...Retrospective analysis of catheter-acquired urinary tract infection (CAUTI): Relationship to stroke diagnosis Abstract Background: Eighty percent of hospital-acquired urinary tract infections are associated with urinary catheters (Joint Commission Resources, 2011). Catheter-acquired urinary tract infections (CAUTI) continues to be at the forefront of the fight against hospital-acquired infections (HAI). Despite ongoing efforts to decrease the incidence of catheter-acquired urinary tract infections (CAUTI) in the acute care setting, overall standardized infection rates (SIR) for CAUTI have decreased only 7% since 2009 (Centers for Disease Control and Prevention (CDC), 2013). Purpose: The purpose of this study was to compare patients with a diagnosis of stroke to patients without a primary diagnosis of stroke to determine if patients diagnosed with stroke had a higher incidence of CAUTI infection. A secondary aim was to examine use of antibiotics, steroids, length of hospital stay, catheter days, and ICU length of stay in both stroke and non-stroke patients. Methods: The study method is a retrospective chart review analysis uses data from an 874-bed large teaching hospital located in the Southeastern United States from 2011 and 2012. After approval from both the Nursing Scientific Advisory Committee and the Institutional Review Board of the institution, analysis of data began. Results: 600 patients were potential candidates for analysis. Of the 600 patients...
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...An APIC Guide 2008 Guide to the Elimination of Catheter-Associated Urinary Tract Infections (CAUTIs) Developing and Applying Facility-Based Prevention Interventions in Acute and Long-Term Care Settings About APIC APIC’s mission is to improve health and patient safety by reducing risks of infection and other adverse outcomes. The Association’s more than 12,000 members have primary responsibility for infection prevention, control and hospital epidemiology in healthcare settings around the globe. APIC’s members are nurses, epidemiologists, physicians, microbiologists, clinical pathologists, laboratory technologists and public health professionals. APIC advances its mission through education, research, consultation, collaboration, public policy, practice guidance and credentialing. Look for other topics in APIC’s Elimination Guide Series, including: • • • • Catheter-Related Bloodstream Infections Clostridium difficile Mediastinitis MRSA in Long-Term Care Copyright © 2008 by APIC All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission of the publisher. All inquires about this document or other APIC products and services may be addressed to: APIC Headquarters 1275 K Street, NW Suite 1000 Washington, DC 20005 Phone: 202.789.1890 Email: APICinfo@apic.org Web: www.apic.org ISBN: 1-933013-39-7 ...
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...Review of Literature: Decreasing Catheter Associated Urinary Tract Infections Urinary Tract Infections are one of the most common hospital-acquired infection and many are associated with an indwelling catheter. For each day a catheter is in place the risk of developing a CAUTI increases 3%-7% (Kahnen, Flanders, & Magalong, 2011 ). Although indwelling urinary catheters are widely used in hospitalized patients and can provide an appropriate means of therapeutic management, they are often used without clear indications putting the patient at a risk for complications during their hospitalization. Complications related to a urinary catheter include physical and psychological discomfort to the patient, bladder calculi, renal inflammation and most frequently CAUTI (Bernard, Hunter, & Moore, 2012, 32(1)). Not only does the urinary catheter cause complications to the patient and put them at a higher risk for morbidity and mortality they also increase the hospital costs. Therefore CAUTIs are considered by the Medicare and Medicaid Services to represent a reasonably preventable complication of hospitalization and as such will not provide any additional payment to hospitals for CAUTI treatment (American Association of Critical Care Nurses, 2012). A great amount of attention has been placed on improving quality of care and minimizing preventable harms that are occurring in the healthcare setting. With the passage of the Deficit Reduction Act of 2005 and the implementation...
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...Introduction The primary focus of this study is to assess the effectiveness of a simple reminder system to aid clinicians and nurses in remembering that a patient has a urinary catheter can decrease the duration of time that a patient is catheterised and successfully reduce the rates of CAUTIs. The study was completed by a team medical doctors and registered nurses with the aim of confirming the efficacy of this simple reminder intervention. Both the title and the abstract of the article give the reviewer a clear idea of the purpose and intent of the study. Purpose of the study The purpose of this study was to assess whether, if simple interventions were used properly they will reduce the number of catheter associated urinary tract infections. The researchers found that there were a lot of catheter associated urinary tract infections; particularly in the duration of indwelling catheterization was a factor. The researchers found many hospitals in the United States did not monitor the duration of catheter use. Nor were the physicians aware of patients who were catheterised for some duration. The research also notes that there was a cost factor involved with lengthy duration of indwelling catheters. Method - Design and Data collection The study follows a quantitative analysis, using a controlled trial method. A pre intervention and post intervention study was conducted and the data was collected over three time periods. The Pre intervention commenced September 2008 followed...
