Preview

Research

Better Essays
Open Document
Open Document
6751 Words
Grammar
Grammar
Plagiarism
Plagiarism
Writing
Writing
Score
Score
Research
Research

A Review of Strategies to Decrease the Duration of Indwelling Urethral Catheters and Potentially Reduce the Incidence of CatheterAssociated Urinary Tract Infections
Michael S. Bernard, Kathleen F. Hunter, and Katherine N. Moore

I

ndwelling urinary catheters are widely used in hospitalized patients and can be an appropriate means of therapeutic management under specific circumstances. However, many indwelling urinary catheters are used without clear indications (Gokula, Hickner, & Smith, 2004; Jain, Parada, David, & Smith, 1995), thus putting patients at an unnecessary risk for complications during their hospitalization. Catheter-associated complications include physical and psychological discomfort to the patient, bladder calculi, renal inflammation, and most frequently, catheter-associated urinary tract infections (CAUTI) (Gokula, Smith, & Hickner, 2007). The development of CAUTI in older adults can result in falls, delirium, and immobility (Hazelett, Tsai, Gareri, & Allen, 2006).

© 2012 Society of Urologic Nurses and Associates Bernard, M.S., Hunter, K.F., & Moore, K.N. (2012). A review of strategies to decrease the duration of indwelling urethral catheters and potentially reduce the incidence of catheter-associated urinary tract infections. Urologic Nursing, 32(1), 29-37.

The use of indwelling urinary catheters in hospitalized patients presents an increased risk of the development of complications, including catheter-associated urinary tract infection (CAUTI). With regard to the risk of developing a CAUTI, the greatest factor is the length of time the catheter is in situ. The aim of this article is to review the evidence on the prevention of CAUTI, particularly ways to ensure timely removal of indwelling catheters. Published studies evaluating interventions to reduce the duration of catheterization and CAUTI in hospitalized patients were retrieved. The research identified two types of strategies to reduce the duration of indwelling


