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CAUTI

Melissa Dean RN, BSN-BC


NURSING PROBLEM
• Problem
• CAUTI
• Common HAI
• Preventable
• Adverse patient outcomes
• Mortality
• Morbidity
• Health care costs
• There is a significant gap of understanding regarding catheter care among
nurses . (Gesmundo, 2016)
• PICO/Clinical Question
• In the Inpatient setting, how does catheter-associated urinary tract infection
(CAUTI) education affect patient outcomes?
GESMUNDO (2016)
Design Data analysis
• multi-phased mixed method design • pre- and post-test scores
Sample • Quantitative data were analyzed
• convenience sampling – 13 nurses using a paired t-test
• 2 post op wards (high IDC rates) • Qualitative data were analyzed
Data collection using an inductive approach
• 3 phases over 17 weeks • Focus group data were individually
• Pre-intervention with commonalities compared
• administering the pre-test
• Intervention
• lectures and distribution of
educational materials and
posters
• Post-intervention
• post-test and getting
feedback
PARKER ET AL., 2017
• Design • Data analysis
• pre-post control intervention study using a phased • Statistical analysis Point prevalence data
mixed method approach • mixed methods analysis will compare pre and
• Proposed study post data within the groups,
• Sample • Qualitative analysis
• convenience sampling (IDC patients) • mixed methods approach
• Across four facilities in two districts • data from the point prevalence survey and
the clinician survey will be analyzed to inform
• Data collection the questions for the focus groups.
• Pre and post implémentation
• prevalence
• patient démographiques
• Pre and post implementation
• clinician knowledge
• competence
• Post implementation
• perceived barriers
• enablers to implementation
• 6 months
RICHARDS ET AL., 2017
• Design • Data analysis
• A prospective, interventional design • Tool used in analysis not addressed
• application of evidence-based • RCA for any CAUTI occurrences
practices • SIR (Standardized infection ratio)
• Sample • Less than 1.0
• Convivence sampling
• All patients with IDC in 18 bed unit
• Data collection
• Chart analysis
• CAUTI occurrences
• RCA for any CAUTI occurrences
FINDINGS

Gesmundo, 2016 Parker et al., 2017 Richards et al., 2017


Education improved test scores in all Proposed findings 15 total CAUTIs reported
nurses in the study - Proposed findings
(2-tailed P < .05; CI 95%, 0.271-0.902)
Improved patient outcomes
5 nurses received a perfect score on reduction of CAUTIs
post test Improved healthcare outcomes
$165,912 savings in 2014
mean difference of 6.64 and 95% CI Anticipated
(4.96, 8.33). 2 CAUTIS investigated during the RCA
CAUTI reduction
process found attributed to other
Improved mortality and morbidity settings
Reduction in healthcare costs
No negative impacts on patients
regarding falls or skin breakdown
RECOMMENDATIONS

Gesmundo, 2016 Parker et al., 2017 Richards et al., 2017


1. Regular in-service education for Proposed study, recommendation is 1. Apply current EBP to reduce
nursing staff to perform the study. CAUTI
2. Facility policy to follow EBP 2. Daily huddle to discuss every IDC
3. Developed and implement 3. Bundling current
1. Workflow reminders recommendations to maximize
2. CAUTI surveillance program
outcomes
3. QI program

4. Standardized IDC product


procurement
5. Further research with larger
sample
STRENGTHS

Gesmundo, 2016 Parker et al., 2017 Richards et al., 2017


Easy to replicate Strong proposed study with a large Strong impact on patient outcomes
sample size.
Data is easy to understand
Reduction in healthcare costs.
Potential to improve patient
Potential to improve patient outcomes and reduce healthcare
outcomes and reduce healthcare costs.
costs.
WEAKNESSES

Gesmundo, 2016 Parker et al., 2017 Richards et al., 2017


1. Convenience sampling 1. Proposed study 1. Tool used in analysis not
addressed
2. Small sample size 2. Convivence sampling, but large
2. Performed at one location
3. CAUTI rate unavailable 3. Reliability and validity not
1. May not apply to other locations
addressed
3. Staff perceptions not
4. Generalizability not addressed
investigated
4. Atheoretical approach
1. Theory approach may have
yielded higher success

5. Reliability and validity not


addressed
6. Generalizability not addressed
GENERALIZABILITY, RELIABILITY AND VALIDITY

Gesmundo, 2016 Parker et al., 2017 Richards et al., 2017


1. Generalizability 1. Generalizability 1. Generalizability
1. generalizability of the findings to 1. not discussed 1. Not discussed
be limited to the population in
the sample 2. Reliability and validity 2. Reliability and validity
1. not addressed 1. Not discussed

2. Reliability and validity 3. Recommendations for clinical


1. Ensured consistency with testing practice 3. Recommendations for clinical
2. Formally published tests used to practice
adapt study’s test

3. Recommendations for clinical


practice
SUMMARY
• Typical nurses can easily understand the findings as they are provided using
common medical terminology.
• Findings appear to be valid.
• Gesmundo (2016) offers reliability and validity in their proven testing methods.
• Richards et al. (2017) findings show remarkable reduction in CAUTI
• Parker et al. (2017) is a proposed study
• Meaningful evidence
• Gesmundo (2016)
• education showed an improvement in overall test scores
• Richards et al. (2017)
• shows significant impact to nursing practice by providing proof in reduction of CAUTI
• Parker et al. (2017) proposed study
• potential to significantly impact many patients over four hospitals
CONCLUSION
• Patients with IDCs are at high risk for infection
• CAUTI has the potential to impact every patient across all settings in which
an IDC is used.
• Gesmundo, 2016 has shown the ability for nursing interventions to
dramatically reduce CAUTI
• Parker et al is., 2017 in a proposed study that will add to existing evidence
through EBP interventions
• Richards et al., 2017 SIR results of less than 1.0 reinforce application of EBP
REFERENCES

Gesmundo, M. (2016). Enhancing nurses’ knowledge on catheter-associated urinary tract


infection (CAUTI) prevention. Kai Tiaki Nursing Research, 7(1), 32-40.

Parker, V., Giles, M., Graham, L., Suthers, 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. BMC Health Services
Research,17(1).

Richards, B., Sebastian, B., Sullivan, H., Reyes, R., D’Agostino, J. and Hagerty, T. (2017).
Decreasing catheter-associated urinary tract infections in the neurological Intensive
care unit: One unit’s success. Critical Care Nurse, 37(3), 42-48.