NSG 6101 – Nursing Research MethodsThis is a continuation of the assignment that you completed for me this past Monday. I had to make corrections according the instructions so I have attached a copy of that as your guide. Please message me with any questions.Assignment 2: Research Proposal DraftBy Monday, December 19, 2016, write a 1-page paper addressing the sections below of the research proposal.Theoretical FrameworkOverview and Guiding Propositions(s) Described in TheoryApplication of Theory to Your Study’s/Project’s FocusPost your assignment to the W5: Assignment 2 Dropbox.Assignment 2 Grading CriteriaMaximum PointsTheoretical Framework is described and includes overview and guiding propositions.15Application of theory to proposed study is explained fully.10Followed APA guidelines for writing style, spelling and grammar, and citation of sources.5Total:30Running head: CATHETER ASSOCIATED
Catheter Associated Urinary Tract Infection
Tamisha Hodum
South University
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CATHETER ASSOCIATED
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Catheter Associated Urinary Tract Infection
Catheter associated urinary tract infections (CAUTIs) are one of the most common
infections acquired in the health care environment. Most of the CAUTIs are closely related to
the utilization of the indwelling urethral catheters, particularly the foley catheters. Banks,
Abdella, & Willmann (2016) assert that around 40\% of all infections acquired within the health
care environment are urinary tract infections (UTIs). Around 80\% of these infections are
catheter-related (Banks, Abdella, & Willmann, 2016). Urinary catheters use is overwhelmingly
common in health care facilities. Catheter-associated UTIs have many implications, including
increased cost of care, morbidity, mortality, length of stay, and healthcare burden. Since catheter
utilization cannot be completely avoided, mitigating the risks associated with the use of this
medical device becomes imperative. Health care systems have increased the number of
programs dedicated to the prevention of catheter-related infections. The current research
proposal will delve deeper into the issue of the catheter associated UTIs in an effort to establish
ways of preventing the associated infections.
Review of Literature
Despite there being a broad array of reasons for the utilization of urinary catheters,
comprehensive care should be taken before the commencement of the insertion processes. Yates
(2016) argues that individuals should go through various risk assessments to ensure that
comprehensive analyses of all complications that can arise as a result of the catheters are
established (p. S4). Further, any contraindications linked to a specific type of catheter insertion
should be evaluated, and the necessary measures are taken to mitigate any unwarrantable risks.
Yates views are supported by Purvis, et al. (2014), arguing that indwelling urinary catheters
should only be utilized when no better medical intervention could have been used rather than the
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risky insertion (p. 142). Additionally, the insertion procedure should be carried out by a trained
practitioner through the use of the sterile technique. Some of the catheter insertions are
unnecessary and could be replaced by alternative methods (Magers, 2013; Holroyd, 2016). The
nursing community should utilize several preventive measures to avoid the increased prevalence
of these infections. Evidence-based strategies and enhancement of awareness about the infection
are among the first steps that should be taken towards the reduction of catheter-associated
infections.
Reduce Unnecessary Catheter Use
Scholarship and laboratory research have established that the most efficient way of
reducing the incidence of CAUTIs is the avoidance of the use of the catheters as much as
possible (Magers, 2013; Holroyd, 2016). According to Purvis, et al. (2014), the unnecessary
insertion of catheters has been linked to the heightening prevalence of the infections in most
health care facilities (p. 142). The fact that almost half of all catheterized patients experience
around two days of unnecessary catheterization implies that they are exposed to avoidable risks
of contracting the CAUTIs, as well as other complications that may arise as a result of the
insertion. Unfortunately, studies have established that a significant number of health care
practitioners do not have sufficient knowledge on the best practices regarding the appropriate
indications for the insertion of catheters. Worse still, some of the medical providers do not even
know whether hospitalized patients have the indwelling catheters or not (Purvis, et al., 2014). To
avoid such instances, the health care centers should ensure that all information justifying the
insertion of catheters is accurately documented.
In situations where the use of urinary catheters is inevitable, a comprehensive clinical
indication regarding the condition and the most appropriate measures to be taken should be
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available as to ensure that catheterization is the most befitting alternative. Moreover, the catheter
should be removed within the shortest time possible (Purvis, et al., 2014). According to Holroyd
(2016), nursing convenience has been consistently cited as one of the most common reasons for
catheterization in patients with incontinence in the urinal system (p. 143). The urinary catheter
may also have been inappropriately inserted for the extraction of urine samples, even when the
affected individual can urinate without the device. Furthermore, urinary catheters are used for
other inappropriate reasons postoperatively.
