AHRQ Cauti Prevention

Author

McCoy, C., Paredes, M., Allen, S., Blackey, J., Nielsen, C., Paluzzi, A., … Radovich, P. (2017).

Type of Article/Paper

(EB guideline, systematic review, RTC, case study, etc.)

Qualitative study

Aim of Article/Paper

The aim of the paper is to come up with preventions strategies towards Catheter Associated Urinary Tract Infection within the inpatient oncology population by implementing part of the evidence based nurse driven protocol used in the discontinuation of the indwelling urinary catheters.

Conceptual Framework (if any)

The conceptual framework is based on the findings from the literature review which has openly demonstrated that ensuring staff education is very fundamental to the CAUTI prevention and also ensures a reduction of the IUC duration.  The educational interventions are also going to be important to ensure that there is application of some of the best practices for the IUC care in addition to evidence based indications for the continuation of the IUC removal. Also when it comes to empowering nurses regarding the inpatient oncology units is important as this also advocate for the patient’s with inappropriate IUC and can play a very important role in respect to the prevention protocols.

Study Design &

Method

●       Due to lack of evidence IUC practices the methodology entailed a team of seven acute care nurses from two of the medical surgical oncology units that were required to ensure the development of an evidence based   CAUTI prevention protocol.

●       There was then a clinical question to be followed with was that in adults, how would the implementation of the nurse driven IUC algorithm, compared to the current practices in urinary catheter affect the number of CAUTI as per quarter?

●       The study conducted a literature review that analyzed 45 articles on the said topic.

●       From the selection, eighteen articles were not used on the ground that there was poor research done and the quality or relevance of the article was also low in respect to the clinical question.

●       After this, the inpatient oncology unit evidence based practice team made use of the Johns Hopkins process of review to ensure the level and quality of evidence in respect to the remaining articles.

●       After this, each of the article was then reviewed independently three times to ensure the validation on the level of quality of evidence.

●       The study also came up with a summary of the table of articles to used, which was important in allowing for the ease in identification of the CAUTI prevention best practices.

●       In any case all the articles used during the literature review were based on the development of the protocol in levels I and III which as ranged from good to high quality.

Population/

Sample/ sample size

Setting

Since the study methodology was based on a literature review of previous done studies there was not population sample.

Major Variables and their definitions

CAUTI rates:  being able to come up with a particular number of infections in regard to the number of urinary catheter line days, multiplied by 1000, it is important to mention that the CAUTI rates are often mentioned per the catheter days.

Measurements/

Instruments/

Tools

Knowledge of Inpatient Oncology team:  the study made use of a survey to check whether the knowledge of the impatient oncology team was enough to manage the urinary catheter care in regard to the level of knowledge they had on CAUTI.

Understanding institutional policies:  it was also important for the study to investigate the role that institutional policies play in the current application in the management of CAUTI.

Knowledge of the prevention Methods:  In this study, the issue of education was important and began with the presentation of the research team and the development protocol at the staff meeting. The study also included various case studies that engaged the bedside oncology nurses in viewing this through the evidence based IUC indication in addition to the nurses driven removal protocol. Also education is addressed in the IUC care component including the new charting requirement.  In this regard an education audit tool is also very  important to ensure the oncology team adheres to compliance and nurses understand the key steps in prevention of CAUTI

Data Analysis

The study analyzed the implementation of compliance strategies which showed the need collaboration between different professional in regard to lack of reduction in the IUC days.

Findings

●       There was a significant presence of nurse knowledge on the compliance with guidelines towards the CAUTI procedures.

●        There was however lack of understanding on the IUC related complications among other healthcare providers with affected the outcome.

Study limitations:

●       Data was not reliable since it was a literature review and no primary data was collected.

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Appraisal:

Level of Evidence

Quality

Were the study patients similar to my patients of interest?

 Yes        No        NA

Were all patient-important outcomes considered?

 Yes        No        NA

Were patient safety variable considered?

 Yes        No        NA

Were the outcomes objective and unbiased?

 Yes        No        NA

Are the likely benefits worth the cost & potential risk?

Yes         No        NA

How do the results fit with previous research in this area?

Yes         No        NA

Can the study be replicated at my facility?

Yes        No        NA

Are the results applicable to my patient population?

Yes        No        NA

Can I use the results in managing my patients?

Yes        No        NA