Abstract
The most common hospital-acquired infections are UTIs with an approximated prevailing rate of 1-10% which represents 30-40% of all nosocomial disorders. More than 560, 000 hospital-acquired UTIs have been reported every year. The main objective of the paper was is conduct research on Catheter-associated urinary tract infections (CAUTIs) and recommend an appropriate quality improvement plan. The quality improvement process employed in the research is evidence-based bundles of CAUTI prevention. The Prevent CAUTI team was formed which established an intensive education plan for all healthcare professionals working in units with the highest rate of urinary catheter placement in supplementing the fight against CAUTI.
Introduction
CAUTIs account for the most common healthcare-associated infections seen in hospital facilities. According to research, more than 560, 000 hospital-acquired UTIs (Urinary tract infections) occur every year. Approximately 15-20% of hospitalized patients receive a urinary catheter in the course of their stay in the hospital. Furthermore, a survey shows that 75% of hospital-acquired UTIs arise as a result of using urinary catheters (“Catheter-Associated Urinary Tract Infection (CAUTI)”, 2015). The challenges occur because of using catheters for a long period.
Research points out that 40% of infections that occur in acute care environments are mostly UTIs. Most studies attribute UTI to the main cause of disorders that affects the secondary nosocomial bloodstream. An estimated 17% of nosocomial bacteremia originates from the urine, with corresponding mortality of 10%. There are various reasons for employing the use of urinary catheters in hospital settings. Some of these include assisting a patient who is facing challenges in urinating, measuring urine output, using catheters in pre and post-surgery operations, and the use of catheters when doing bladder and kidney tests. There are various quality indicators of CAUTIs. Some of these include patient readmissions, increased cost of medications, and death. The main objective of the paper was to conduct research on Catheter-associated urinary tract infections (CAUTIs) and recommend an appropriate quality improvement plan.
Literature Review
The most common hospital-acquired infections are UTIs with an approximated prevailing rate of 1-10% which represents 30-40% of all nosocomial disorders. A study was conducted by Oman et.al (2012) with the purpose of establishing nurse-directed interventions to minimize CAUTIs. The study utilized a pre/post intervention design method to examine the impacts of nurse-driven interventions on the basis of the present evidence to decrease CAUTIs in the admitted patients in two surgical and medical departments. The study found that the number of catheter days decreased from 3.01 to 2.2 (p=108) in the surgery department and from 3.53-2.7 (p=.076) in the medical units. However, the survey also found that CAUTI rates were extremely minute to attain a reasonable reduction. According to the findings of the research, product cost savings are estimated at $520, 000 per year.
In another study conducted by Chan et.al with the purpose of evaluating various bundles of catheter control interventions against tick-borne infections. The methods used included strengthening training and avoiding missed diagnoses. The study found that prior to conducting new measures in 2006, the secondary attacking rate of human granulocytic anaplosmosis was 23.08% whereas after implementing the prevention care bundle, no patients with severe fever with thrombocytopenia syndrome (SFTS) were reported.
Research shows that 40% of infections that occur in acute care environments are mostly UTIs. Mojtahedzadeh et.al carried out a survey with an aim of evaluating risk factors, etiology, and the patterns of resistance behavior of antimicrobials in the ICU-acquired UTIs in patients hospitalized with sepsis. The method employed was a selection of 100 patients admitted in the ICU with septic disorders. A chart review was then used in collecting outcome, demographic and clinical data. MIC (minimal inhibitory concentration) technique was employed in determining antibiotic resistance/susceptibility. The results of the research showed that UTI was present in 28% of the patients, the ratio of male to female was 19:9, and 58.71 was the average age of the patients.
Düzkaya et.al (2016) conducted research with the aim of evaluating 2-year CAUTI rates in a PICU where the prevention bundle for the CAUTI had been implemented. The method used was surveying 390 patients in the PICU of the school of medicine of Istanbul, Turkey in July 2013-July 2015. The selection of the patients was done based on the Center for Disease Control and Prevention diagnostic criteria. The findings of the survey indicated that 8 (2.2%) of the patients in the pre-bundle group reported urinary colonization while 3 (0.8%) of patients in the post-bundle group had urinary colonization. Additionally, the survey found that the rate of occurrence of contamination was 10 (2.8%) for pre-bundle group patients and 6 (1.5%) for the post-bundle group patients. The rates of incidence of CAUTI were 5.8% and 6.1 per 1000 urinary catheter days and 1.5% and 1.8 per 1000 urinary catheter days pre-bundle and post-bundle respectively.