References: Apisarnthanarak, A., Thongphubeth, K., Sirinvaravong, S., Kitkangvan, D., Yuekyen, C., Warachan, B., … Fraser, V.J. (2007). Effectiveness of multifaceted hospitalwide quality improvement programs featuring an intervention to remove unnecessary urinary catheters at a tertiary care center in Thailand. Infection Control & Hospital Epidemiology, 28(7), 791798. Cochran, S. (2007). Care of the indwelling urinary catheter: Is it evidence based? Journal of Wound Ostomy & Continence Nursing, 34(3), 282-288. Cornia, P.B., Amory, J.K., Fraser, S., Saint, S., & Lipsky, B.A. (2003). Computerbased order entry decreases duration of indwelling urinary catheterization in hospitalized patients. American Journal of Medicine, 114(5), 404-407. Crouzet, J., Bertrand, X., Venier, A.G., Badoz, M., Husson, C., & Talon, D. (2007). Control of the duration of urinary catheterization: Impact on catheter-associated urinary tract infection. Journal of Hospital Infection, 67(3), 253-257. Dingwall, L., & McLafferty, E. (2006). Nurses’ perceptions of indwelling urinary catheters in older people. Nursing Standard, 21(14-16), 35-42. Elpern, E.H., Killeen, K., Ketchem, A., Wiley, A., Patel, G., & Lateef, O. (2009). Reducing use of indwelling urinary catheters and associated urinary tract infections. American Journal of Critical Care, 18(6), 535541. Fakih, M.G., Dueweke, C., Meisner, S., Berriel-Cass, D., Savoy-Moore, R., Brach, N., … Saravolatz, L.D. (2008). Effect of nurse-led multidisciplinary rounds on reducing the unnecessary use of urinary catheterization in hospitalized patients. Infection Control & Hospital Epidemiology, 29(9), 815819. Fernandez, R. S., & Griffiths, R. D. (2006). Duration of short-term indwelling catheters – A systematic review of the evidence. Journal of Wound Ostomy and Continence Nursing, 33(2), 145155. Gardam, M.A., Amihod, B., Orenstein, P., Consolacion, N., & Miller, M.A. (1998). Overutilization of indwelling urinary catheters and the development of nosocomial urinary tract infections. Clinical Performance & Quality Health Care, 6(3), 99-102. Gokula, R.R., Hickner, J.A., & Smith, M.A. (2004). Inappropriate use of urinary catheters in elderly patients at a midwestern community teaching hospital. American Journal of Infection Control, 32(4), 196-199. Gokula, R.M., Smith, M.A., & Hickner, J. (2007). Emergency room staff education and use of a urinary catheter indication sheet improves appropriate use of Foley catheters. American Journal of Infection Control, 35(9), 589-593. Gould, C.V., Umscheid, G.A., Agarwal, R.K., Kuntz, G., Pegues, D.A., & Healthcare Infection Control Practices Advisory Committee. (2009). Guideline for prevention of catheter-associated urinary tract infections 2009. Retrieved March 19, 2010, from http://www.cdc.gov.login.ezproxy. library.ualberta.ca/hicpac/cauti/001_ cauti.html Hampton, T. (2006). Urinary catheter use often “inappropriate” in hospitalized elderly patients. JAMA: Journal of the American Medical Association, 295(24), 2838. Hart, S. (2008). Urinary catheterisation. Nursing Standard, 22(27), 44-48. Hazelett, S.E., Tsai, M., Gareri, M., & Allen, K. (2006). The association between indwelling urinary catheter use in the elderly and urinary tract infection in acute care. BMC Geriatrics, 6, 15. Holroyd-Leduc, J.M., Sen, S., Bertenthal, D., Sands, L.P., Palmer, R.M., Kresevic, D.M., … Landefeld, C.S. (2007). The relationship of indwelling urinary catheters to death, length of hospital stay, functional decline, and nursing home admission in hospitalized older medical patients. Journal of the American Geriatrics Society, 55(2), 227-233. Hooton, T.M., Bradley, S.F., Cardenas, D.D., Colgan, R., Geerlings, S.E., Rice, J.C., … Nicolle L.E. (2010). Diagnosis, prevention, and treatment of catheterassociated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clinical Infectious Diseases, 50(5), 625-663. Huang, W.C., Wann, S.R., Lin, S.L., Kunin, C.M., Kung, M.H., Lin, C.H., … Lin, T.W. (2004). Catheter-associated urinary tract infections in intensive care units can be reduced by prompting physicians to remove unnecessary catheters. Infection Control & Hospital Epidemiology, 25(11), 974978. Jain, P., Parada, J.P., David, A., & Smith, L.G. (1995). Overuse of the indwelling urinary tract catheter in hospitalized medical patients. Archives of Internal Medicine, 155(13), 1425-1429. Joanna Briggs Institute. (2008). Removal of short-term indwelling urethral catheters. Nursing Standard, 22(22), 42-45. Loeb, M., Hunt, D., O’Halloran, K., Carusone, S.C., Dafoe, N., & Walter, S.D. (2008). Stop orders to reduce inappropriate urinary catheterization in hospitalized patients: A randomized controlled trial. Journal of General Internal Medicine, 23(6), 816820. Melnyk, B.M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing and healthcare: A guide to best practice (2nd ed.). Philadelphia: Lippincott, Williams & Wilkins. Munasinghe, R. L., Yazdani, H., Siddique, M., & Hafeez, W. (2001). Appropriateness of use of indwelling urinary catheters in patients admitted to the medical service. Infection Control & Hospital Epidemiology, 22(10), 647649. Nazarko, L. (2008). Reducing the risk of catheter-related urinary tract infection. British Journal of Nursing, 17 (16), 56-58. Rabkin, D.G., Stifelman, M.D., Birkhoff, J., Richardson, K.A., Cohen, D., Nowygrod, R., … Hardy, M.A. (1998). Early catheter removal decreases incidence of urinary tract infections in renal transplant recipients. Transplantation Proceedings, 30(8), 43144316. Raffaele, G., Bianco, A., Aiello, M., & Pavia, M. (2008). Appropriateness of use of indwelling urinary tract catheters in hospitalized patients in Italy. Infection Control & Hospital Epidemiology, 29(3), 279-281. Robinson, S., Allen, L., Barnes, M.R., Berry, T.A., Foster, T.A., Friedrich, L.A., … Weitzel, T. (2007). Development of an evidence-based protocol for reduction of indwelling urinary catheter usage. MEDSURG Nursing, 16(3), 157-161. Saint, S. (2000). Clinical and economic consequences of nosocomial catheterrelated bacteriuria. American Journal of Infection Control, 28(1), 68-75. Saint, S., Lipsky, B.A., Baker, P.D., McDonald, L.L., & Ossenkop, K. (1999). Urinary catheters: What type do men and their nurses prefer? Journal of the American Geriatrics Society, 47(12), 1453-1457. Saint, S., Lipsky, B.A., & Goold, S.D. (2002). Indwelling urinary catheters: A onepoint restraint? Annals of Internal Medicine, 137(2), 125-127. Topal, J., Conklin, S., Camp, K., Morris, V., Balcezak, T., & Herbert, P. (2005). Prevention of nosocomial catheterassociated urinary tract infections through computerized feedback to physicians and a nurse-directed protocol. American Journal of Medical Quality, 20(3), 121-126. Wald, H.L., & Kramer, A.M. (2007). Nonpayment for harms resulting from medical care: Catheter-associated urinary tract infections. JAMA: Journal of the American Medical Association, 298, 2782-2784. Warren, J.W., Tenney, J.H., Hoopes, J.M., Muncie, H.L., & Anthony, W.C. (1982). A prospective microbiologic study of bacteriuria in patients with chronic indwelling urethral catheters. Journal of Infectious Diseases, 146(6), 719-723. UROLOGIC NURSING / January-February 2012 / Volume 32 Number 1 37 Copyright of Urologic Nursing is the property of Society of Urologic Nurses & Associates, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder 's express written permission. However, users may print, download, or email articles for individual use.
Continue Reading
View Writing Issues

