Abstract
Urinary tract infections (UTIs) constitute an important public health concern because they account for the largest proportion of all hospital-acquired infections. UTIs are more prevalent in nursing homes and affect the elderly disproportionately. Catheterization is the principal factor that increases the vulnerability of institutionalized patients to UTIs. As such, it is essential to identify evidence-based practices to minimize the risk of these conditions in nursing homes. The proposed solution entails the implementation of three strategies: catheterization checklists, hand hygiene protocols, and catheterization policies. The evidence from previous literature has underscored the significance of these strategies in nursing practice. The implementation plan constitutes three critical phases. The first step will involve the formation of a panel of experts to identify the gaps and opportunities for improvement. The second stage will emphasize the development of a business case to create the urgency for change, as well as its benefits. The final phase will focus on incorporating the proposed solutions into the current systems and procedures. The evaluation plan will assess the effectiveness of the new guidelines and policies using expert reviews, the analysis of existing documentation, performance observations, and surveys. Finally, the dissemination process will employ posters, podium presentations, and journal articles.
Problem Description
Urinary tract infections (UTIs) account for the largest proportion of hospital-acquired infections (HAIs). The principal concern is that the incidence and prevalence rates of UTIs are much higher in nursing homes (Flanagan et al., 2014). Advanced age, co-morbid conditions, poor nutrition status, and medication use predispose the elderly to urinary retention (Liang & Mackowiak, 2007). In addition, excessive catheterization increases the concentration of bacterium, which exacerbates the risk of UTIs (Ping, Traynor, & Hailey, 2014). Thus, it is essential to identify evidence-based practices to minimize the risk of these conditions in nursing homes.
Solution Description
First, the introduction of checklists will improve the effectiveness of supervision. Beveridge, Davey, Phillips, and McMurdo (2011) have found out that urinary catheter checklists play a fundamental role in minimizing the incidences of UTIs. Second, the nursing home should develop robust systems to monitor the level of compliance with the hand hygiene protocols (Daniels, 2012; Haas & Larson, 2007). Thirdly, the unnecessary catheterization of patients increases the risk and incidences of CAUTIs (Liang & Makowiak, 2007). Blango and Mulvey (2010) have underscored the significance of having written policies that specify the indications for catheterization.
Implementation Plan
The first phase of implementation will entail a review of the current procedures and systems to identify gaps and opportunities for improvement. The nursing home will have to conduct baseline investigations through a panel of experts. The investigators will review the current practices and make proposals for implementing the proposed solutions. The change agents will then develop a business case, which will provide the rationale for the evidence-based proposals, including the benefits.
Evaluation Plan
The evaluation plan will consist of four components. First, expert reviews will evaluate the new guidelines and protocols to determine their effectiveness. The second technique will involve the identification, retrieval, and analysis of information from the existing documents (Acheterberg, Schoonhoven, & Grol, 2008). Thirdly, the use of questionnaires will be essential to gather crucial data from the nurses and other caregivers to make policy and process adjustments (Oman, Duran, & Fink, 2008; Titler, 2007). Finally, performance observations will be essential to gain first-hand experience about the performance of the new guidelines (Gale & Schaffer, 2009).
Dissemination Plan
The continuous dissemination of information reduces the risk of failure significantly because it provides feedback (Acheterberg et al., 2008). First, poster presentations will convey a summary of the new guidelines, policies, and procedures (Oman et al., 2008). The second technique will entail podium presentations at conferences, seminars, and workshops. This approach is that the audience will have the opportunity to ask questions and make proposals (Gale & Schaffer, 2009). Thirdly, the publication of the findings in journal reports will benefit other nursing homes that are planning to change their processes and systems (Titler, 2007).
Review of Literature
Urinary tract infections (UTIs) represent some of the most frequent bacterial infections in hospitals and nursing homes (Agata, Loeb, & Mitchell, 2013; Yates, Davies, Gorely, Bull, & Khunti, 2009). Carlsson, Haglin, Rosendahl, and Gustafson (2013) have indicated that UTIs recur in approximately twenty percent of women. In addition, Hyang, Blegen, and Harrington (2014) have affirmed that 30% of this group of women will have a second recurrence whereas 80% will have subsequent repetitions. It is imperative to prevent the incidences of UTIs to reduce patient suffering, antibiotic use, and resistance the antibiotic medications.
A review of the literature has identified numerous factors that constitute the underlying risks of UTIs. Nonetheless, catheterization is the principal factor that increases the vulnerability of institutionalized patients to UTIs (Chang et al., 2014; Trinkoff et al., 2015). The unnecessary use of catheters and the mismanagement of catheterized patients increase the risk of Catheter-Associated UTIs (CAUTIs). CAUTIs are the most frequent hospital-acquired infections (HAIs) in nursing homes and among hospitalized patients (Blango & Mulvey, 2010). According to Liang and Mackowiak (2007), CAUTIs account for approximately 40% of all hospital-acquired infections. CAUTIs increase the mortality and morbidity rates, as well as the length of hospital stay (Figueiredo, 2014; Flanagan et al., 2014).
References
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