Response 2
Great PICOT question. From clinical experience I can attest that CAUTI’s are increasingly becoming a problem. As an ICU float nurse, I transit between three different facilities and infectious disease (ID) is encouraging nurses to become proactive about getting urinary catheters out of patients. Urinary tract infection (UTI) as the most common healthcare-associated infection accounts for up to 36% of all healthcare-associated infections (Parker et al, 2017). Additionally, recent changes to Medicare reimbursement policies seems to have influence over increased CAUTI vigilance. Catheter-associated urinary tract infection, a common and potentially preventable complication of hospitalization, is one of the hospital-acquired complications chosen by the Centers for Medicare and Medicaid Services (CMS) for which hospitals no longer receive additional payment (Saint et al, 2013).
Both articles, along with other evidence-based research, focuses on removing the urinary catheter as promptly as possible in a hospitalized patient. In preventing a catheter-associated urinary tract infection, priority should be given to the importance of maintaining an appropriate infrastructure for infection surveillance and prevention, education and training of healthcare personnel about catheter-associated urinary tract infection, appropriate insertion and maintenance of the indwelling catheter, consideration of alternatives to indwelling catheter use (e.g., condom and intermittent catheterization), and early removal of the indwelling catheter (Saint et al, 2013). From clinical experience, our organization requires 12-hour documentation of the need for the device, catheter hygiene, and surveillance of the urine. Using reminders or stop-orders for urinary catheters, led by nurse-driven protocols is an excellent research topic.
References
Parker, V., Giles, M., Graham, L., Suther, B., Watts, W., O’Brien, T., and Searles, A. (2017).
Avoiding inappropriate urinary catheter use and catheter-associated urinary tract infection
(CAUTI): a pre-post control intervention study. Biomed Health Services Research, 17(314),
1-9. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5414128/
Saint, S., Meddings, J., Calfee, D., Kowlaski, C., and Krein, S. (2013). Catheter-associated
urinary tract infection and the Medicare rule changes. Annals of Internal Medicine, 150(12),
877-884. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2754265/