Johnson, Gilman, Lintner, & Buckner (2016) argue that the discontinuation of urinary
catheters should be within one day after the surgery unless there is sufficient evidence supporting
the continued use of the catheter (p. 356). According to Magers (2013), CAUTI incidences are
high in health care environments where the inappropriate insertions are frequent (p. 35). Health
care centers should implement restriction protocols to control the inappropriate utilization of the
catheters. The rules are instrumental to the enhancement of care when contemplating the
insertion of the catheters. Restrictive protocols remind medical practitioners of the specific
indications that warrant the use of catheters before any decision regarding insertion could be
made. An indication sheet is among the best approach when striving to enhance patient care and
accuracy in the catheter issues (Banks, Abdella, & Willmann, 2016). The indication sheet should
be attached to all trays for catheter placement so that any licensed health care provider with the
potential to perform insertion of a urinary catheter can have a clear understanding of whether the
decision is appropriate or not. Ideally, the practitioner using the sheet is expected to choose the
indicator that supports the decision to insert the catheter. If the indication is not on the list, then
the health care provider is expected to add the alternative reason for the insertion. If no other
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option is available, then urinary catheter placement may be avoided completely (Banks, Abdella,
& Willmann, 2016).
Education and Training
Most of the challenges facing the health care systems are centered on the lack of
sufficient knowledge on several fundamental technicalities. Patients, nurses, and all other care
plan members in the health care environment should be familiar with all the requisite information
on the catheters as to avoid situations in which the implications are overwhelmingly detrimental.
Central to the health care awareness about catheter utilization is the nurse education. According
to Magers (2013), evidence-based strategies that would significantly mitigate the risks of
catheter-associated UTIs are compromised by the failure of the nursing community to embrace
new and improved beliefs and habits (p. 37). Thus, the implementation of a relevant nursing
education in the health care environment would be pivotal in the reduction of the barriers to
change when addressing the catheter insertion issue. According to Holroyd (2016), guidelines
highly recommended that each nurse acquires sufficient knowledge concerning CAUTIs, as well
as all other alternatives that can be used instead of the urinary catheter in case of urinary
complications (p. 256).
Purvis (2014) argues that training camps and focused multidisciplinary educational
approaches are instrumental in the establishment of a solid background of catheter-related
awareness (p. 145). The nurse education should focus on the best and most effective evidencebased approaches like the importance of understanding catheterization alternatives, issues related
to the daily review, indications for catheter placement, and any other relevance information that
may be applicable when managing such patients (Johnson, Gilman, Lintner, & Buckner, 2016, p.
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353). Studies have proven that the education is effective in the reduction of CAUTIs, as well as
the reduction of other infections related to urinary problems (Magers, 2013)
Further, patient education becomes essential in the mitigation of catheter-related risks.
Studies have proven that patient awareness significantly improves outcomes in the healthcare
environment, patient satisfaction, and health costs. The nurses are entitled to the establishment of
education routines favorable for the patients, particularly the ones that affect the patients’
wellness. The care of the catheter is deemed as a priority for the nurses, the patient, and the
patients family. Thus, any education related to the catheter should be beneficial to all these
parties. Nurses should communicate any care and maintenance guidelines about CAUTIs to the
patient, as well as preventive techniques (Johnson, Gilman, Lintner, & Buckner, 2016). There
should be an evidence-based teaching material for the patient to ensure that all the crucial
information is clearly captured. The guidelines outline the hygiene instructions, symptoms of
other complications, catheter use, and ways of preventing CAUTIs among others.
There should also be written guidelines to assist the medical providers in making
decisions whenever faced with certain challenging situations. While some nurses may feel that
nurse education is sufficient for their practice, situations arise in which it becomes difficult to
establish the exact way forward for a certain health care problem. Therefore, the written
guidelines can be easily accessible. According to Johnson, Gilman, Lintner, & Buckner (2016),
guidelines on catheter utilization enhance the delivery of evidence-based, high-quality care (p.
360).
