Even though catheter-associated urinary tract infections (CAUTIs) are preventable, they remain one of the leading causes of the increase in patient morbidity. According to Richards et al. (2017), “more than 560,000 CAUTIs occur annually, resulting in approximately 13000 deaths and $131 million a year in excess health care costs” (p. 42). The researchers also note that CAUTIs are especially prevalent in intensive care units (Richards, 2017). This report is going to discuss the intervention approach implemented by Richards et al. (2017) in an 18-bed neurological intensive care unit. The study describes the success of the nursing strategies in reducing the number of CAUTIs.
In terms of an evidence-based intervention incorporated by the unit, it implied a multidisciplinary approach to nursing practice. Firstly, charge nurses (assisted by the CAUTI arrest team) conducted chart audits on a daily basis. Physicians on duty then examined the findings in order to determine whether some catheters could be discontinued. In addition, chart audits helped the medical staff to “check for documentation of perineal and catheter care and for records of daily assessments by staff nurses of continued need for catheters” (Richards et al., 2017, p. 45). Secondly, the electronic order system was upgraded to include an auto-stop feature that ensured urinary catheters were discontinued automatically after three days in place. The unit also focused on utilization of electronic records “for current physician orders, appropriate indications for indwelling urinary catheters, and duration of catheterization” (Richards et al., 2017, p. 45). The integration of technology was a crucial part of the infection prevention initiatives implemented by Richards et al. Other studies such as the one by Rea et al. (2018) emphasize the importance of technological interventions for nurses engaged in preventing CAUTIs. Technology innovations are integral to nursing quality improvement and disease prevention.
The evidence-based intervention described in the study also implied that every incidence of a catheter-associated urinary infection was followed by the root-cause analysis. This allowed the unit to uncover that some of the containers for urinalysis samples might have been contaminated since they were stored uncapped in the supply room (Richards et al., 2017). Therefore, it is apparent that the strategies applied by Richards et al. (2017) were both effective in decreasing the number of CAUTIs and flexible enough to make changes, which were necessary during the intervention.
As for the technicalities of the nursing intervention implemented by Richards and his colleagues, it is important to acknowledge that their approach included a bundle of various strategies. The aforementioned CAUTI arrest team “designed a 3-pronged approach to help staff members make the difficult shift in practice: evidence-based interventions, educational interventions, and supportive interventions” (Richards et al., 2017, p. 44). Educational interventions consisted of staff huddles, where members of the CAUTI team discussed results from chart reviews and explained the best practices to avoid unnecessary catheterizations and properly maintain catheters. Additionally, clinical nurse specialists and members of the nursing education department educated staff nurses on catheter insertion and care.
Supportive interventions included weekly room audits and additional guidance from unit leaders regarding the management of urinary incontinence. Richards et al. (2017) indicate that the intensive care unit provided positive reinforcement to the nurses compliant with the hospital interventions for CAUTIs prevention by rewarding them with gift cards. Thus, it is crucial to understand that the success of the interventions described by Richards et al. can be attributed to the culture change in the unit, which resulted in a more open cooperation between attending physicians and charge nurses.
Rea, K., Le-Jenkins, U., & Rutledge, C. (2018). A technology intervention for nurses engaged in preventing catheter-associated urinary tract infections. CIN: Computers, Informatics, Nursing, 36(6), 305–313. Web.
Richards, B., Sebastian, B., Sullivan, H., Reyes, R., D’Agostino, J. F., & Hagerty, T. (2017). Decreasing catheter-associated urinary tract infections in the neurological intensive care unit: One unit’s success. Critical Care Nurse, 37(3), 42–48. Web.