Running head: EVIDENCE-BASED NURSING PRACTICE

Evidence-Based Nursing Practice
Karen Medley
Walden University
NURS 4000 Section 05, Research and Scholarship for Evidence-Based Practice)
July 22, 2012

Abstract
For patients that have 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.
Importance of the clinical problem and its significance to nursing practice

Nosocomial infections more than double the mortality and morbidity risk for hospitalized patients, resulting in an estimated 20,000 deaths a year (Nguyen, 2004). Nosocomial infections increase the costs of hospitalization in addition to increasing morbidity and mortality risk. A meta-analysis of 55 studies examining nosocomial infections and infection control interventions determined that attributable costs are significant; costs associated with bloodstream infections (mean = $38,703) and methicillin-resistant Staphylococcus aureus infections (mean = $35,367) are the largest (Stone, 2002). The CDC supports education of staff and involvement of health care workers at all levels in implementing interventions to prevent indwelling catheters infections, and nurses are an essential component of these preventive efforts. This begins with hand hygiene, and educating nurses and other healthcare professionals of the first line of defense. Nurses must become educated and stop taking shortcuts when it comes to sterile technique with insertion and be proactive with the physicians to discontinue catheters when they are no longer medically necessary. Nurse should also be educating non licensed staff on proper routine foley catheter care. Nurses should also become aware of the alternatives to indwelling catheters if possible, for patients that could benefit from bladder training and etc. The interventions that BSN nurses could do to assist ADN or Diploma nurses would be to develop a QA program to monitor and track the numbers of UTI’s and report this to staff at meetings quarterly. They could also develop a UTI project to educate and train the non-licensed staff and other healthcare professionals.
Impact on patients and/or a community
The specific problems for the patients with indwelling catheters would be the high cost of extended hospital visits due to infections. If the patient is still of working age the loss of wages due to the extended hospital stay. The long term use of antibiotics may cause the patient to become resistance to the antibiotics. It may also interfere with the patient’s intimate relations with their significant other to have an indwelling catheter as well as frequent infections of the GU system. The problem is more prevalent in the older population of 65 years or older and with more African Americans and Caucasians. The lower income communities are probably more affected. The cost of a single episode to treat UTI’s ranges from $980-$2900, depending on the presence of the bacteremia (Saint, 2000).
Differences in care based on evidence Sterile technique is required for insertion of an indwelling urinary catheter in the hospital setting, but clean technique can be used for intermittent catheterization in non-acute settings. By itself, sterile technique on insertion doesn't prevent UTI’s. Prevention of UTI’s depends on knowledge of causes, proper care techniques, and early catheter removal. Nurses are taught early on in school that sterile technique helps to reduce infections. It was drilled in our heads the entire time and now to have the evidence tell us that early catheter removal, along with proper technique good hand hygiene is the key to reduce UTI’s.
Summary
UTI’s is an all too common problem that causes unnecessary distress to patients and delays their recovery during their hospital stay. All healthcare professionals should adhere to these good practice points that could reduce the risk of UTI’s and assure staff that they are demonstrating best practice in their care.

References
Burke J.P. (2003). Infection control- a problem for patient safety. New England Journal Medicine, 348(7):651-656.
Hobbs F.B. (2001).The elderly population. US Census Bureau, Population division and Housing and House-hold Economic Statistics Division. Retrieved July 22, 2012, from http://www.census.gov/population/www/pop-profile/elderpop.html
Saint S, Chenoweth C.E. (2003). Biofilms and catheter-associated urinary tract infections. Infect Dis Clin N Am.17:411-432.
Nguyen Q.V. (2004). Hospital acquired infections. Retrieved July 22, 2012, from http://www.emedicine.com/PED/topic1619.htm. Stone P.W, Larson E, Kawar L.N. (2002). A systematic audit of economic evidence linking nosocomial infections and infection control interventions: 1990-2000. American Journal Infection Control 30(3):145-52.