The Clinical Issue
The hospital has been experiencing higher cases of Catheter-Associated Urinary Tract Infection (CAUTI). A urinary tube called a catheter that has been implanted to drain urine from the bladder is responsible for causing a urinary tract infection called Catheter-Associated Urinary Tract Infection. According to the internal hospital reports, approximately one person for every ten patients in the hospital wards or discharged from the hospital develop a Catheter-Associated UTI. The disorder has persisted in the hospital despite the fact that there have been guidelines for the past ten years to address the preventative measures and care of patients with an indwelling catheter. To mitigate the issue, one of the major, evidence-based comprehensive changes in the revised guidelines would be to reduce the initiation and duration of urinary catheters or use them under rigid compliance to aseptic technique and Florence Nightingale’s Environmental theory.
Background Evidence of Hospital-Acquired Infection; Catheter-Associated Urinary Tract Infection (CAUTI)
Hospital-acquired infection is a disorder obtained in a healthcare facility by a patient admitted for a cause other than that disorder. In other words, a hospital-acquired infection is one that develops in a patient while they are receiving care at a hospital or another healthcare facility and was not prevalent or active at the hospitalization. This kind of infection is also referred to as nosocomial infection. With an incidence of almost 35 percent, the condition is the most prevalent hospital UTI worldwide and one of the major causes of illness and death among admitted patients using indwelling catheters (McHugh, 2020). Since more than 150 million people each year contract the disease, the annual cost exceeds $6 billion.
According to CDC (2019), urinary catheters—a tube inserted into the bladder through the urethra to drain urine—are responsible for 75% of UTIs contracted in hospitals in the United States. Additionally, between 15 and 25 percent of inpatients get urinary catheters throughout their stay. The patients’ propensity to develop a catheter-associated UTI is increased by the frequent and prolonged use of the urinary catheter.
Concepts Related to Hospital-Acquired Infection; Catheter-Associated Urinary Tract Infection (CAUTI)
Urinary catheter use is a well-known risk factor for urinary infection. Poor hygiene practice is the major factor contributing to the increased disorder cases concerning the handling, placement, and maintenance of the patients and hospitals equipment. In addition, there are other factors that contribute to the high incidences of acquired CAUTI infections, including inadequate surveillance of hospital-acquired infections, disregard for patient safety, and subpar medical care. In many cases of patients diagnosed with CAUTI, the duration of cauterization has been established to be longer than 28 days indicating that the longer a catheter remains in situ, the higher the chances that the process would result in urinary tract infection. According to CDC (2019), the probability of acquiring catheter-associated infection is 5 percent for every day the catheter remains in the urethra of the patient from day five. After four weeks with the urethral catheter in place, this increases to 100%.
The incidence is primarily higher in elderly individuals associated with declined immunity. The most common agent implicated in asymptomatic and symptomatic bacteriuria is Escherichia coli which is responsible for over 50% of hospital infections. Other microorganisms associated with UTI are Klebsiella pneumonia, Pseudomonas aeruginosa, Staphylococcus spp, and Proteus spp. Other causative agents of hospital-acquired infection, such as Catheter-associated UTIs, include fungi, viruses, and helminth.
Moreover, regardless of the cause or type of hospital-acquired infection can have several consequences, but the catheter-associated UTI is associated with a longer hospital stay. People who develop CAUTI require longer hospital stays. The longer stays in the hospital put the individuals at even higher chances of developing more complications. Moreover, the disorder is associated with increased costs as prolonged hospital stays mean more treatment and more costs. According to Wong et al. (2018), approximately ten billion dollars are used to treat hospital-acquired infections yearly. The disorder is also linked to income loss because a prolonged hospital stay brought on by CAUTI lengthens the patient’s recovery period and prevents them from getting back to work, which results in income loss. In some cases, the hospital-acquired infection can be fatal as approximately 99,000 individuals in the United States die annually from hospital-acquired infections such as CAUTI.
In order to address Catheter-Associated Urinary Tract Infection, one of the most significant examples of hospital-acquired infections, the chosen nursing theory is Florence Nightingale’s “Environmental theory.” This is because the Environmental Theory calls for the nurse to take the initiative to set up the patient’s environment in a way that will gradually restore their health and because an internal hospital assessment determined that environmental factors like cleanliness were the main factors for the development of the hospital’s acquired infection. Generally, the Environmental Theory emphasizes changing the patient’s surroundings to promote health. The theory integrates numerous environmental factors that are described in Nightingale’s 13 major canons, which include “Ventilation and warming, Light, Cleanliness of rooms and walls, Health of houses, Noise, Bed and bedding, Personal cleanliness, Variety, chattering hopes and pieces of advice, Taking food, What food, Petty management and Observation of the sick” (Gilbert, 2020). As a result, the proposed health intervention for controlling the increased cases of Catheter-Associated Urinary Tract Infection is based on: reduction of unnecessary catheter use, length of catheter use, improving insertion technique, and changing the patient’s surrounding and personal factors that are linked to cleanliness as proposed by Florence Nightingale’s “Environmental theory.” In addition to adhering to the aseptic techniques of handling catheter.