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...Introduction Catheter associated urinary tract infections (CAUTIs) are a common problem found in patients who endure long-term indwelling urinary catheterization. However, some research has started to prove that the use of clean intermittent catheterization (CIC), and or the use of adult briefs can decrease the incidence of CAUTIs in acute care settings by reducing the use of indwelling catheters. CAUTIs are known the be caused by the buildup of bacteria around the urinary catheter due to improper hygiene, and or its long-term use. The use of clean intermittent catheterization in patients with urinary retention will reduce the number of unnecessary long-term indwelling catheters, which will in turn reduce the number of CAUTIs. Also, for patients who are incontinent of their bladder functions, it is proven that the use of adult briefs will reduce the number of catheter associated UTIs. It is thought that with the use of alternative methods such as...
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...ORIGINAL ARTICLE Factors associated with catheter-associated urinary tract infections and the effects of other concomitant nosocomial infections in intensive care units EKREM TEMIZ1, NIHAL PISKIN2, HANDE AYDEMIR2, NEFISE OZTOPRAK2, DENIZ AKDUMAN2, GUVEN CELEBI2 & FURUZAN KOKTURK3 From the 1Departments of Infectious Diseases and Clinical Microbiology, Bitlis Government Hospital, Bitlis, 2Departments of Infectious Diseases and Clinical Microbiology, and 3Department of Biostatistics, School of Medicine, Zonguldak Karaelmas University, Zonguldak,Turkey Abstract Background: Catheter-associated urinary tract infections (CAUTIs) are the most common nosocomial infections in inten- sive care units (ICUs). The objectives of this study were to describe the incidence, aetiology, and risk factors of CAUTIs in ICUs and to determine whether concomitant nosocomial infections alter risk factors. Methods: Between April and Octo- ber 2008, all adult catheterized patients admitted to the ICUs of Zonguldak Karaelmas University Hospital were screened daily, and clinical and microbiological data were collected for each patient. Results: Two hundred and four patients were included and 85 developed a nosocomial infection. Among these patients, 22 developed a CAUTI alone, 38 developed a CAUTI with an additional nosocomial infection, either concomitantly or prior to the onset of the CAUTI, and 25 devel- oped nosocomial infections at other sites. The CAUTI rate was 19.02 per 1000 catheter-days. A Cox proportional...
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...guidelines reduce or decrease, “Never Events”, while improving quality care and patient safety. The purpose of this paper is to review the guidelines that has been developed to address the Urinary Tract Infections (UTI) problem, it’s importance and significance to nursing practice, as well as its impact on the patients and community, and the differences in care based on evidence. “Patients with indwelling catheters, even with current standards of care and evidence-based practice, urinary tract infections continue to be a problem”(Kevin J. Ribby, June 2006). Practice setting problem Urinary tract infections continue to be a problem in healthcare. The numbers of patient’s with urinary tract infections are still too high. “A plethora of articles have been written about nosocomial urinary catheter-related infections, management of the catheter, and proper placement of the indwelling catheter in the male patient 4 but little about the impact of nursing education on outcomes related to decreasing UTIs and usage of indwelling urinary catheters” (Doyle B, Zubina M, Horgan M, 2001). There are a various reasons for why nurses continue to see urinary tract infections like incorrect perineal cleaning, a break in aseptic technique when inserting urethral catheters, and the amount of time a urethral catheter remains in a patient. There have been various evidence-based practices that...
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...PREVENTING CATHETER ASSOCIATED URINARY TRACT INFECTION Elizabeth Quartey Abstract According to the CDC estimates in 2002 there were 1.7 million Healthcare-Associated Infections (HAI), and 99,000 HAI- associated deaths in the hospital. The report stated that the four largest categories of HAI, responsible for more than 80% of all reported HAI, are central line-associated bloodstream infections (CLABSI, 14%), ventilator-associated pneumonia (VAP, 15%), surgical site infections (SSI, 22%), and catheter-associated urinary tract infections (CAUTI, 32%). HAI are a great financial costs to health care facilities. The Centers for disease Control and Prevention (CDC) estimates the medical cost of HAI in the U.S. hospitals as $6.65 billion in 2007, and that number has increased to almost $10 billion a year currently. Statement and Significance of the Problem One in 20 patients who are admitted to a hospital will be a victim to an infectious agent they are exposed to during their hospitalization according to the Centers for Disease Control (CDC) (Goodman, Brenda, 201, Hospital-Acquired Infections cost $10 Billion a year). The five most common infections are surgical site infections, infections associated with the use of devices like central lines, catheters, ventilators and clostridium dificile are costing the health care System in the USA almost $10 billion a year to treat. In the article Vitamin D has the potential to reduce the risk of Hospital-Acquired...
