American Journal of Infection Control Assignment

In nursing practice, there are quite a number of challenges related to quality of care that nurses often have to deal with. The challenges are related to the quality of care that the nurses deliver and are often used as a measure of the same. As a result, a number of performance measures or outcome measures associated with these issues form the basis of gauging the level of evidence-based practice (EBP) and quality of care. These include the length of hospital stay, the rate of development of hospital-associated infections (HAIs), and hospital readmission amongst others. The HAIs in this case include ventilator-associated pneumonia (VAP), catheter-associated urinary tract infections (CAUTI), and central line-associated blood stream infections (CLABSI) amongst others. The purpose of this paper is to look at the clinical practice problem of CAUTI in acute care settings and how it can be prevented to improve care quality by nurses. American Journal of Infection Control Assignment

Overview of the Problem and the Setting

The setting for this problem of CAUTI is critical care units, otherwise referred to as intensive care units or ICUs (Tuttle, 2017; Witwer et al., 2019). The reason for this is that almost all critically ill patients are invariably fixed with an indwelling Foley’s catheter since they are bedridden. Other reasons for this include that critically ill patients must have their input and output fluid volumes recorded strictly and correctly. The problem therefore arises when the nurses in the ICU cannot consistently and properly care for the catheters following infection prevention protocols. Reasons for this include nurse shortages, lack of leadership/ supervision, lax institutional policies and so on. According to Tuttle (2017), apart from causing mortality figures to increase CAUTI raises the cost of hospitalization by up to $500 million per year. American Journal of Infection Control Assignment

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Need for a Quality Improvement (QI) Initiative

The main reason why a QI initiative is needed in this problem of CAUTI is that it causes poor patient outcomes. As has been stated above, the patient stays longer in the ICU as a result of CAUTI. Also, chances of complications such as sepsis occurring due to the CAUTI are high and this may lead to preventable mortality. The fact that hospitalization days increase due to the CAUTI means that the hospitalization costs will definitely go up for the patient (Davies et al., 2018; Pashnik et al., 2017). The expected outcome of the QI initiative to be instituted is that the rate of CAUTI is reduced substantially to levels that are not statistically significant.

Previous Research Evidence Supporting the QI Initiative

There is sufficient evidence from previous studies that support the implementation of a bladder care bundle by nurses in critical care to reduce CAUTI. Five of these studies can be mentioned here and they are those by Davies et al. (2018), Mody et al. (2017), Pashnik et al. (2017), Prakash et al. (2017), and Ravi and Joshi (2019). The results from these studies unanimously indicate that the proper use and implementation of a nurse-led bladder care bundle in the ICU and other settings will result in a reduction of CAUTI cases. Some of the effective individual elements that form the CAUTI bundle as studied in these previous research efforts are:

• Nurse education and training on effective CAUTI prevention.
• Use of the aseptic technique and sterile instruments in catheter insertion.
• Correct catheter maintenance including daily periurethral care using antiseptics like chlorhexidine.
• Regular emptying of the drainage bag for urine.
• Daily monitoring and immediate removal if signs of infection are noted. American Journal of Infection Control Assignment

The previous research efforts therefore demonstrate support for the QI initiative suggested here (a nurse-led bladder care bundle) in that they showed the effectiveness of these bundles.

Steps Necessary for Implementing the QI Initiative

The steps necessary for the implementation of the above QI initiative are education and training (dissemination), implementation in practice, and evaluation of outcomes. These steps will follow each other and the evidence and rationale for this comes from the change model that will need to be used to implement the change. This change model is the Rogers’ Diffusion of Innovations model (Dearing & Cox, 2018). According to this model, there are five important steps that the change process must go through for it to be implemented successfully. These include knowledge (education and training), persuasion, decision-making, implementation, and confirmation.

Education and Training

This step mirrors the knowledge and persuasion stages in the Rogers’ DOI model of change. This means that the nurses who are the ones that will carry out the bladder care bundle will be given more education and training on prevention and detection of CAUTI. It is at this stage that dissemination of the recommended evidence-based practice measures for CAUTI prevention will be delivered. The nurses will also be taught how to assess risk of CAUTI and take appropriate preventive action. American Journal of Infection Control Assignment

Implementation

This is the next step and it involves the actual application of the bundle measures on a daily basis to see if the CAUTI rates will go down. For instance, the nurses in critical care will after the education and training insert catheters aseptically, monitor for infection, do periurethral care daily, and regularly empty the urine collection bag amongst other measures. This step corresponds to the decision and implementation stages of the Rogers’ DOI model of change.