You May Also Find These Documents Helpful

  • Powerful Essays

    Independent Prescribing Case Study
    • 6153 Words
    • 25 Pages

    Independent Prescribing Case Study

    Stanton,S.L. and Dwyer, P.L. 2000 in Bardsley, A. Urinary tract infections: prevention and treatment of a common problem Nurse Prescriber 1(13) pp113-117…

    • 6153 Words
    • 25 Pages
    Powerful Essays
    Read More
  • Satisfactory Essays

    Chapter 64 Nursing Management Musculoskeletal Problems
    • 3275 Words
    • 16 Pages

    Chapter 64 Nursing Management Musculoskeletal Problems

    signs of infection at the IV site and how to care for the catheter during daily activities such as…

    • 3275 Words
    • 16 Pages
    Satisfactory Essays
    Read More
  • Better Essays

    Prevention of Cauti
    • 2053 Words
    • 9 Pages

    Prevention of Cauti

    CAUTIs are the most commonly reported HAI in the US. Although morbidity and mortality from CAUTI is considered to be relatively low compared to other HAIs, the high prevalence of urinary catheter use leads to a large cumulative burden of infections with resulting infectious complications and deaths ("Prevention of CAUTI-Acute care settings," 2011, p. 1). In addition, bacteriuria frequently leads to unnecessary antimicrobial use, and urinary drainage systems may serve as reservoirs for MDR bacteria and a source of transmission to other patients ("Prevention of CAUTI-Acute care settings," 2011, p. 4). Healthcare-associated infections exact a significant toll on human life. They are among the top ten leading causes of death in the United States, accounting for an estimated 1.7 million infections and 99,000 associated deaths in 2002. In hospitals, they are a significant cause of morbidity and mortality. Currently, urinary tract infections comprise the highest percentage (34%) of HAIs followed by surgical site infections (17%), bloodstream infections (14%), and pneumonia (13%). Some of the guidelines set forth for prevention of CAUTI are frequent catheter care, removal of the catheter as soon as possible, and using sterile technique on insertion (Center for Disease Control, n.d.). Education of the staff, frequent RN assessment and patient education are also a very important factor in the prevention of complications associated with urinary catheterization.…

    • 2053 Words
    • 9 Pages
    Better Essays
    Read More
  • Good Essays

    Cauti Case Study In Nursing
    • 372 Words
    • 2 Pages

    Cauti Case Study In Nursing

    Most of the articles I reviewed addressed the causes of CAUTIs, the risks of indwelling urinary catheters, as well as the successful evidence-based interventions implemented for the reduction of CAUTIs. Strouse (2015), reports that UTIs account for approximately 35% to 40% of hospital-acquired infection (HAIs) and about 80% of the UTIs are associated with presence of indwelling foley catheter. The CAUTIs not only affect the increased hospital cost, but also increases the risk of morbidity and mortality. Both the Centers for Medicare and Medicaid Services consider CAUTIs as preventable complications hence no reimbursement is provided to the health care institutions for CAUTI treatment-related costs (Strouse, 2015).…

