Using evidence-based practice to reduce catheter-associated urinary tract infections

Contrada, Emily

AJN, American Journal of Nursing: June 2013 - Volume 113 - Issue 6 - p 44,43

doi: 10.1097/01.NAJ.0000431270.01203.4b

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Catheter-associated urinary tract infections (CAUTIs) are associated with significant morbidity and mortality, with an estimated 93,300 urinary tract infections (UTIs) and 13,000 UTI-related deaths occurring each year in acute care hospitals. A preventable cause of UTIs is the use of long-term indwelling urinary catheters, an ideal focus of evidence-based practice (EBP) initiatives.

A team of nurses at Loma Linda University Medical Center in California published a report of an EBP project to decrease the incidence of CAUTIs in an oncology population. Carol Nielsen, BSN, PHN, RN, OCN®, and Charis McCoy, MSN, FNP-BC, APRN, discussed their project and the factors that led to their success: particularly the importance of a team-based approach to EBP and the need for evidence in making practice changes.

A Team-Based Approach

McCoy and Nielsen explained that the CAUTI project was conducted by a unit-based research team of staff on a medical-surgical acute care oncology unit. Although they had internal support from the director of nursing research, administration, and physicians, local involvement from the team was crucial. This enabled proposed changes to come from colleagues, not from administration, and for the team to be involved in identifying the evidence. The team members could ask and answer the important question, “Is our practice the best it can be?” An unintended benefit of the project, according to McCoy, was that having more nurses involved in the EBP project created a ripple effect that brought the knowledge of EBP to more bedside nurses who feel empowered to use best-care practices for their patients.

Incorporating the Evidence

The staff followed the Johns Hopkins review process to identify the quality and level of relevant evidence. Reviewing the literature was time-consuming but illuminating, according to Nielsen, and using Hopkins’ standard process was essential and helped the staff overcome initial overwhelming thoughts about reviewing such a large body of literature. To ensure staff buy-in on the project, the staff reviewed and leveled approximately 60 articles as a group. McCoy also noted the benefit of exposing all staff to the evidence: “It’s hard to argue with the evidence.”

The group did not start out envisioning where it could eventually go, how big of a project it would grow to be, and the positive impact it would have on patient care. Rather, they wanted to make a difference for their patients. As McCoy learned, “Nurse-led change is the most sustainable and impactful way to improve the care we provide to our patients. I would encourage other nurses to not be intimidated by the literature.”

@article{Magers2013UsingEP,
  title={Using Evidence-Based Practice to Reduce Catheter-Associated Urinary Tract Infections},
  author={Tina L Magers},
  journal={AJN, American Journal of Nursing},
  year={2013},
  volume={113},
  pages={34–42}
}

OverviewIn November 2009, AJN launched a 12-part series, Evidence-Based Practice, Step by Step, authored by nursing leaders from the Arizona State University College of Nursing and Health Innovation's Center for the Advancement of Evidence-Based Practice. Through hypothetical scenarios, based on the authors' collective clinical experience, the series illustrated the seven steps of evidence-based practice (EBP), defined as “a problem-solving approach to the delivery of health care that…

30 Citations

Preventing Urinary Tract Infections in the Acute Care Setting

Charlotte Evette Philyaw
Medicine
2016

The purpose of the project was to develop an indwelling urinary catheter maintenance checklist using evidence-based practice guidelines related to preexisting inappropriate risk factors for catheterization and appropriate indications forCatheterization, as well as evidence- based maintenance practices for care of the indwelled catheter.

References

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ANA Initiative to Prevent CAUTI There are three areas to improve evidence-based clinical care to reduce the rate of CAUTI: (1) prevention of inappropriate short-term catheter use, (2) nurse-driven timely removal of urinary catheters, and (3) urinary catheter care during placement.

What is the best way to prevent catheter associated urinary tract infections?

CAUTI can be prevented by things such as hand washing, not using urine drain tubes and if they must be used, inserting them properly and keeping them clean. Catheters should be put in only when necessary, and removed as soon as possible.

Is CAUTI evidence

This document, published by the Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Centers for Disease Control and Prevention (CDC) [11] in 2009 and subsequently updated in 2019, recognises the verified steps of CAUTI prevention based on evidence-based practice (EBP).

How can you reduce the risk of CAUTI?

Minimize urinary catheter use and duration of use in all patients, particularly those at higher risk for CAUTI or mortality from catheterization such as women, the elderly, and patients with impaired immunity. I.A. 2. Avoid use of urinary catheters in patients and nursing home residents for management of incontinence.