Evaluation

The evaluation step involves analyzing CAUTI data including the rate within the period of implementation of the change in practice to determine effectiveness. If found that the CAUTI rates dropped in response to the application of the CAUTI care bundle, the change will be made permanent (confirmed) and made part of the standard operating procedures of the institution. In other words, the use of the bladder bundle will become part of evidence-based clinical practice going forward. This step corresponds to the confirmation stage of the Rogers’ DOI model.

Evaluation of the QI Initiative

The QI initiative as has been seen above will involve the application of a nurse-led bladder care bundle with several components. Some of these components have been listed above. After implementation, the best way to evaluate for effectiveness will be to look at the only one outcome measure that is reflective. That is the rate of CAUTI since the start of the implementation of the initiative. The variables to be looked at will be the care bundle application as the independent variable (IV) and the resulting CAUTI rate as the dependent variable (DV). To prove effectiveness, hypothesis and statistical testing will make use of a nonparametric inferential statistical test such as the Chi-square test of significance. American Journal of Infection Control Assignment

Conclusion

Clinical practice problems in nursing practice are common. They often have a bearing on the quality of nursing care that is delivered by nurses. For this reason, they usually form the basis for various quality improvement initiatives. This paper has looked at the practice problem of CAUTI in critical care settings. By presenting scholarly evidence from current literature, it has been demonstrated that application of a nurse-led CAUTI prevention bundle is the best change initiative for quality improvement. The multifactorial bundle is effective in reducing the rate of CAUTI in critical care units and other settings where indwelling catheters are used regularly.  American Journal of Infection Control Assignment

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References

Davies, P.E., Daley, M.J., Hecht, J., Hobbs, A., Burger, C., Watkins, L.… & Brown, C.V.R. (2018). Effectiveness of a bundled approach to reduce urinary catheters and infection rates in trauma patients. American Journal of Infection Control, 46(7), 758–763. https://doi.org/10.1016/j.ajic.2017.11.032

Dearing, J.W. & Cox, J.G. (2018). Diffusion of innovations theory, principles, and practice. Health Affairs, 37(2), 183-190. http://dx.doi.org/10.1377/hlthaff.2017.1104

Mody, L., Greene, M.T., Meddings, J., Krein, S.L., McNamara, S.E., Trautner, B.W.… & Saint, S. (2017). A national implementation project to prevent catheter-associated urinary tract infection in nursing home residents. JAMA Internal Medicine, 177(8), 1154. https://doi.org/10.1001/jamainternmed.2017.1689

Pashnik, B., Creta, A., & Alberti, L. (2017). Effectiveness of a nurse-led initiative, peer-to-peer teaching, on organizational CAUTI rates and related costs. Journal of Nursing Care Quality, 32(4), 324–330. https://doi.org/10.1097/ncq.0000000000000249

Prakash, S.S., Rajshekar, D., Cherian, A., & Sastry, A.S. (2017). Care bundle approach to reduce device-associated infections in a tertiary care teaching hospital, South India. Journal of Laboratory Physicians, 9(4), 273-278. http://dx.doi.org/10.4103/JLP.JLP_162_16

Ravi, P.R., & Joshi, C. (2019). Role of “bladder care bundle” and “infection control nurse” in reducing catheter-associated urinary tract infection in a peripheral hospital. Journal of Marine Medical Society, 20(2), 116-121. https://doi.org/10.4103/jmms.jmms_8_18

Tuttle, J.C. (2017). Cutting CAUTIs in critical care. Journal of Clinical Outcomes Management, 24(6). https://www.mdedge.com/jcomjournal/article/145872/infectious-diseases/cutting-cautis-critical-care

Witwer, M., Dobbins, G., Uher, C., & McFarren, M.D. (2019). Auditing CAUTI best practices bundle adherence in a 24-bed neurovascular/cardiovascular/intensive care unit. American Journal of Infection Control, 47(6), S30. https://doi.org/10.1016/j.ajic.2019.04.062 American Journal of Infection Control Assignment