    • 372 Words
    • 2 Pages
    Good Essays
    Read More
  • Better Essays

    Improved Care for Patients with Quick Response Assessment for Picc Line
    • 1283 Words
    • 6 Pages

    Improved Care for Patients with Quick Response Assessment for Picc Line

    References: Institute for Healthcare Improvement (IHI), (2002). Reducing hospital-acquired infections in acute care hospital. Retrieved August 9, 2009, from http://www.ihi.org/IHI/Topics/CriticalCare/IntensiveCare/Measures/CatheterRelatedBloodstreamInfectionRate.htm…

    • 1283 Words
    • 6 Pages
    Better Essays
    Read More
  • Good Essays

    Urine and Catheter Management Activities
    • 2643 Words
    • 11 Pages

    Urine and Catheter Management Activities

    Because the urinary tract is normally a sterile system, catheterization presents the risk of causing a…

    • 2643 Words
    • 11 Pages
    Good Essays
    Read More
  • Good Essays

    Phi 208 Week 2 Clinical Research
    • 709 Words
    • 3 Pages

    Phi 208 Week 2 Clinical Research

    The research problem that is being explored is how to prevent infections in people who use long term indwelling urinary catheters. As patients get injured or as they age; there is a growing need to have assistance with releasing urine from the bladder. A major problem with urinary catheters is that whilst they drain the bladder, they often block the urethra and the urinary mucosa becomes inflamed, and may become damaged because of the catheter (Traunter & Darouiche, 2004). Catheter associated infections are a prevailing issue because it is best practice to reduce the costs of infections, while implementing quality and safe practices.…

    • 709 Words
    • 3 Pages
    Good Essays
    Read More
  • Good Essays

    CSA Chapter014
    • 664 Words
    • 3 Pages

    CSA Chapter014

    The most important host defense mechanism to protect from a urinary tract infection is frequent emptying of the bladder with no stasis of urine. Increased fluid intake will increase urine formation and increase bladder emptying. In this patient, the catheter should empty the bladder continuously, but if there is any obstruction, there is an increased chance of…

    • 664 Words
    • 3 Pages
    Good Essays
    Read More
  • Good Essays

    nursing research that improve patient outcome
    • 572 Words
    • 2 Pages

    nursing research that improve patient outcome

    . Nurses and other healthcare personnel are able to use the skills learned through evidence based research to decrease a patient’s length of stay, decreases morbidity and mortality, and healthcare cost. Nursing research is a scientific process that validates and refines existing knowledge and generates new knowledge that directly and indirectly influences nursing practice (Burns & Grove, 2011) Extensive research is needed to develop sound empirical knowledge for synthesis into the best research evidence needed for practice. This research evidence might be synthesized to develop guidelines, standards, protocols, or policies to direct the implementation of a variety of nursing interventions (Burns & Grove, 2011) One example of nursing research that has patient outcomes is through the use of foley insertion causing UTI( Urinary tract infection) . The presence of a urinary catheter is the most important risk factor for bacteriuria. Once a catheter is placed, the daily incidence of bacteriuria is 3-10%. Between 10% and 30% of patients who undergo short-term catheterization (ie, 2-4 days) develop bacteriuria and are asymptomatic. Between 90% and 100% of patients who undergo long-term catheterization develop bacteriuria. About 80% of nosocomial UTIs are related to urethral catheterization; only 5-10% are related to genitourinary manipulation Risk factors for bacteriuria in patients who are catheterized include longer duration of catheterization, colonization of the drainage bag, diarrhea, diabetes, absence of antibiotics, female gender, renal insufficiency, errors in catheter care, catheterization late in the hospital course, and immunocompromised or debilitated states.(emedicine.medscape.com). These strategies include an indwelling catheter has been in place for more than 2 weeks at the onset…

