Nurse-Driven Catheter-Associated Urinary Tract Infection Reduction Process and Protocol

Abstract

Translating evidence-based practices to the bedside can be facilitated by an active academic-practice partnership between nursing faculty and frontline nursing staff. A collaborative effort between the university's academic nurses and the medical center's clinical nurses explored, created, implemented, and evaluated an evidence-based nurse-driven protocol for decreasing the rate of catheter-associated urinary tract infections. The nurse-driven protocol was piloted in 4 intensive care units and included nurse-driven orders for catheter discontinuation, utilization of smaller bore urinary catheters, addition of silver-based cleansing products for urinary catheter care, and education of staff on routine catheter care and maintenance. Data were collected for more than 8 months pre- and postimplementation of the nurse-driven protocol. Postimplementation data revealed a 28% reduction in catheter-associated urinary tract infections in the intensive care units as compared with preimplementation. Secondary benefits of this academic-practice partnership included strengthening the legitimacy of classroom content as lessons learned were integrated into courses in the nursing curriculum. The result of the partnership was a stronger sense of collaboration and collegiality between hospital staff and the university faculty. Transformative leadership engaged numerous stakeholders through collaborative efforts to realize best practices. An academic-practice partnership facilitates transformative change and provides structural stability and sustainability.

Evidence for a nurse-led protocol for removing urinary catheters: A scoping review

“…A PRISMA flowchart ( McGowan et al, 2020 ) was used to report the study retrieval and selection as displayed in Figure 1 . Thirteen studies met the criteria ( Adams, Bucior, Day, & Rimmer, 2012 ;Dumigan et al, 1998 ;Elpern et al, 2009 ;Johnson, Gilman, Lintner, & Buckner, 2016 ;Major-Joynes, Pegues, & Bradway, 2016 ;Mori, 2014 ;Parry, Grant, & Sestovic, 2013 ;Russell, Leming-Lee, & Watters, 2019 ;Topal et al, 2005 ;Tyson et al, 2020 ;Underwood, 2015 ;Wenger, 2010 ;Yatim et al, 2016 ) for inclusion in this scoping review ( Fig. 1 ) and are described in the data extraction table ( Table 1 ).…”

“…Articles varied in study design: one point prevalence study ( Adams et al, 2012 ); one prospective cohort study ( Dumigan et al, 1998 ); seven observational pre and post intervention studies ( Elpern et al, 2009 ;Johnson et al, 2016 ;Major-Joynes et al, 2016 ;Parry et al, 2013 ;Topal et al, 2005 ;Underwood, 2015 ;Yatim et al, 2016 ); three retrospective studies ( Mori, 2014 ;Tyson et al, 2020 ;Wenger, 2010 ) and one quality improvement project ( Russell et al, 2019 ). No randomised controlled trials were identified.…”

“…JID: COLEGN [m5G;September 11, 2022;11:1 ] eas of a single hospital ( Mori, 2014 ;Parry et al, 2013 ), five studies were conducted exclusively in intensive care units ( Dumigan et al, 1998 ;Elpern et al, 2009 ;Johnson et al, 2016 ;Tyson et al, 2020 ;Underwood, 2015 ), and the remainder were conducted in a combination of medical, surgical or intensive care units ( Adams et al, 2012 ;Russell et al, 2019 ;Topal et al, 2005 ;Wenger, 2010 ;Yatim et al, 2016 ). There were considerable differences in study duration ranging from 6 weeks ( Russell et al, 2019 ) to 3 years ( Parry et al, 2013 ).…”

Optimising Interventions for Catheter-Associated Urinary Tract Infections (CAUTI) in Primary, Secondary and Care Home Settings

“…We identified 37 relevant studies which met the inclusion criteria ( Figure S1 ) [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ]. Thirty-five studies were conducted in secondary care (hospital care).…”

Maintenance of Health Documentation as a Part of the Prevention of Urinary Tract Infections Related to Urinary Bladder Catheterisation

“…Jedním z rizikových faktorů vzniku CAUTI je prolongovaná katetrizace, která většinou souvisí s absencí přehodnocování nutnosti katetrizace (Jindrák et al, 2014). Ve studiích uvedených již v úvodu diskuze (Fuchs et al, 2011;Oman et al, 2012;Andreessen et al, 2012;Carter et al, 2014;Purvis et al, 2014;Alexantis a Broome, 2014;Underwood, 2015;Quinn, 2015;Yatim et al, 2016;McCoy et al, 2017;Johnson et al, 2016;Kim et al, 2017;Zurmehly, 2018) (2019) byly při rozhovorech identifikovány dlouhodobé překážky při přehodnocování indikace ke katetrizaci a odstraňování katetrů bez relevantní indikace. Problémy byly zejména v nepřehlednosti a nedostupnosti dokumentace (chyběla IT technika/tablety), nebyly k dispozici jednotné a jasné záznamy, nebyly jasně stanoveny kompetence zdravotníků v případě přehodnocování katetrizace, odstranění katetru nebylo stanoveno jako priorita a mezi zdravotníky byly identifikovány komunikační bariéry (Quinn et al, 2019).…”