Catheter Care and Maintenance
Sometimes the use of catheters cannot be avoided so effective care and maintenance is an
essential way of reducing the incidence of the CAUTIs. Scholars estimate that a significant
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percentage of the catheter associated UTI is caused by bacteria introduced into the body during
the insertion of the catheters (Johnson, Gilman, Lintner, & Buckner, 2016, p. 355). Thus, the best
approach for reducing these bacterial infections is ensuring that safety guidelines for the catheter
insertion techniques are in place. All health care professionals that will manage patients with
urinary catheters will have to follow the instructions strictly. The use of proper aseptic
techniques during urinary catheter insertion is effective in the reduction of CAUTIs. The
primary objective of an aseptic technique is keeping the risk of contamination at minimal levels.
For optimal safety, indwelling urinary catheters should only be inserted by highly qualified
professionals. Furthermore, the fundamental safety requirements like washing hands before the
catheter insertion should also be followed to the latter. If any of the equipment being utilized for
the insertion is contaminated, then the whole process should be restarted and a new catheter
utilized (Johnson, Gilman, Lintner, & Buckner, 2016).
The routine hygiene of the patients should also be kept at very high standards. The
genital and perianal area of the patient must always be kept very clean. Maintaining high
standards of cleanliness helps minimize the probability of infection. Clean non-sterile gloves
should be used when cleaning these areas. Sterilization of bath basins and other related
equipment is essential for the minimization of hospital-acquired infections (Magers, 2013, p. 35).
The use of antiseptics is not recommended here nor does not even reduce the likelihood of a
catheter infection.
Studies have found reliable evidence regarding the importance of maintaining sterility
after the insertion of the catheter. The urinary system should remain closed to reduce the
chances of introduction of bacteria into the urinary tract (Yates, 2016). Though a regular
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opening of the bag is considered helpful, it should be done only on those occasions when it is
deemed necessary to avoid increasing the chances of infection (Magers, 2013).
Conclusion
The literature reviewed in this paper has pointed out the main ways of mitigating
catheter-associated UTIs. Most of the infections can be effectively avoided if the
recommendations are to be followed. Some of the primary approaches are education and
awareness, catheter care and maintenance, and use of catheters only when deemed necessary to.
Lack of sufficient education on catheter utilization is one basic factor that leads to most CAUTIs.
Nurses, patients, and families of the patients should all be provided with fundamental education
on proper use of urinary catheters, care and maintenance, CAUTI symptoms, and any other
preventive measures to ensure that risk of infection is very minimal. Further, a comprehensive
list of all indications necessitating the insertion of catheters should be in place to ensure that
insertion of urinary catheter is only performed when necessary.
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References
Banks, H., Abdella, R., & Willmann, Y. (2016). Nursing interventions aimed at reducing the
incidence of hospital acquired catheter-associated urinary tract infections. (Bachelor).
Laurea University of Applied Sciences. Retrieved from
https://www.theseus.fi/bitstream/handle/10024/112505/Banks_Hannah.pdf?sequence=1
Holroyd, S. (2016). Innovation in catheter securement devices: Minimizing risk of infection,
trauma, and pain. British Journal of Community Nursing, 21(5).
doi:10.12968/bjcn.2016.21.5.256
Johnson, P., Gilman, A., Lintner, A., & Buckner, E. (2016). Nurse-driven catheter-associated
urinary tract infection reduction process and protocol. Critical Care Nursing Quarterly,
39(4), 352-362. doi:10.1097/CNQ.0000000000000129
Magers, T. L. (2013). Using evidence-based practice to reduce catheter-associated urinary tract
infections. AJN The American Journal of Nursing, 113(6), 34-42.
doi:10.1097/01.NAJ.0000430923.07539.
Purvis, S., Gion, T., Kennedy, G., Rees, S., Safdar, N., VanDenBergh, S., & Weber, J. (2014).
Catheter-associated urinary tract infection: A successful prevention effort employing a
multipronged initiative at an academic medical center. Journal of Nursing Care Quality,
29(2), 141-148. doi:10.1097/NCQ.0000000000000037
Yates, A. (2016). Indwelling urinary catheterisation: What is best practice? British Journal of
Nursing, 25(9). doi:10.12968/bjon.2016.25.9.S4

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