Marra et.al (2011) carried out a study with the aim of preventing CAUTIs in the zero-tolerance era. The method employed was carrying out a quasi-experimental study that involved multiple interventions geared towards reducing CAUTI incidences in the ICU together with 2 step-down units (SDUs). The survey found a reasonable decrease in CAUTI rates in the intensive care department from 7.6 per 1000 catheter days to 5.0 per 1000 catheter days after administering the interventions. Therefore, CAUTI infections can be managed, although sometimes it is difficult to manage them. According to research, 65-70% of CAUTIs are preventable. The quality improvement process employed in the study is evidence-based bundles of CAUTI prevention.
Quality Improvement Process
Quality improvement studies have yielded valuable results on effective strategies for preventing CAUTI in adults. According to research, 65-70% of CAUTIs are preventable. The quality improvement process employed in this case is the implementation of an evidence-based bundle of practices on the basis of CAUTI prevention methods for adults. The main objective of the quality improvement process employed was to reduce the rate of CAUTI by 50% in a period of twelve months.
The quality improvement process was achieved by forming a leadership team with the objective of reducing the prevalence of CAUTIs. The team was composed of stakeholders with complementary experience and influence. The initiative received support and financial aid from senior hospital leaders after seeing the good move in the fight against CAUTI. The quality improvement project was named “Prevent CAUTI” and had the intention of creating a pervasive culture of safety in which all community members were expected to prioritize organization-wide safety. The main reason of selecting the evidence-based bundles of CAUTI prevention is because it has been found to be more efficient as compared to other methods.
Quality Improvement Plan
Each member of the Prevent CAUTI team agreed to take responsibility for ensuring the group met its desired goals. The team meetings took place each week and the Prevent CAUTI team created a driver diagram, drew objectives, and developed and ensured the implementation of an education plan in the efforts toward achieving a rapid change. The team also identified and solved any problems which could be barriers to success.
The Prevent CAUTI team established an intensive education plan for all healthcare professionals working in units with the highest rate of urinary catheter placement. Some of these departments included ICUs, emergency, and oncology departments. The education program consisted of simulation pieces of training and online training which were managed by a qualified specialist. The simulation training focused mainly on techniques of catheter insertions to prevent the recipients from contracting CAUTIs.
The training was done by the use of insertion checklists to ensure the trained professionals achieve competency and thus execute their duties effectively. The program was able to train 200 physicians, APNs (advanced practice nurses), RNs (registered nurses), and radiology specialists. These professionals were able to attain the required skills in fighting CAUTIs. They were able to perfect catheter insertion skills and maintenance requirements of the instrument.
The module was first offered to the healthcare professionals working in ICU and then transferred to other units. These departments include oncology, emergency, and radiology departments. The process enabled 1300 additional health specialists to get acquitted with the necessary skills. These specialists completed an online tutorial including a training video with an extensive presentation covering effective insertion techniques.
The professionals working in ICU received refresher education and demonstrations after every four months because it is a high-risk department. The system helped to remind the personnel of important approaches to prevent CAUTI like aseptic insertion, catheter maintenance, antimicrobial UCs, and bladder bundle implementation. These techniques were found to improve patient safety.
After the implementation the prevention bundle, the team started to conduct bedside reviews of every CAUTI and this assisted in the identification of any barriers. Moreover, the process helped in identifying opportunities for improvement. The reviews involved personnel such as improvement advisors, frontline clinicians, IPs (infection perfectionists), and the management of the Prevent CAUTI team. The team used the results of the reviews in designing future PSDA (Plan, Do, Study, Act) cycles which include the need for 2-person insertion, consistent use of securable devices, and perfect emptying of the reservoir bags among others.
Resources
There are various resources needed to effect these evidence-based bundles of CAUTI prevention practices. Some of these include personal time, supplies for the staff education, purchasing of new equipment, and the cost of software required for facilitating the training. For the quality improvement plan to succeed, every team member is required to dedicate his or her time towards the same.
Various supplies are required for staff education. Some of the materials include insertion checklists, and computers among others. New equipment like catheters and antimicrobial UCs need also to be purchased for use in simulations and in the treatment of sick people. Soft wares are also crucial because the training is online based. They are required in executing various computer programs for effective training to take place.
Conclusion
CAUTIs account for the most common healthcare-associated infections arising from hospital facilities. An approximate 40% of infections that occur in acute care settings are UTIs. Quality improvement studies have yielded valuable results on effective strategies of preventing CAUTI, especially in senior patients. Research shows that 65-70% of CAUTIs are preventable. The quality improvement process employed in the research is evidence-based bundles of CAUTI prevention.