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...indwelling catheters, with the evidence-based practice and standards of care, UTI’s does still continue to be an ongoing problem today. In one of the large hospitals in my area had recently developed a poster and video approach with special focus on alternatives to urinary catheterization, removing catheters early, and the reinforcement of sterile technique prior insertion and foley catheter care were used to educate nursing staff and improve outcomes. The purpose of this paper is to educate nursing on how to be proactive with this issue and to inform the providers when there is no further need for the catheters to reduce infections in patients. Practice setting problem Urinary tract infections (UTIs) account for approximately 35% of nosocomial infections but are the lowest in mortality and cost (Burke, 2003). Patients with UTIs as a secondary diagnosis have an average length of stay of 9.1 days versus those without a urinary catheter of 4.7 days. As individuals live longer, the probability of them being hospitalized and requiring specialized care services is increased (Hobbs, 2001). Hospitalization of any aged person increases the risk for them to have a urinary indwelling catheter, which predisposes them to a nosocomial urinary tract infection (Saint, 2003).Nurses are responsible for placing and maintaining the indwelling catheters. Often non-licensed staff are being delegated these tasks, without the proper training and education on routine catheter care and catheter insertion...
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...* Nephrolithiasis refers to renal stone disease; urolithiasis refers to the presence of stones in the urinary system. Stones, or calculi, are formed in the urinary tract from the kidney to bladder by the crystallization of substances excreted in the urine 1. Urinary calculi are stones in urinary tract * a. Nephrolithiasis: stones form in kidneys * b. Urolithiasis: stones form in urinary tract outside kidneys 2. Highest incidence in * 3. Males more often affected than females (4:1) * 4. Most common in young and middle adults B. Risk factors * 1. Majority of stones are idiopathic (no demonstrable cause) * 2. Prior personal or family history of urinary calculi * 3. Dehydration: increased urine concentration * 4. Immobility * 5. Excess dietary intake of calcium, oxalate, protein * 6. Gout, hyperparathyroidism, urinary stasis, repeated UTI infection ETIOLOGY * METABOLIC * LIFESTYLE * GENETIC FACTORS * DRUGS * OTHERS RISK FACTORS * IMMOBILITY * SEDENTARY LIFE STYLE * DEHYDRATION * METABOLIC DISTURBANCES * HISTORY OF RENAL CALCULI RISK FACTORS * HIGH MINERAL CONTENT IN DRINKING WATER * DIETARY INTAKE * UTI & H/O FEMALE GENITAL MUTILATION * PROLONGED INDWELLING CATHETERISATION * NEUROGENIC BLADDER Development and location of calculi within the urinary tract Pathophysiology 1. Factors leading to lithiasis include supersaturation (high concentration of insoluble...
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...organization that serves many patients with different backgrounds and cultures. The organization is a hospital that is magnet certified and strives to surpass the recommended levels in health care regulatory outcomes such as core measures, patient satisfaction, never events, employee satisfaction, and many other outcomes. Because the organization prides itself in being the best, it is important to attempt to find methods to improve the care provided to the patients. A improvement identified by the staff in a medical surgical unit is portable bladder scanners to help improve catheter associated urinary tract infections, decrease the need for foley catheters, improve patient outcomes, decrease patient days and complications. Bladder Scanner Elpern, E., Killeen, K., Ketchem, A., Wiley, A., Patel, G., & Lateef, O. (2009). Reducing use of indwelling urinary catheters and associated urinary tract...
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...m e dic i n e Clinical Practice Caren G. Solomon, M.D., M.P.H., Editor Urinary Tract Infections in Older Men Anthony J. Schaeffer, M.D., and Lindsay E. Nicolle, M.D. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors’ clinical recommendations. From the Feinberg School of Medicine, Northwestern University, Chicago (A.J.S.); and the University of Manitoba, Winnipeg, Canada (L.E.N.). Address reprint requests to Dr. Schaeffer at the Feinberg School of Medicine, Northwestern University, 303 E. Chicago Ave., Tarry Bldg. 16-703, Chicago, IL 60611, or at jschaeffer@ a northwestern.edu. N Engl J Med 2016;374:562-71. DOI: 10.1056/NEJMcp1503950 Copyright © 2016 Massachusetts Medical Society. An audio version of this article is available at NEJM.org 562 A 79-year-old community-dwelling man presents with urinary frequency, dysuria, and fever. Culture reveals extended-spectrum beta-lactamase Escherichia coli. He had a similar infection several months ago, with the same organism isolated, and he had a response to nitrofurantoin treatment. How would you further evaluate and manage this case? U The Cl inic a l Probl em rinary tract infection in men without indwelling catheters is uncommon among men younger than 60 years of age, but the incidence increases...
