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Prevalence and impact of UTIs among elderly patients due to long-term use of catheters

Question:

Disucuss about the Post-Operative Patient with Urinary Catheter Associated With Urinary Tract Infection.

Urinary tract infection (UTI) is the most prevalent disease found among the male and female elderly patients admitted in hospitals. UTI is caused by the bacterial infection due to long term use of catheter. The patient often experiences cloudy or bloody urine with foul odor and pain in urination. As a nurse, they should conduct proper preventive measures for combating UTI. One of the most important strategies is the reduction of the use of urinary catheters.

UTI is one of the leading sources of morbidity among the elderly patients. It causes significant pain and infections of bacteria. They cause the health care cost as well as increase the duration of the patient in the hospital. Nurses play the leading role in administration of catheters to the patient. In the orthopedic ward the conditions are worse (Lai et al, 2017).

The main objective of the plan includes the reduction in the use of the catheters which is the main cause of the infections. Before starting the plan, the initial step will include the measuring of the effects related to the early removal of catheters (Lo et al, 2014). The nurses can go for a pilot study in the orthopaedic unit and see if the evidence is the drop in the percentage of infections (Weiner et al, 2016). The implementation plan concerning the issue will be directed to mitigate the chances of acquiring urinary tract infections among the elderly patients during the post-operative session by means of removing the urinary catheter within 24-48 hours.

Empirical studies have highlighted on the issue of UTI due to bacterial colonization because of prolonged use of urinary catheter. The vulnerability of the aged patient has been fund to be even more compared to others. Qualitative studies have revealed that infection prevention guide is required to streamline the safety and efficacy of the urinary catheters when introduced in the patient group. Incorporation of a self-assessment tool has been suggested in this respect to harbor optimum outcomes (Saint et al, 2014). There have been reports of abatement of the rates of catheter associated UTIs following implementation of reminder system and adoption of infection control programs. Additionally proper use of material like that of hydrophilic coated catheter has been found to be effective in case of clean intermittent catheterization (Tenke, Köves & Johansen, 2014). Research has also shown that the nurses should be well expert to guide on the aseptic conditions that should be maintained while the insertion of catheters (Boev & Kiss, 2016).

Importance of reducing the use of catheters as a strategy to combat UTIs

Corroborating the findings of various studies it is quite evident that reduction in rates of catheter associated UTIs is a challenging task and hence collaborative approach is essential to tackle the situation. At the orthopedic unit of the clinical setting, a round the clock monitoring system must be introduced in post operative session where the appointed nurses must take record of any possible symptoms of UTI. The written documentation of UTI must be noted on an hourly basis so that there is no missing out of information and prompt intervention may be ensued on detection. Nurses must be thorough of their duty and engage in making the catheters aseptic for the elderly patient so that infection chances are reduced. In consultation with the attending nurses and professionals of the infection control department in the hospital, the indicators for catheter associated UTI must be presented that will aid in determining the prevalence of UTI in the concerned patient population.

The impacts show that if the preventive measures are taken on time, then the occurrence of UTI can be avoided. The potential impacts are leading to any positive effects can be verified with the portfolios that is to be maintained and see if the rate of occurrence of the infections have decreased or not (Advani et al, 2017). Symptoms for fever, suprapubic tenderness and urinary culture examination must be noted in the process. Baseline data prior to operation for each of the admitted patents must also be noted to compare and analyze with the post operative patient condition. Final assessment will be done with respect to the reporting of the number of incidences of catheter induced UTI following the intervention after running of a pilot study.


They must evaluate properly to see that the preventive strategies that are taken are followed properly (Soe et al, 2015). They must firstly evaluate the safety in handling catheter. The nurses should have the proper knowledge of the catheter use and must follow the updated version for the guideline of the use of catheter. They must see if the catheter is placed properly in patient with safety and with care (Carter et al, 2016). The potential impacts can only be inferred if there is valuable fall in the infection rates in the ward.

If the scheduled pilot studies and the monitor studies are not done in time then that could be a possible barrier in achieving the goal that is taken. Sometimes there could be barriers in getting right amount help. In that case the persons that will be helping are the nurse clinician, nurse educator, advance practice nurse, infection control nurse.

Empirical studies on UTIs and the need for infection prevention guides and self-assessment tools

The evidence based project that interests me is the adoption of new protocol that can decrease the incidence of CAUTI. The project included the prevalence study with health team education and prompt communicating with the catheter insertion date and time and the removal recommendations. The implementation plan can include forming a team of experts in nursing that know the preventive plans. The team will be made after choosing the nurses through training. The authority of the hospital organization must be given responsibilities to check if the plan is being well performed. A metric should be made according to the plan. If any further issues develop during the implementation of the plans than the root cause should be made for the adjustments.


The evidence based studies include the infrastructures and the resources required to implement any plan on the prevention of the infections. According to the evidence based studies from the practice state of Singapore.

The key implementation plans would include (Weiner et al, 2016)

  • Prevent the use of the indwelling catheters
  • Use of the alternative catheters
  • Following a detailed guidelines during administration of the catheters
  • Evaluation and collection of the data after implementing the plan.

Conclusion

The quantitative study through the health conditions due to UTI can only be well prevented by taking strategies. The nurses will first set some objectives and implement a plan to work on the strategies. The plans should be performed at the scheduled time of the nurses and they must overcome all the barriers that come in way. The plan is implemented with the help of team of experts in handling and managing the catheters. Their main goal is to reduce the use of catheters or using any alternatives.

