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Abstract

CAUTI is a preventable urinary infection that mostly occurs amongst patients having catheter insertions. This condition is more rampant amongst the elderly population; however, the cases of CAUTI infections among some groups of patients are not extensively covered. Some of them include patients in facilities such as acute and rehabilitation centers, for instance, trauma rehabilitation centers. Hence, there is an information gap in preventive measures being utilized amongst some groups of people such as patients with traumatic injuries. Therefore, the proposed paper seeks to assess the preventive measures that can be adopted in the traumatic rehabilitation unit in Trauma 4A in Jackson Memorial Hospital in Miami to avert the prevalence of the menace. Furthermore, the proposed paper will try to gain an insight into the risk factors associated with CAUTI in the traumatic rehabilitation unit setting and develop strategies to minimize the infection. The qualitative research method will be used to conduct the study. To collect data for this research, a sample of 40 participants, particularly 10 nurses and 30 patients in the trauma unit, were randomly selected. Observation and interview will be the main tools of data collection. These results of this research will be useful in changing the nurse perceptions and behaviors when caring for traumatized patients. This study will also help health providers to adopt new methods of preventing CAUTIS for patients under their care.

Keywords: catheter-associated urinary tract infections, traumatic care unit

CAUTI PREVENTION 12

Background

In the modern day, the most common health facility related infections are the catheter-associated urinary tract infections (CAUTI). CAUTI is estimated to amount to up to 40% of all nosocomial infections in the USA (Goldstein et al., 2018). The use of urinary catheter insertions is a factor predisposing one to CAUTI. Thus, 25 % of the patients using catheter insertions are reported to undergo urinary catheterization during their hospitalization (Goldstein et al., 2018). Moreover, the cases of urinary catheterization in intensive care units can amount to as high as 100% of the patients. Inappropriate usage of catheters in the population with trauma is a substantial problem that leads to increased number of urinary tract infections. Other related problems are financial implications, patient safety and ethical issues.

Reducing healthcare developed infections is a part of the objective of the 2010 joint commission on national patient safety (Goldstein et al., 2018). However, the incidences of CAUTI can be mitigated if certain retention and catheter principles are applied. In numerous incidences, insertion of a urinary catheter is unnecessary among traumatic patients, however, it leads to the development of CAUTI infection. Therefore, if indwelling a catheter is a requirement, they should be eliminated as soon as possible to prevent contracting CAUTI infections. The duration within which a catheter is used is the leading predictor of CAUTI (McKee & Williams, 2014). Therefore, the main aim of this research proposal will be to review the urinary catheter procedures aimed at the prevention of CAUTI among traumatic patients in Jackson Memorial Hospital in Miami.

Problem Statement

Traumatic patients are a very special group of people with various risk factors for CAUTI that are not present in the general population. For example, urinary catheterization is deemed necessary having in mind the mobility restrictions of some traumatic unit patients. Some of the deposing factors for CAUTI infections include female sex, head injuries, distorted sensorium, hear failures and prolonged hospital stays. However, it is necessary to determine whether these patients develop CAUTI as a consequence of their hospitalization or have the comorbid urinary tract infection even before the admission to be able to develop preventive measures.

According to Goldstein et al. (2018), health care-associated infections in the USA are very common amongst hospitalized patient. Urinary tract infection has the highest prevalence of 40% of all diagnosed cases of health care associated infections (Goldstein et al., 2018). Most adult patients are at the risk of contracting CAUTIS, which has grave consequences such as bacterium, pyelonephritis and meningitis infections. Additionally, CAUTIS have been linked with deprived healthcare outcome amongst hospitalized patients these poor outcome include increased inpatient stay, increased expenses and even death. For instance CAUTIS is associated with about 13,000 deaths and about $500 million of direct costs in the US (Goldstein et al., 2018).

