of debris” (Moola & Konnos, 2010, Results, para. 1). Moola and Kronnos (2010) also found that intermittent catheterization had a reduced incidence of CAUTI’s compared to an indwelling Foley catheter. These findings show that regular and simple soap and water suffice to maintain an environment free of bacterial invasion around the genital openings, prompt removal of catheters plays a significant impact on CAUTI prevention, and intermittent catheterization proves better than indwelling Foleys.
Results
The examination of the relevant literature produced a number of results supported by strong evidence. The first is that it may be beneficial for nurses to go through a training course on sterilization due to the low quality of the present sterilization practice. The second finding shows that relatively simple procedures such as cleaning of genital openings with soap and water before utilizing a catheter may be highly beneficial for the prevention of urinary infections. Catheters also require prompt removal after the need for them disappears. However, no alternative catheters were found to be significantly effective.
Discussion
The studies conducted provide a significant contribution to existing research. The resulting data can help to guide further research on areas in the acute care setting that require additional intervention. The acquired information from the studies is significant because they display a need for Registered Nurses to receive refresher courses on the importance of sterile technique as well as the psychomotor ability to do so in order to prevent contamination. The need for quality improvement projects revolving catheter-related UTI’s in acute care units has also been conveyed by the researched studies. Furthermore, there must be an implemented way that strengthens the efforts of hospitals to continue practices that prevent UTI’s since the deterrent financial gesture of Centers of Medicare and Medicaid services will not suffice.
Conclusion
In conclusion, the fight against the high rates of Hospital Acquired UTI’s remains. The vast amount of management techniques for the prevention of HA-CAUTI’s is a reflection of how sensitive and essential it is for hospitals to keep quality improvement projects and programs based on this subject. There is much evidence that suggests certain preventative measures are more instrumental than others. By reviewing the literature on studies based on the problem of indwelling Foley catheters associated with UTI’s we can expand our knowledge and commit to improving ourselves as nurses. This project has shown that new technological solutions may not always have significant benefits for medicine or nursing practices. Out of all the examined studies, none have presented significant reductions in urinary infection occurrences. One of the most significant lessons of this study is that simple and timeless techniques can still have drastic effects on the quality of care. Sterilization of instruments and the cleaning process of patients are considered a basic part of the medical practice, but it is not a reason to take them lightly. An unclean area on a person may lead to highly harmful infections, and nurses have to be aware of such consequences. To avoid them in the future, a special training course should be created. It would be focused on the promotion of the most effective cleaning techniques and awareness of urinary infections.
References
Lam, T.B., Omar, M.I., Fisher, E., Gillies, K., MacLennan, S. (2014). Types of indwelling urethral catheters for short-term catheterization in hospitalized adults. Cochrane Database of Systematic Reviews. Web.
Lobão, M. J., & Sousa, P. (2017). Hospital-Acquired Urinary Tract Infections: Results of a Cohort Study Performed in an Internal Medicine Department. Acta Medica Portuguesa, 30(9), 608-614. Web.
Moola, S., Konnos R. (2010). A systematic review of the management of short-term Indwelling urethral catheters to prevent urinary tract infections. JBI Library of Systematic Reviews, 8(17), 695-729. Web.
Parida, S., & Mishra, S. K. (2013). Urinary tract infections in the critical care unit: A brief review. Indian Journal Of Critical Care Medicine: Peer-Reviewed, Official Publication Of Indian Society Of Critical Care Medicine, 17(6), 370-374. Web.
Peasah, S. K., McKay, N. L., Harman, J. S., Al-Amin, M., & Cook, R. L. (2013). Medicare non-payment of hospital-acquired infections: infection rates three years post implementation. Medicare & Medicaid Research Review, 3(3). Web.