I was introduced with the topic of the UTI by my teacher during the discussion on the leading cause of death in the hospitals. The teacher also explained to us that this is the main reason for the long stay of the patients in the hospitals. The teacher also said about various ways nurses can adopt rules like preventing the use of catheters. The teacher also told us that hygiene is the most important factors with the introduction of the foley bags to the patients. Initially I was really interested to know more about this topic. Then I found out that the infections can be prevented by the strategic implementation plans by the nurses. The nurses can not only assist the persons with the accurate diagnosis and the treatment but can also implement certain strategies to prevent the infections.  I wanted to learn more on how to adopt preventive plans in order to remove the infections in the patients. I also understood that the plan can only be implemented if the nurses can form a team of experts that know the updated rules in handling catheters. I also think that nurses should bring out some time to indulge in the task of monitoring the pivot study and see if the plan that is made is standing well or not.  I went through several journals available that helped me to construct the objective and then develop a strategy to form the implementation plan.  The problem I faced while developing the plan was that the manual for using the alternatives of new available catheters were not given. I feel that the implementation plan made according to the guideline of the catheter use can make the prevention effective. I already have learnt that the bacteria are mostly multidrug resistant and the cure is not possible every time with antibiotics. Thus prevention is the best way to resist the infections. I think the plan must satisfy both the long term and short term goals. The plan cannot be made by any particular formula here but only by the response of the steps that are to be taken. Thus the encouragement and active participation of the team members is must. In terms of issues regarding barriers, m immediate steps need to be taken otherwise the procedure will be lengthy. The program monitoring framework should be well accountable and constructed statistically. Any kind of resources like proper guidelines and the alternative catheters if required they are to be brought by the nurses in time. I say that the plan implementation can only be made by the learning the situation first that is to be handled. The next key step should consider the regular practice of the monitoring framework that will eventually make the plan a success.

Role of nurses in preventing catheter-associated UTIs and managing catheters

References

Advani, S. D., Lee, R. A., Schmitz, M., & Camins, B. C. (2017). Impact of Changes to the National Healthcare Safety Network (NHSN) Definition on Catheter-Associated Urinary Tract Infection (CAUTI) Rates in Intensive Care Units at an Academic Medical Center. Infection Control & Hospital Epidemiology, 38(5), 621-623.

Bellamy, N. (2016). Educating Staff on the ANA CAUTI Prevention Tool in Order to Reduce Infections on the Nursing Unit.

Boev, C., & Kiss, E. (2016). Hospital-Acquired Infections: Current Trends and Prevention. Critical Care Nursing Clinics of North America.

Carter, E. J., Pallin, D. J., Mandel, L., Sinnette, C., & Schuur, J. D. (2016). A Qualitative Study of Factors Facilitating Clinical Nurse Engagement in Emergency Department Catheter-Associated Urinary Tract Infection Prevention. Journal of Nursing Administration, 46(10), 495-500.

Chenoweth, C. E., Gould, C. V., & Saint, S. (2014). Diagnosis, management, and prevention of catheter-associated urinary tract infections. Infectious disease clinics of North America, 28(1), 105-119.

Fletcher, K. E., Tyszka, J. T., Harrod, M., Fowler, K. E., Saint, S., & Krein, S. L. (2016). Qualitative validation of the CAUTI Guide to Patient Safety assessment tool. American journal of infection control, 44(10), 1102-1109.

Gray, D., Nussle, R., Cruz, A., Kane, G., Toomey, M., Bay, C., & Ostovar, G. A. (2016). Effects of a catheter-associated urinary tract infection prevention campaign on infection rate, catheter utilization, and health care workers' perspective at a community safety net hospital. American journal of infection control, 44(1), 115-116.

Lai, C. C., Lee, C. M., Chiang, H. T., Hung, C. T., Chen, Y. C., Su, L. H., ... & Chuang, Y. C. (2017). Implementation of a national bundle care program to reduce catheter-associated urinary tract infection in high-risk units of hospitals in Taiwan. Journal of Microbiology, Immunology and Infection.

Lo, E., Nicolle, L. E., Coffin, S. E., Gould, C., Maragakis, L. L., Meddings, J., ... & Yokoe, D. S. (2014). Strategies to prevent catheter-associated urinary tract infections in acute care hospitals: 2014 update. Infection Control & Hospital Epidemiology, 35(5), 464-479.

Saint, S., Gaies, E., Fowler, K. E., Harrod, M., & Krein, S. L. (2014). Introducing a catheter-associated urinary tract infection (CAUTI) prevention guide to patient safety (GPS). American journal of infection control, 42(5), 548-550.

Soe, M. M., Gould, C. V., Pollock, D., & Edwards, J. (2015). Targeted assessment for prevention of healthcare-associated infections: a new prioritization metric. infection control & hospital epidemiology, 36(12), 1379-1384.

Tenke, P., Köves, B., & Johansen, T. E. (2014). An update on prevention and treatment of catheter-associated urinary tract infections. Current opinion in infectious diseases, 27(1), 102-107.

Weiner, L. M., Webb, A. K., Limbago, B., Dudeck, M. A., Patel, J., Kallen, A. J., ... & Sievert, D. M. (2016). Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2011–2014. infection control & hospital epidemiology, 37(11), 1288-1301.

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