Foley catheters are a significant risk factor for urinary tract infections. Using catheters contributes to up to 75% of hospital-acquired urinary tract infections. The condition worsens among patients in the intensive care unit (ICU). This is a group of incontinent patients, and they entirely rely on eternal aid to get things done. To help protect these patients from lengthy stays in the hospital alongside increased pain and medical costs, healthcare professionals, especially nurses, should take a keen look to ensure that catheters are timely removed. However, when left for long hours without removal, the patient risks developing CAUTI. Nurses should also ensure that the Foley catheters are only used when necessary. This project proposal presents Houdini’s protocol as a guide to the timely removal of catheters by the nurses. This way, Patients in the ICU reduce their vulnerability to developing CAUTI. Houdini’s protocol is straightforward to implement and thus suitable for this intervention.
Comparing Research Questions
As a guide to the project, a PICOT question was formulated as follows; among elderly patients in intensive care units, does early removal of urinary catheters using the Houdini’s protocol, compared to late removal, reduce CAUTI in six months? While reviewing the available literature, the studies focused on different aspects of CAUTI. A comparison of their research questions is discussed here. The first study was a cross-sectional study covering six hospitals by Letica-Kriegel et al. (2019). The study wanted to identify the risk factors associated with CAUTI. Its research question was to answer how the risk factors for CAUTI change over time. The second study by Ling et al. (2022) was titled budget impact analysis of a multifaceted nurse-led intervention to reduce indwelling urinary catheter use. Its research question was; what is the budget projection for using urinary catheters and everyday care strategies on patients? Another article reviewed was a 2021 meta-analysis by Shen et al., which inquired about the accuracy of diagnosing CAUTI using electronic surveillance tools in tertiary hospitals. This study’s research question asked about the accuracy level when using electronic surveillance tools in diagnosing CAUTI. One more literature review was a qualitative review by Gad et al. (2021). This searched on the adoption of preventive protocols for CAUTI by adult patients. Their research question was about the relationship between UTIs and catheterization and how to manage the two.
Comparing Sample Populations
All the literature materials reviewed used different sample populations to fit their inquiry. A qualitative review by Gad et al. 2021 reviewed 59 studies for a sample population. The study aimed to provide a detailed overview of the relationship between UTIs and urinary catheterization and to suggest preventive measures. Letica-Kriegel et al. 2019 used a sample size of 47 926 patients. The study’s focus was on the risk factors of CAUTI. Another study used 8785 individuals both with and without CAUTI. Its objective was to identify the aspects that expose hospitalized patients to developing CAUTI. One more article considered for this review used an anonymous number of studies. This was a literature review by Shen et al.2021 about the accuracy of electronic surveillance tools in diagnosing CAUTI.
A Comparison of the Limitations of the Studies Reviewed
The study by Zilberberg et al. (2022) was limited because its case study depends on administrative coding that could easily lead to miscalculations. The study by Ling et al., 2022 was limited to using only four hospitals that could not produce a representative sample population. The study by Shen et al. 2021 was limited in providing the extent to which the electronic surveillance tool for diagnosing CAUTI has been used. The study by Gad et al. was equally limited in focusing on CAUTI among the adult population, neglecting those at a younger age.
Conclusion and Recommendations
In the research done by Al-Qahtani et al. 2019, it was found that by coating the exteriors of the UCs with antifouling chemicals, we may prevent bacteria from colonizing them in dense mats developing into harmful biofilms. When coming up with new types of UCs or improving existing ones, the patient’s comfort and welfare should be prioritized above other issues like cost and medicine resistance problems. It recommended that alternative strategies for addressing these problems should be included in plans. Compared to the other research done by Li et al. (2019), the findings were that Catheter-associated urinary tract infections are more common in female patients, those whose catheterizations last longer, those with diabetes, those who have been catheterized before, and those who spend more time in the hospital or critical care unit. Catheter-associated UTIs have been linked to an increase in mortality rates. The research recommended additional research to investigate the microbiological isolates and focus on care strategies for catheter-associated urinary tract infections to reduce their incidence and mortality.
Elsewhere is a different study conducted by Evans et al. 2022, which was about infections contracted in hospitals and nursing homes cared for veterans during the 2019 Coronavirus Disease (COVID-19). Its findings were that there was an increase in one kind of HAI while another decreased during the COVID-19 pandemic in VA acute care. The drop in CDI HAIs might be attributable to better diagnosis. Pandemic. It further recommended that conventional infection prevention and control measures be created, preserved, and implemented before and during a pandemic. The meta-analysis done by Shen et al. 2021 found that electronic diagnostic monitoring is a valuable technique for reducing CAUTIs in hospitalized patients due to its high sensitivity and specificity. It is recommended that tertiary care facilities may benefit from using electronic surveillance to screen for CAUTI patients as a monitoring strategy because of its efficiency and low cost.
References
Al-Qahtani, M., Safan, A., Jassim, G., & Abadla, S. (2019). Efficacy of anti-microbial catheters in preventing catheter-associated urinary tract infections in hospitalized patients: A review on recent updates. Journal of Infection and Public Health, 12(6), 760-766. https://doi.org/10.1016/j.jiph.2019.09.009
Evans, M. E., Simbartl, L. A., Kralovic, S. M., Clifton, M., DeRoos, K., McCauley, B. P., Gauldin, N., Flarida, L. K., Gamage, S. D., Jones, M. M., & Roselle, G. A. (2022). Healthcare-associated infections in veterans’ acute and long-term healthcare facilities during the Coronavirus Disease 2019 (COVID-19) Pandemic. Infection Control and Hospital Epidemiology, 1–24. https://doi.org/10.1017/ice.2022.93
Gad, M. H., & AbdelAziz, H. H. (2021). Catheter-associated urinary tract infections in the adult patient group: A qualitative systematic review on the adopted preventative and interventional protocols from the literature. Cureus, 13(7), e16284. https://doi.org/10.7759/cureus.16284
Letica-Kriegel, A. S., Salmasian, H., Vawdrey, D. K., Youngerman, B. E., Green, R. A., Furuya, E. Y., … & Perotte, R. (2019). Identifying the risk factors for catheter-associated urinary tract infections: A large cross-sectional study of six hospitals. BMJ Open, 9(2), e022137. http://dx.doi.org/10.1136/bmjopen-2018-022137
Li, F., Song, M., Xu, L., Deng, B., Zhu, S., & Li, X. (2019). Risk factors for catheter‐associated urinary tract infection among hospitalized patients: A systematic review and meta‐analysis of observational studies. Journal of Advanced Nursing, 75(3), 517-527. https://doi.org/10.1111/jan.13863
Ling, R., Giles, M., & Searles, A. (2022). Budget impact analysis of a multifaceted nurse-led intervention to reduce indwelling urinary catheter use in New South Wales Hospitals. BMC Health Services Research, 22(1), 1000. https://doi.org/10.1186/s12913-022-08313-7
Shen, Y., & Cui, H. (2021). Diagnostic accuracy of electronic surveillance tool for catheter-associated urinary tract infections in tertiary care hospitals: A meta-analysis. Medicine, 100(39), e27363. https://doi.org/10.1097/MD.0000000000027363
Zilberberg, M. D., Nathanson, B. H., Sulham, K., & Shorr, A. F. (2022). Descriptive epidemiology and outcomes of hospitalizations with complicated urinary tract infections in the United States, 2018. Open Forum Infectious Diseases, 9(1), ofab591. https://doi.org/10.1093/ofid/ofab591
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