Preventing Catheter-Associated Urinary Tract Infections in Acute Care
The Bundle Approach
Speranta Duliepre
Nursing Research NYC Tech
The purpose of this quantitative research is to prevent urinary tract infection by reducing the use of catheterization and increase the use of adult catheter bundle. The adult catheter bundle was a series of steps to prevent infection prior to insertion and maintenance after insertion. The purpose is to reduce the use of catheterization and increase the use of adult catheter bundle (Andreessen, Wilde & Herendeen, 2012). The researchers gather information through the positive scientific method and empirical evidence. They did this by randomly choosing their sample that fit the inclusion criteria and assisting the data through numerical charts, graphs, and analyzing the data.
The design was experimental because it introduced an intervention into the research which was the catheter bundle which also included the computerized catheter order template. Even through it didn’t have a controlled variable there were so many interventions added to the research that only a limited segment was used and the data was compared before and after the bundle was introduced. The sample included patients with only acute placements of 30 days or less, who had an indwelling urinary catheters (Andreessen, Wilde & Herendeen, 2012). The Catheter Associated Urinary Tract Infection (CAUTI) prevention group a multidisciplinary team was created to design a prevention program for the use of catheterization. The team included 2 infection control nurses, educators, surgical nurses, clinical nurse leaders and information technologists. It also included 3 staff nurses, an urologist, a chief medical resident and 4 nurse mangers (Andreessen, Wilde & Herendeen, 2012). The prevention team also developed a computerized documentation template that recorded the data of insertion and removal of urinary catheter. The new 24 hour catheter order for urinary catheter template requires the indication for use and a daily assessment of the need to continue the urinary catheter (Andreessen, Wilde & Herendeen, 2012).
The independent variable is the catheter bundle which included the new computerized catheter order template and the dependent variable is decreasing CAUTI. The rationales for this study are to prevent CAUTI and control the measures of infection and related deaths per year. According to the Center for Disease Control and Prevention (CDC) (2010) each time a patient acquire a CAUTI it is estimated that the cost would be an additional $1000 in care. It is also estimated that the total cost of CAUTI is $450 million per year and it is becoming more costly for hospitals because Medicare and Medicaid Services no longer reimburse hospitals for the extra cost to treat patient who develop CAUTI.
The method and procedures took 8 months and the preprogram appraisal was 3 weeks of daily analysis and a total of 1200 computerized medical charts to be used as a baseline data. The post program assessment took about 3 weeks of daily review of 1385 computerized medical charts for the data outcome (Andreessen, Wilde & Herendeen, 2012). A random project number was assigned protecting patients confidentiality and privacy to all patient data collected (Andreessen, Wilde & Herendeen, 2012). The research project setting was at the VA medical center. Due to the demographic of the VA hospital the sample included only male patients with acute indwelling urinary catheters (Andreessen, Wilde & Herendeen, 2012). The preintervention period introduced the catheter bundle to the computerized VA system. The mandatory education for all nurses on the content of catheter bundle which included insertion and removal guidelines was the intervention period which took 2 months to complete. The postintervention period where all data was collected took 1 month in order to establish if the nurses and providers complied with the daily practices of the urinary catheter bundle and the new documentation/order templates (Andreessen, Wilde & Herendeen, 2012). Post data information was collected during the catheter device days and reported from the infection control nurses on the CAUTI rates. The statistical data was compared between the 3 weeks of preintervention and 3 weeks of postintervention. “The process measures included outcome measures (catheter device days) and process measures (documentation rates)” (Andreessen, Wilde & Herendeen, 2012). The information was collected for every unit and all 3 unit information were combined including compliance with computer based documentation, indication for use and the average catheter duration. Only the catheter bundle insertion element was evaluated for this project (Andreessen, Wilde & Herendeen, 2012).
The implications of this research was the finding the most effective preventive strategies that involved the use of closed drainage system, the removal of the catheter as soon as it is no longer needed, a new automated computer system allowing 24 hour orders for urinary catheters and stop orders (Andreessen, Wilde & Herendeen, 2012). The computer based documentation would indicate stricter procedures for infection control practices. This project addressed the best practice and strategies of urinary catheter bundle and computer based documentation/order system to prevent CAUTI.
Hierarchies of evidence offer a systematic method of ranking the strength of an intervention’s. Particular research methods are ranked according to their scientific validity. These types of hierarchies are frequently used by reviewers when creating systematic reviews or meta-analyses of evidence in a particular area of research (Polit & Beck, 2010). Based on the Evidence hierarchy this research is placed on level II b because it lacks a controlled variable and they used what they have on hand.
The findings resulted in a 114 charts initially that met the inclusion criteria for the project but only 90 charts were used due to missing data and lack of documentation. After multiple implementation of the program only 51 computerized medical charts met the inclusion criteria. The most important criteria for all devices related to the bundles are the continuous questioning of the need for the catheter use. This will routinely prompt physicians and nurses to remove unnecessary use of urinary catheters to decrease the rate of CAUTI (Andreessen, Wilde & Herendeen, 2012). “After the intervention, the catheter durations had decreased for each unit and overall. The catheter duration significantly decreased (P=.002) pre to postintervention for all units combined” (Andreessen, Wilde & Herendeen, 2012). This was significant because (P=.002) is less than (P=.05). Statistical significance means that the results from analysis of sample data are unlikely to have been caused by chance, at a specified level of probability (Polit & Beck, 2010).
References
Andreessen, L., Wilde, M. H., & Herendeen, P. (2012). Preventing Catheter-Associated Urinary Tract Infections in Acute Care: The Bundle Approach.Journal of Nursing Care Quality, 27(3), 209-217.
Polit, D. F., & Beck, C. T. (2010).Essentials of nursing research: appraising evidence for nursing practice (7th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Center for Disease Control and Prevention. (2010) The direct medical costs of healthcare-associated infections in the U.S hospital and the benefits of prevention. Retrieved from http://www.cdc.gov/ncidod/dhqp/pdf/