    • 572 Words
    • 2 Pages
    Good Essays
    Read More
  • Better Essays

    Kot Task 3.4
    • 2014 Words
    • 9 Pages

    Kot Task 3.4

    Urinary tract infections (UTI’s) are the most common type of nosocomial infections (Holland, 2012) however UTI’s are also one of the infections that is preventable. As a health care provider we are responsible for preventing infections by hand washing and or sanitizing and the other is by following current evidenced based protocols. Due to the facility not following the current evidenced based protocols for catheter care Mrs. Zwick’s had to endure a longer stay at the hospital. The negative implications that may have affected Mrs. Zwick’s could be increased anxiety for having to be hospitalized for an extend stay. Having an IV antibiotics may have caused her to stay in bed longer than needed. Unfortunately Mrs. Zwick’s will be responsible for the cost related to the hospital acquired infection. At 77 years old Mrs. Zwick’s is possibly on a fixed income having to pay the extra expense may lead to possibly her not being able to pay for her medications or not being able to pay for food. It’s important that health care facilities practice their infection control policies and continue to use evidence based protocols overall it will help the hospitals by reducing their infection rates but most of all it will help the…

    • 2014 Words
    • 9 Pages
    Better Essays
    Read More
  • Powerful Essays

    Preventing Central Line Blood Stream Infections
    • 2144 Words
    • 9 Pages

    Preventing Central Line Blood Stream Infections

    There are a variety of intravascular devices used for vascular access and they are becoming more common in today’s healthcare system, mainly due to their convenience. Whether it’s a short-term triple lumen central venous catheter or an arterial catheter for hemodynamic monitoring or long term venous access for inpatient or outpatient use for fluids, TPN, chemo, home antibiotics or hemodyalisis; central venous catheters are here to stay. Their convenience and ease of access makes them almost a necessity in patient care, but at what cost? Regardless of their purpose and ease of use, it is up to us as nurses and healthcare workers to recognize when patients are at risks for infection due to venous catheter use. In this paper, I will identify guidelines to prevent blood infections from central lines.…

    • 2144 Words
    • 9 Pages
    Powerful Essays
    Read More
  • Better Essays

    National Patient Safety Goal
    • 1153 Words
    • 5 Pages

    National Patient Safety Goal

    Hospital acquired infections are referred to as nosocomial infections. They are costly and typically can be avoided. Central line infections are no exception. Central line infections are mostly acquired in the hospital since patients aren’t usually discharged with a central line. The national patient safety goal NPSG.07.04.01 is to implement evidence-based practices to prevent central line-associated bloodstream infections. This requirement covers short- and long-term central venous catheters and peripherally inserted central catheter lines. New guidelines regarding central line infections have been established for health care facilities to execute based on the most recent findings and statistics.…

    • 1153 Words
    • 5 Pages
    Better Essays
    Read More
  • Better Essays

    Nursing research Utilization section C
    • 975 Words
    • 4 Pages

    Nursing research Utilization section C

    Bernard, M. S., Hunter, K. F., & Moore, K. N. (2012). A Review of Strategies to Decrease the Duration of Indwelling Urethral Catheters and Potentially Reduce the Incidence of Catheter- Associated Urinary Tract Infections. Urologic Nursing, 32(1), 29-37.…

    • 975 Words
    • 4 Pages
    Better Essays
    Read More
  • Better Essays

    The Use of Specific Catheters to Reduce the Risk of Catheter Associated Urinary Tract Infection
    • 1549 Words
    • 7 Pages

    The Use of Specific Catheters to Reduce the Risk of Catheter Associated Urinary Tract Infection

    The expenses are attributed to prolonged hospitalization and expenses due to lengthy diagnostic methods such as bacteria culturing. Among all hospital-acquired infections, UTI accounts for about 40% and increasing costs for health delivery by 25%. Catheter-associated UTIs accounts for over 40% or 1 million cases of all nosocomial infections in nursing homes and hospitals annually, the high incidence of this complication increases the overall cost of medication and untreated cases often leads to fatality. To reduce mortality and morbidity associated with urinary catheter infections, new approaches in prevention and treatment need to be designed. suggested that a more promising initiative is the anti-infective catheters. A review of literature may help us to answer question of whether anti-infective catheters helps in prevention of UTIs.…

    • 1549 Words
    • 7 Pages
    Better Essays
    Read More
  • Good Essays

    Smart Goals
    • 1072 Words
    • 5 Pages

    Smart Goals

    | My goal is to prevent complications caused by the use of indwelling catheter- associated UTI in the acute care. It will take place on medical-surgical/oncology unit where I’m working. People that will be involved are; unit manager, charge nurses, nurses, and doctors and I.…

    • 1072 Words
    • 5 Pages
    Good Essays
    Read More

Related Topics