Goldstein et al. (2018) maintain that despite quality improvement efforts in hospitals which have yielded essential information on the strategies to avert the menace of CAUTI, only scanty details are available of CAUTI prevention measures involving traumatic patients (McKee & Williams, 2014) .Therefore, this study is aimed at identifying the causes on CAUTI infection and measure that can be adopted to prevent CAUTI infections in the traumatic rehabilitation unit in Trauma 4A in Jackson Memorial Hospital in Miami.

Purpose

CAUTIs can be linked to many negative outcomes, such as mechanical trauma , urethra, impaired mobility outcomes to traumatic patients .CAUTI can further bring about cases such as urethra strictures, mechanical trauma, urethra inflammation, impaired mobility and increases the risk in mortality for individuals .Therefore, this study tries to assess the risk factors associated with CAUTIS and at the same time investigate preventive measures that can be adopted to curtail the rate CAUTIs infections amongst traumatic patients in Jacksons memorial hospital, traumatic rehabilitation unit in Miami.

Objectives

The proposed study’s main goal will be to investigate the protocols and measures that prevent CAUTI infection at Trauma 4A in Jackson memorial hospital in a trauma rehabilitation ward in Miami. Specifically, this study will look at how indwelling urinary catheter contributes to the CAUTI infection amongst traumatic patients in Jackson Memorial hospital. The proposed research will further utilize the following behavioral objectives:

· Risky factors that increases the vulnerability of CAUTI infection amongst traumatic patients.

· Preventive measures being utilized at Jackson memorial hospital to minimize CAUTI infections.

· Contribution of insertion of urinary catheter in the rise of CAUTI infections amongst traumatic patients in Jackson memorial Hospital.

Literature Review

There have been made several attempts to try and mitigate the problem of CAUTI infections. For instance , Lam, Omar, Fisher, Gillies, and MacLennan (2014) studied the use of silver –alloy antimicrobial catheters which are designed by use of non-infectious raw materials to make the catheter more comfortable and prevent infections. He further explains that the use of coating materials such as hydrogels, silicone and silver alloy have proved to decrease CAUTI infection rates in the elderly patients. A study conducted by McKee and Williams (2014) on patients using catheters in a hospital setting produced positive results. Thus, the study showed that there is a consistent pattern of using silver-alloy coated catheters for the reduction of the associated urinary tract infections such as CAUTI.

Campbell (2016) notes that despite the knowledge of possible CAUTI infections drawbacks, health professionals continue to regularly insert indwelling catheters in the hospitalized patients. In the study, Campbell (2016) found that only 46% elderly patients had draper indications which required catheterization. However, the majority of patients were being routinely catheterized in many departments, and mostly the emergency department, without a doctor’s recommendation. This is a worrying tendency since even in short-term usage of catheters such as one week can result in infections. Some of the infections rerecorded included urethritis, perforation of the bladder, and urosepsis, which can cause death.

Weiner et al. (2016) advises that indwelling urethra catheters should only be used for surgical purposes and among critically ill patients, severe urinary retention, and help in pressure ulcer treatments for incontinent patients. On the other hand, the Centre for Disease Control and prevention (CDC) in 2009, listed the appropriate usage of catheters. CDC outlines that before a catheter is placed in a patient, the health practitioner needs to analyze whether the patient really needs the catheter. If there is no valid reason, the nurse needs to question the reason for the catheter insertion.

Lam et al. (2016) note that the most significant risk factors for CAUTI infection can be attributed to the duration of catheterization. He concludes that the risk of generation of bacteria increases by 3% to 10% every day, the catheter continues to dwell on the patient’s body. Lam et al. (2016) further estimate that 10 to 50 percent of patients under short term catheterization will most likely develop CAUTI. Therefore, catheter insertion of is a very important nursing practice, and the health practitioner such as the nurses must regularly question the physician decision to use the catheter.