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...Gap: A Critical Analysis of Quality Improvement Strategies (Vol. 6: Prevention of Healthcare–Associated Infections)" under the head Quality Improvement and Patient Safety What is Accountability? In Fundamentals of Nursing it says “The ability and willingness to assume responsibility for ones’ actions and accepting the consequences of one's behavior.” Accountability of nursing professional is a legal obligation; for a professional nurse it is relating to ethics and moral responsibility. Within the kingdom of professional accountability, there are many factors. The American Nursing Association (ANA) states in its code that the nurse will assume accountability for nursing judgment and actions. A professional nurse has the responsibility to take decisions and practice within the scope of care, calling upon his/her information and skills to make judgments in favor of the patient. A professional nurse is accountable to their profession, their patients, employer, and other health care team members and to themselves. Nurses are accountable to provide safest care for their patient based on evidence based practice and safe nursing interventions. Nursing profession as a whole is build up on accountability, unselfishness, integrity and social justice. A professional nurse who take decisions and practice on the basis of those ethical values will always be in favor of the patient, no matter what is his/her professional level. Methods The Healthcare-associated infections. ...
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...NURSING CARE PLAN COURSE: Basic Adult Health CLIENT INITIALS: DATE OF ADMISSION: AGE: GENDER: JL June 13, 2011 85 M HT: WT: ALLERGIES: 140 lbs. NKA CODE STATUS: FULL RACE/ETHNICITY: CULTURAL CONSIDERATIONS: Caucasian None RELIGION/SPIRITUAL CONSIDERATIONS: Unknown OCCUPATION/HOBBIES/RECREATIONAL ACTIVITIES: Retired LIVING SITUATION/WITH WHOM: (home, assisted living, LTC, etc) Lives with daughter. SOCIAL HISTORY: (tobacco, ETOH, illicit drugs, family dynamics) Quit smoking many years ago, no history of ETOH or drug use. NURSING CARE PLAN ADMITTING MEDICAL DIAGNOSIS: Client's principal admitting diagnosis was leukocytosis. Definition: (from Taber’s) “An increase in the number of leukocytes (usually above 10,000/mm3) in the blood. It occurs most commonly in disease processes involving infection, inflammation, trauma, or stress, but it also can result from the use of some medications” (Venes, 2009, p. 1327). Etiology/pathophysiology: ( NOT from Taber’s or Wikipedia) Etiology: Causes of leukocytosis are infection, inflammation, tissue damage, immune reaction, bone marrow problems, medications, and stress (Drug Information Online, 2011). Pathophysiology: “Leukocytosis can be a reaction to various infectious, inflammatory, and, in certain instances, physiologic processes (eg, stress, exercise). This reaction is mediated by several molecules, which are released or regulated in response to stimulatory events that include growth or survival factors (eg, granulocyte...
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...Change in Practice: Preventing Hospital Associated Infections April Shannon Walden University NURS 4000 Section 04, Research and Scholarship for Evidence-Based Practice November 18, 2012 Change in Practice: Preventing Hospital Associated Infections Benjamin Franklin was quoted as saying “an ounce of prevention is worth a pound of cure.” With the increasing costs of healthcare and the emergence of multi-drug resistant organisms this truth still resonates today. Hospital associated infections (HAIs), have been a complication in hospitals for many years. The purpose of this assignment is to address this problem in nursing practice, and discuss evidence on practices that will address this issue. The problem Hospital associated infections (HAIs) can be defined as an infection acquired in hospital by a patient who was admitted for a reason other than that infection. An infection occurring in a patient in a hospital or other healthcare facility in whom the infection was not present or incubating at the time of admission. This includes infections acquired in the hospital but appearing after discharge, and also occupational infections among staff of the facility (central line associated bloodstream infections, catheter associated urinary tract infections, surgical site infections, ventilator associated pneumonia, etc.) (World Health Organization, 2002). HAI’s have become one of the leading caused of hospital related deaths in the United States. However, these infections...
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