Urinary tract infections that are caused by catheters are among the most common acquired infections in the provision of healthcare. The most common presentation of symptoms for this type of infection is fever alone, while extreme presentations present with bacteremia, significant sepsis, or septic shock. These clinical presentations are rare but they do represent a significant concern. Generally, the most effective way to prevent these infections involves limiting catheter use to only administering it to patients who have obvious indications in addition to removing catheters as quickly as possible. This paper discusses various research studies that support evidence-based practice strategies to reduce the clinical incidence of catheter-associated urinary tract infections.
Evidenced-based practice has demonstrated that protocols that are driven by nursing professionals have been effective in reducing catheter-induced UTIs, or CAUTIs, when the catheters are removed in compliance with hospital standards. Also, the risk of UTI caused by catheters can be reduced by implementing proper hygienic techniques such as appropriate cleansing and care of catheters in combination with maintaining the cleanliness of urinary catheters. The risk of CAUTIs can be minimized if they are used after cleaning patients with soap and water, and then using 2% chlorhexidine gluconate cloths to wipe down all parts of the body with the exception of the perineal were areas containing wounds. These baths are able to fight off a range of microorganisms, according to research studies that have examined the causes of UTIs.
Many healthcare organizations have established evidence-based recommendations designed to prevent CAUTIs; the CDC established the earliest of such guidelines in 2009 (McNeill, 2017). However, the implementation of these guidelines has not been rapid, and there is an indication that adherence to the standards has simply not been the case. Between 2009 in 2013, there was a national increase of 6% in documented cases of CAUTIs, and this despite the fact that other infectious agents such as Clostridium difficile, central line associated bloodstream, and methicillin resistant staphylococcus aureus were all on the decline. The increase in CAUTIs demonstrates a significant need for using and adhering to practice guidelines established by and for medical professionals, notably nurses. One of the early measures designed to prevent CAUTIs is to conduct a thorough assessment of whether or not a catheter is needed. If placement of a catheter is not essential, clinicians should look for alternatives and eliminate the possibility of developing a catheter associated UTI. Because there is an overuse of catheters, many of which are utilized without having a valid clinical reason, it becomes crucial to accurately evaluate other options. Of the 5 million catheters placed annually in the US, 50% are not medically necessary (McNeill, 2007).
Frequently, attending doctors are not even aware that their patients have been catheterized, and others may know that there is a catheter in place but are not cognizant of how long it has been there. In many situations, nurses are crucial in making the decision about whether or not to order a catheter. Instead of requesting an order for catheter placement when, for example, a patient has been incontinent nurses should be considering more regular bathroom rounds, intermittent catheterization, or the use of external catheters (McNeill, 2007). In addition, it is vital that nurses and other clinicians develop protocols that reflect standards for placement of catheters and how they should be used in a wide range of settings. The use of catheters is appropriate in many situations, such as use preoperatively for certain surgeries, obtaining legitimate output measures in critically ill patients, relieving severe urinary retention, promoting healing of pressure ulcers, and improving patient comfort during hospice care or other end-of-life measures.
References
CDC. (2014). Catheter-associated urinary tract infection (CAUTI) event.
McNeill, L. (2017). Back to basics: how evidence-based nursing practice can prevent catheter-associated urinary tract infections. Urologic Nursing, 204-206.
Meddings, J., Rogers, M., Krein , S., Fakih, M., Olmsted, R., & Saint, S. (2014). Reducing unnecessary urinary And other strategies to prevent catheter associated urinary tract infection: an integrative review.
Nicolle, L. (2014, July 25). Catheter associated urinary tract infections.