According to Campbell (2016), universal precautions such as hand washing are very important in CAUT prevention. Hospitals are required to develop a safety culture that is able to provide resources for important quality measures such as hand hygiene. More importantly, when emptying the catheter bag, nurses should clean theirs hand thoroughly. Additionally, if a patient empties their own catheter bags, they should be guided and taught on the importance of hand hygiene. The renewed campaign on hygiene for healthcare practitioners will decrease the risk of cross termination between patients in a hospital.

Methodology

The proposed study will use the qualitative research method approach to collect the data. Qualitative data collection is used to obtain data that is non-numerical and non-tangible, which is important for investigating how decisions are made. A qualitative research design is able to provide holistic data that is useful in making conclusions (Smith, 2015). Since a qualitative research method is able to obtain information regarding the focus groups’ behavior, relationship and practices, it will be essential to collect descriptive data on the risk factors and preventive measure used at Jackson memorial hospital, traumatic rehabilitation unit.

Population and Sampling

The proposed research will utilize a randomly selected population of 40 participants. The participants will be categorized into two groups - the staff and the traumatic patients at Jackson memorial hospital. The staff will be represented by 10 nurses working at the traumatic rehabilitation unit, while 30 patients will be randomly selected from the traumatic rehabilitation unit. To collect data from this population, observation will be used for the patients, while the nurses will be interviewed and at the same time observed. The data obtained will be recorded for a period of one month.

Procedure to Be Used

To obtain data from the respondents’ interview schedules will be generated for the nurses and observation for the patient’s phone number. The patients for the research will reflect e. However, the respondents will be assured of secrecy and confidentiality of the information obtained. The respondents will be assured that the data will be used for research purposes and improvement of treatment of the current CAUTI problem.

Analysis

After data collection, the data will be analyzed using statistical analysis packages SPSS version 20 for Microsoft Windows. The analysis will be performed with the focus on the connection of each variable with CAUTI and multivariable logistics regression to predict the effects of catheter insertion on CAUTI infections. Additionally, a descriptive analysis will be conducted to understand the causes of CAUTIC infections and prevention methods available at the Jackson memorial hospital.

Implications for Nursing Practice

The proposed research will bring about an impact on the change of behavior through renewed CAUTI awareness in the hospital. In the process of information collection, the nurses’ perceptions will help understand the gap of information missing and be able to introduce training programs for nurses on safer methods of dealing with CAUTI infections. Therefore. this study will be important in changing the provider behavior. This study will go a long way in educating the patients on the preventive measures of CAUTI such as the basic hygiene of hand washing after catheter box emptying.

On the other hand, the discoveries and conclusion to be obtained from this research can be helpful if applied into a broader context for national healthcare interventions. Furthermore, this research will be important in guiding policy makers and health providers on implementing better strategies of preventing CAUTI infection in the health facilities. especially the trauma rehabilitation centers.

Conclusion

Catheter associated urinary tract infection is the most common healthcare associated infection. CAUTI is preventable if the signs of catheterization, techniques for catheter care and other preventive precautions are followed with outmost care and diligence. Despite the fact that decreasing or preventing CAUTI infections requires the involvement of all the teams and collaboration of different stakeholders, engaging health practitioners at the hospital and unit level is essential. It is evident that the prevention of CAUTI majorly relies on the provision of quality nursing care. This care can be in form of the use of proper insertion of the catheter and maintenance practices such as timely removal and evaluation of whether the catheterization is necessary. It is also evident that general hygiene in acute care units can help inpatients reduce infections in the hospital. Therefore, this research will help change the providers’ behavior, especially when dealing with catheterization cases. Health providers will be required to carefully scrutinize whether it is necessary to insert a catheter and for what period of time to use it. Additionally, this information will be important to nurses in bridging their information gap of preventive measures of CAUTI, the patients will be able to understand the causative factors and ways to protect themselves, whereas policy makers will have an opportunity to improve the policies to deal with traumatic patients as a special case and avoid associating them with normal patients health regulations and protections.