Literature Evidence of the Intervention
The hospital is ought to implement numerous interventions to eradicate the increased cases of CAUTI and other forms of hospital-acquired infections among the patients. The intervention strategies included not using urine drain tubes unnecessarily, inserting them correctly, and keeping them clean if they must be used. The healthcare providers were advised to put on catheters when necessary and remove them as soon as possible to avoid a prolonged duration in which the catheters stay inside the patient’s body, increasing the probability of infection. In an acute care setting, healthcare practitioners are advised to insert catheters using an aseptic technique and sterile equipment. The process ensures a properly maintained closed drainage system that ensures no sucking back of urine and no obstructed urine flow into the drainage bag. Additionally, the hospital put different environmental cleaning management measures in place, including using disposable wipes in various colors to clean high contamination areas, patient bedside areas, common areas, and documentation areas.
Implementation of The New Practice by Nurses in The Hospital
In order to implement the laid down intervention strategies for eradicating hospital-associated infection and precisely CAUTI, the healthcare practitioners will be subjected to a rigorous training session through lectures, videos, posters, and high-fidelity simulations. The training will involve educating the nurses on the aseptic technique as an evidence-based technique for inserting an indwelling urinary catheter. Moreover, nurses will be reminded of the major categories and frequencies of major sterility breaks during catheter insertion. This is because often, nurses touch items on a sterile field with bare hands, non-sterile hands, or the stethoscope, garment, or torso touches the catheter, which increases the chances of its contamination (McHugh, 2020). Moreover, the patient’s catheter tip might touch the patient’s genitalia before being introduced into the urethra or labia close over the catheter during insertion, and nurses do not get a new one which has been established as one of major neglected safety rules.
Furthermore, the nurses will be shown the importance of hospital environmental hygiene, patient and nurse hygiene, and sanitation. It involves reminding the nurses the need to use approved disinfectants to keep the hospital clean and free from agents of hospital-acquired infections. They should also ensure the patient’s bed and bedside are cleaned and disinfected before admitting a new patient and adhering to all the Nightingale’s Environmental Theory cannons. On patient cleanliness, the patients should be guided by the nurses to ensure they maintain high cleanliness levels such as bathing, hand hygiene, and proper use toiletries (Roshan et al., 2020). On the other hand, the nurses should also maintain high levels of hygiene and sanitation. It is by wearing gloves and surgical masks when handling the patients within the hospital and practicing the right-hand washing approaches before and after interacting with a patient or touching the hospital surroundings to avoid the spread of agents associated with hospital-acquired infections.
Evaluation of The New Practice
The evaluation of currently implemented intervention approaches for eradicating CAUTI, a hospital-acquired infection that entails maintaining the hospital, patient, and healthcare practitioner hygiene and sanitation would include monitoring the process and measuring the outcome. The monitoring process will entail inspecting the hospital’s environment, including the bedside areas, surfaces, medical equipment and objects, medical waste, and patient and nurse cleanliness. It is in addition to compliance with the hospital’s hygiene and sanitation protocols and procedures by the trained monitoring consultants. Moreover, the evaluation will also assess the use of the aseptic technique as an evidence-based technique for inserting an indwelling urinary catheter to prevent catheter contamination resulting in CAUTI among hospitalized patients in intensive care units. On the other hand, measurement of the intervention outcomes will involve determining the number of patients diagnosed with Catheter-Associated Urinary Tract Infection and using a luminometer to determine the number of agents of hospital-acquired infection on the surfaces within the hospital.
One of the most typical infections a patient can get in a hospital is CAUTI, or catheter-associated urinary tract infection. Following prolonged or superfluous use of urinary catheters, a disruption in the closed drainage system, or both, this infection is most likely brought on by bacteria entering the body during catheter insertion. However, CAUTI, like many HAIs, can be avoided. The risk of CAUTI in the hospital is reduced by preventive measures such as using standardized indications for catheter use, which will help avoid catheters when unnecessary, and by adhering to the recommended procedures for catheter insertion and management. Another method of preventing CAUTI is adhering to Florence Nightingale’s Environmental Theory’s recommendations that ensure hospital, patient, and nurse hygiene and cleanliness. The expected result is that the intervention will eradicate environmental risk factors for HAIs and subsequently prevent CAUTI cases in the hospital.
CDC. (2019). Background. Center for Disease Control and Prevention. https://www.cdc.gov/infectioncontrol/guidelines/cauti/background.html
Gilbert, H. A. (2020). Florence Nightingale’s Environmental Theory and its influence on contemporary infection control. Collegian, 27(6), 626-633.
McHugh, J. (2020). Evidence-based strategies for successful catheter-associated urinary tract infection reduction hospital-wide: Nurse-driven protocol.
Roshan, R., Feroz, A. S., Rafique, Z., & Virani, N. (2020). Rigorous Hand Hygiene Practices Among Health Care Workers Reduce Hospital-Associated Infections During the COVID-19 Pandemic. Journal of primary care & community health, 11, 2150132720943331. https://doi.org/10.1177/2150132720943331
Wong, S. S., Huang, C. H., Yang, C. C., Hsieh, Y. P., Kuo, C. N., Chen, Y. R., & Chen, L. C. (2018). Reducing healthcare-associated infections by implementing separated environmental cleaning management measures using disposable four-color wipes. Antimicrobial resistance and infection control, 7, 34. https://doi.org/10.1186/s13756-018-0320-6