Several types of research have been carried out on the prevalence of catheter-associated urinary tract infections (CAUTIs) in hospitals. The researches review the impact of CAUTIs and nursing-driven indwelling catheter protocol in terms of reducing CAUTIs. Through quantitative evaluation, the researches in the five articles involved reviewing the CAUTI prevention strategies that hospitals adopt and why they are more effective in some hospitals more than others. The highest effectiveness score was noticed in hospitals which a proactive implementation process. Therefore, hospitals with high levels of success in CAUTI prevention tend to have clear road maps, comprehensive teamwork, and strategic nursing role allocation. It is apparent that “CAUTI prevention is heavily reliant upon adaptive interventions such as behavior change. CAUTI is thus quite representative of patient safety problems such as falls or pressure ulcers” (Saint et al. 2014, p. 549).
As part of the socio-adaptive change in the prevention of CAUTI, the authors are categorical in insisting that all the preventive strategies must integrate the health care workers. This is achievable through a continuous engagement process comprising of defining the scope of care to the stakeholders, engaging the support of essential groups, ensuring that the collaborative nature is streamlined, and pinpointing the leadership of the prevention process (Krein and Saint, 2014).
The authors established that the open engagement of the relevant agencies in CAUTI prevention is not only achievable but also sustainable. From research spanning more than two years, the authors noted that proper prevention of infection is both possible and within the reach of health care workers who have the necessary skills and goodwill from the hospitals. Therefore, through a proactive protocol implementation, it is possible to manage the CAUTI rate, duration, number, and costs involved in the prevention. Besides the quality improvement protocol, factors identified in the articles as equally important in CAUTI prevention include nurses’ education, continuous assessment of the feedback, and revue of the scope of shareholder involvement. These factors ensure that the protocol attracts full commitment from the health care workers who are the agent of their implementation (Parry, Grant, & Sestovic, 2013).
In the five articles, the authors identified the technical elements of proactively addressing behavioral and socio-adaptive factors that must be incorporated in CAUTI prevention to make it successful. For instance, through qualitative research, the authors noted that observing the quality improvement protocol is significant in reduce CAUTI, irrespective of the health care environment. In fact, “feedback between the nurses and the project team fostered communication, collaboration, and improved protocol compliance” (Alexaitis & Broome, 2014, p. 253). Through reduced use of catheters, the authors concur that it is possible to reduce the CAUTI infection rates by aggressively implementing the “nurse-directed catheter removal protocol” (Parry et al. 2013, p.1185).
Since the purpose of this proposed study is to evaluate the effectiveness of the nurse-driven indwelling catheter protocol in decreasing hospital-acquired UTIs, the above literature offers empirical evidence on which the scope of the study will be based. Especially, this literature review captures factors that directly and indirectly affect nursing-based protocol for CAUTI prevention. The main factors identified include quality improvement, health care workers’ involvement, reduction of catheter use, and maximum commitment through training. Therefore, the proposed research will be based on these concepts in addressing the prevention of hospital-acquired UTIs, which the researchers do not cover.
Critique of the five sources
For instance, in the research carried by Saint, Gaies, Fowler, Harrod, and Krein (2014), the authors noted that “nearly 2 million Americans develop a healthcare-associated infection each year. Catheter-associated urinary tract infection accounts for about one-third of all healthcare-associated infections” (Saint, Gaies, Fowler, Harrod, and Krein, 2014, p. 548). As established by Fakir, Krein, Edson, Watson, Battles, and Sanjay (2014), the best strategy for preventing catheter-associated urinary tract infection lies in the proactive engagement of health care workers. The authors noted that several efforts have been directed by different health agencies to reduce devise use. For instance, the authors noted that the efforts of CDC and HICPAC have resulted in the creation of several guidelines for preventing CAUTI through the involvement of the healthcare personnel. The main indications suggested by the agencies are;
“(1) acute urinary retention or bladder outlet obstruction, (2) accurate measurements of urinary output in critically ill patients, (3) preoperative use for selected surgical procedures, (4) to assist in the healing of open sacral or perineal wounds in incontinent patients, (5) prolonged immobilization requirement, and (6) improved comfort for end-of-life care” (Fakir et al. 2014, p. 224).
Through qualitative research, Fakir, Krein, Edson, Watson, Battles, and Sanjay (2014) noted that the involvement of an ideal CAUTI prevention group might reduce infections by more than 40% in a very short time. However, the authors are categorical that the strategy to involve different health care workers must be sustainable. Therefore, “sustainability is achieved if the improvements are maintained or augmented after implementation; for CAUTI prevention, the improvements are reflected in an increase in appropriate catheter use and a reduction in CAUTI events” (Fakir et al. 2014, p. 226). When successfully implemented, the authors concluded that engaging the health care workers will be critical in sustaining all the prevention programs, “thereby providing the ability to implement changes that will enhance patient safety” (Fakir et al. 2014, p. 228).
Among the notable factors identified by Krein and Saint (2014) in CAUTI prevention are “having a passionate champion, the critical role of leadership, the lack of healthcare worker engagement, and perceptions of risk. These factors underscore the importance of understanding the socio-adaptive elements of preventing CAUTI, with a specific focus on ‘people’ and behavior” (Krein and Saint 2014, p. 2). Krein and Saint (2014) concluded that “this undertaking, which like marriage ‘takes perseverance and determination’, is essential for ensuring healthier and safer patients both in the US and worldwide” (Krein and Saint, 2014, p. 2).
According to Alexaitis and Broome (2014), the element of quality improvement is critical in the reduction of CAUTI. The authors noted that despite the fact that “CAUTIs are one of the most preventable hospital-acquired infections in the United States yet remain the most prevalent hospital-acquired infection in acute care hospitals” (Alexaitis and Broome, 2014, p. 250). In fact, Alexaitis and Broome (2014) observed that “the nurse-driven protocol for urinary catheter management was successful in improving 3 of 5 patient outcome goals” (Alexaitis & Broome, 2014, p. 250).
According to Parry, Grant, and Sestovic (2013), significant CAUTI reduction is possible through reducing the use of urinary catheters. Through an intervention study, the authors established that “urinary catheter use, and ultimately CAUTI rates, can be effectively reduced by the diligent application of relatively few evidence-based interventions” (Parry et al. 2013, p.1183).
Alexaitis, I., & Broome, B. (2014). Implementation of a Nurse-Driven Protocol to Prevent Catheter-Associated Urinary Tract Infections. Journal of Nursing Care Quality, 29(3), 245-252.
Fakih, M., Krein, S., Edson, B., Watson, S., Battles, J., & Saint, S. (2014). Engaging health care workers to prevent catheter-associated urinary tract infection and avert patient harm. American Journal of Infection Control, 42(1), 223-229.
Krein, S., & Saint, S. (2014). Preventing catheter-associated urinary tract infection: a happy marriage between implementation and healthier patients. Healthcare Infection, 19(2), 1-3.
Parry, M., Grant, B., & Sestovic, M. (2013). Successful reduction in catheter-associated urinary tract infections: Focus on nurse-directed catheter removal. American Journal of Infection Control, 41(1), 1178-1180.
Saint, S., Gaies, E., Fowler, K. Harrod, M., & Krein, S. (2014). Introducing a catheter- associated urinary tract infection (CAUTI) prevention guide to patient safety (GPS). American Journal of Infection Control, 42(1), 548-550.