Potential Barriers to Implementation and Solutions
Catheter associated urinary tract infections are preventable and should be treated with the seriousness it deserves. However, the evidence-based researched provided this author with insight of what some of the possible barriers would be during the EBP implementation. One key barrier is the lack of nurse driven catheter removal protocols, poor staff engagement and adherence to policies and procedures, the need to further the nursing staff knowledge regarding catheter need, insertion techniques, maintenance and care.
In the instance that the implementation could become obscured, some of the solutions to the implementation could be; revision of plan proposal, re-training staff on the proper use and aseptic insertion techniques, and guidelines on using CHG wipes for perineal care (see Appendix C). Furthermore, leadership and risk management will be consulted and assignation of CAUTI prevention champions will be endorsed. Obtaining the staff’s feedback throughout the implementation will also be measured.
Conclusion
Exercising basic nursing care and advocating for patients can ultimately lead to positive change in patient outcomes. Reviewing institutional policy and procedures and current evidence based research assisted in the development of a tool that helps guide and remind nurses of proper
indications and maintenance of urinary catheters. Implementing training and education for
nursing staff and ancillary staff on proper maintenance of urinary catheters and CHG bathing
supports an efficient change for this project. Lewin’s Change Model and Plan-Do-Study-Act
(PDSA) Improvement Model was incorporated as theoretical frameworks for implementing,
reinforcing, and preserving changes for this project. As a CNL student, I have learned a great
deal from this experience. I’ve learned this journey is a rocky road and need shared
accountability between the leadership, providers, nursing and other ancillary staff. I’ve also
learned:
· CAUTI prevention is a culture change and needs constant attention.
· Not to be afraid to refine the process
· Not to give up
· To continue talking to front line regarding obstacles and removing them
· To keep talking about patient and WHY we are doing this work!
· To focus on patient safety all the time
· To include all providers in education
· Respectful communication is a MUST!
This project’s result is not just CAUTI prevention; it is cost reduction, decrease length of stay,
fall reduction, and delirium prevention. Continuing nursing education and training will allow for nurses to grow within their organization and to practice to their full scope of practice. The nursing workforce is ready to help Americans achieve a healthy lifestyle and to increase patient satisfaction in every encounter.
References
Afonso, E., Llauradó, M., & Gallart, E. (2013). The value of chlorhexidine gluconate wipes and prepacked washcloths to prevent the spread of pathogens—A systematic review. Australian Critical Care, 26158-166. doi: 10.1016/j.aucc.2013.05.001
American Association of Critical-Care Nurses. ([AACN], 2017). AACN issues new protocols for bathing patients. Retrieved from https://www.nurse.com/blog/2013/04/21/aacn-issues-new-protocols-for-bathing-patients/
Cassir, N., Thomas, G., Hraiech, S., Brunet, J., Fournier, P., La Scola, B., & Papazian, L. (2015). Major article: Chlorhexidine daily bathing: Impact on health care–associated infections caused by gram-negative bacteria
Flores-Mireles, A. L., Walker, J., Caparon, M., Hultgren, S. (2015). Urinary tract infections: Epidemiology, mechanisms of infection and treatment options. Retrieved from http://www.nature.com/nrmicro/journal/v13/n5/fig_tab/nrmicro3432_F4.html
Galiczewski, J. M. (2016). Review: Interventions for the prevention of catheter associated urinary tract infections in intensive care units: An integrative review. Intensive & Critical Care Nursing, 321-11. doi: 10.1016/j.iccn.2015.08.007
Gesmundo, M. (2016). Enhancing nurses’ knowledge on catheter-associated urinary tract infection (CAUTI) prevention. Kai Tiaki Nursing Research, 7(1), 32-40.
Knudson, L. (2014). CAUTI prevention requires improved practices and policies. AORN Journal, 100(1), C1. doi:10.1016/S0001-2092(14)00377-9
Martínez-Reséndez, M. F., Garza-González, E., Mendoza-Olazaran, S., Herrera-Guerra, A., Rodríguez-López, J. M., Pérez-Rodriguez, E., & … Camacho-Ortiz, A. (2014). Major article: Impact of daily chlorhexidine baths and hand hygiene compliance on nosocomial infection rates in critically ill patients. AJIC: American Journal of Infection Control, 42713-717. doi: 10.1016/j.ajic.2014.03.354
Rainio, K. (2009). Kurt Lewin’s Dynamical Psychology Revisited and Revised. Dynamical Psychology: An International, Interdisciplinary Journal of Complex Mental Processes, 1-20.
Stevens, K.R., Puga, F., & Low, V. (2012). The ACE-ERI: An instrument to measure EBP readiness in student and clinical populations. Retrieved from: www.acestar.uthscsa.edu/institute/su12/documents/ace/8%20The%20ACE-ERI%20%20Instrument%20to%20Benchmark.pdf
Strouse, A. C. (2015). Appraising the literature on bathing practices and catheter-associated urinary tract infection prevention. Urologic Nursing, 35(1), 11-17. doi:10.7257/1053-816X.2015.35.1.11
The Joint Commission. (2015). Hospital: 2015 National Patient Safety Goals. Retrieved from http://www.jointcommission.org/standards_information/npsgs.aspx
U.S. Department of Health and Human Services, n.d. Guidance on Institutional Review Board Review of Clinical Trial Websites. Retrieved from http://www.hhs.gov/ohrp/policy/clinicaltrials.html
Appendix A
Revision of policies and procedures for CAUTI reduction Analysis
One of the most common HAI, CAUTI is considered a preventable complication of a patient’s hospital stay. The healthcare industry is expected to report any urinary tract infection related to indwelling catheter insertions. The widespread use of catheters is related to the increase rate of CAUTIs. Knudson (2014) cites “one in 333 indwelling urinary catheters will cause infection and an estimated 1.5 infections occur per 1,000 catheter days.” Improvements to the healthcare infrastructure requires for a revision on the adherence to CAUTI reduction policies and procedures.
The nursing staff need to be re-evaluated in their understanding of catheter insertion, maintenance and care. “The CDC -guideline for prevention of catheter-associated urinary tract infections” emphasizes using urinary catheters only as necessary, rather than routinely.” (Knudson, 2014). This analysis finally concluded that “data from 1,653 ICUs found that the presence of CAUTI prevention policies ranged from 27 to 68 percent and adherence to the policies ranged from 6 to 27 percent.” (Knudson, para. 3., 2014). Clearly, this study highlights the necessity for implementation of and adherence to evidence-based practices related to CAUTI prevention.
Appendix B
CAUTI Bundle by Gesmundo, N. (2015) Review
CAUTI
(Image retrieved from htps://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=119345448&site=eds-live&scope=site)
Appendix C
Universal ICU Decolonization Protocol for CHG Bathing- (Agency of Healthcare Research and Quality)
Poster for Universal ICU Decolonization Protocol for CHG Bathing. Drawings depict the front and back of a person, with numbers that correspond to use of chlorhexidine gluconate (CHG) cloths below the jawline only. Text is below the image.
(Image retrieved from https://www.ahrq.gov/professionals/systems/hospital/universal_icu_decolonization/universal-icu-ape3.html)
