Annotated Bibliography – 213 Project

Table of Contents

Annotated BibliographyAmanda PeregoyFayetteville Technical Community CollegeThe topic I have chosen, is National Patient Safety Goal 07.06.01 – Use proven guidelines to prevent infections of the urinary tract that are caused by catheters. Focus will be on Teaching & Learning, utilizing evidence based practice. According to DHHS, catheter associated urinary tract infections (CAUTIs) in NC in 2013 occurred in 1.23-3.57 per 1,000 catheter days. This is a preventable infection, that leads to longer hospital stays, larger incurred costs for the facilities, and the possibility of increased patient harm, including death. Decreasing, if not eliminating this hospital acquired infection is an understandable priority, and since I will be working on a floor that handles surgical urology patients, I feel it is an important one to research.Annotated BibliographyIgnatavicius, D. D., Workman, M. L., Blair, M., Rebar, C. R., & Winkelman, C. (2016). Medical-surgical nursing: Patient-centered collaborative care (Eighth ed.). Saunders.states that the best practice for patient safety and quality care is to assess the need for a foley catheter daily. The reason for this, is that the length of time that a patient has a catheter is the best way to predict whether or not that patient will get a catheter-associated urinary tract infection. Essentially, the longer a catheter is in place, the more likely an infection will occur. The text states that besides removing a catheter as soon as possible, other options should be utilized, if available, instead of the foley catheter, to help prevent an infection. For example, using an external catheter on male patients, if appropriate. Ignatavicius, D.D. (2016) also gives guidelines for best practice when a foley catheter must be used, such as utilizing sterile technique, providing daily perineal and catheter care, anchoring the catheter to the patient using a catheter securing device, ensuring the bag is never more than half full and held below the level of the bladder at all times, and ensuring that the closed system is maintained at all times. This text was published in two years ago, in 2016, so it contains the most current scholarly and evidence-based practice up to that point. The purpose of this book is for the education of potential new nurses, so the information must be accurate and up to date. The text also has multiple authors, all of which are proficient in their areas of practice, so the information contained is undoubtedly fact checked. The information regarding care of the catheter to prevent infection has been tested again and again and is policy in many facilities. For these reasons, this text is a valid source for catheter-associated urinary tract infection education. This source is mainly utilized by student nurses and nurse educators, so it is very useful in general. The text presents the information about CAUTIs and prevention in a simple and logical way, that provides simple ways for students to prevent infections in their future practices. The usefulness of the book may extend beyond the school setting, as it can be utilized by practicing nurses as well as students. Nicolle, L. E. Catheter Associated Urinary Tract Infections. Antimicrobial Resistance and Infection Control, BioMed Central, 7 July 2014, the cause and prevention of CAUTIs seems to be pretty standard across the board, but until catheters are created using better materials, CAUTIs cannot be entirely eliminated. On the National Institutes of Health website, Nicolle, L.E. (2014) mentions the same information cited everywhere else; that CAUTIs are directly correlated to the use, and length of use, of foley catheters, and that evidence-based practice prevention methods include creating guidelines for the use of, insertion process, and utilization of daily indicators to determine the continued need. However, this author also states that the actual cause of CAUTIs is the biofilm that inevitably covers the surface of catheters. This biofilm contains the actual microorganisms that cause infection. Daily perineal and catheter care can help to remove this biofilm, hopefully before an infection occurs, but Nicolle, L.E. (2014) states that creating a catheter using materials that prevent this biofilm from ever forming is paramount in the future prevention of catheter associated urinary tract infections. The author of this piece is Lindsay E. Nicolle, who is a professor in the Department of Internal Medicine and Medical Microbiology at the University of Manitoba. She is also an infectious diseases consultant, and the chair of the Biomedical Research Ethics Board at the University of Manitoba. She received her M.D. from the University of Manitoba in 1974, and her Certificate of Special Competence in Infectious Disease in 1983. She is a recognized leader in area of practice, and a primary reason for the validity of the information contained on this page of the website. Her article was published on the NIH website in 2014, so it is current and utilized by a reputable organization.I chose to include this website because this piece is primarily focused on future advancements in the prevention of CAUTIs, rather than just noting the current best evidence-based practice. This is important and relevant to nursing practice, because it emphasizes the need for future research. Improving on current best practices should be the driving force for everyone’s patient care. Good enough should not be considered okay, and if someone in research is able to take the information from Nicolle and can actually develop a catheter that prevents the biofilm from forming, CAUTIs and their detrimental effects on the healthcare system could be entirely eliminated and a thing of the past. Strosahl, J. K. (2014). Utilizing a Central Line and Foley Catheter Daily Indicator to Decrease Central-line Associated Blood Stream and Catheter-associated Urinary TractInfections. American Journal of Infection Control, 42(6), S48. Doi:10.1016/j.ajic.2014.03.125 utilized a prevention tool for the management of both CLABSIs and CAUTIs. The research article covers the utilization of a daily indicator to help determine if a catheter should remain in place or not. It used a standardized form that was attached to the charts of patients in a 20-bed ICU that currently had a foley catheter in place. The form was used over a 3-month period. Each night, the ICU nurse was in charge of completing the form. The form would then be discussed at change of shift, to determine if a catheter was still necessary; with the idea being to remove the catheter as soon as safely possible. It is important to note that staff were educated on when catheters were appropriate, and for what reasons they should remain in place. Education and input was provided to, and given by, both nurses and physicians, since physicians would need to write the actual order for catheter removal. The form simply gave the nurses a platform to suggest or request the removal of a catheter. The form created an environment where nurses were advocating for their patients, and beginning the conversations leading to catheter removal. This led to a decrease in both catheter days and CAUTI rates for the unit.            This source is valid for many important reasons. First, it is an article that was written within the past 5 years, so the research is current. It was also published in the American Journal for Infection Control, so it meets certain standards. It utilizes evidenced-based practice to show that it is a viable option for decreasing not only the number of catheter days, but also the number of CAUTIs. The test can easily be duplicated, and it was successful in this trial, reducing the utilization of catheters and subsequent infections. By educating staff on when catheters are appropriate, we can advocate for our patients. Having an agreed upon utilization checklist will help make conversations with physicians easier and more productive, which will in turn keep our patients safe.             The usefulness of this source in nursing practice is obvious. By creating a checklist that can be duplicated, this option for reducing CAUTIs can be utilized in different facilities easily. The form can be changed to fit specific policies that vary from location to location, and results can be shared between hospitals and other operations easily. The importance of preventing nosocomial infections cannot be denied, and the evidence from this study should be considered in every day practice. Parry, M., Grant, B. and Sestovic, M. (2013). Successful reduction in catheter-associated urinary tract infections: Focus on nurse-directed catheter removal. American Journal of Infection Control, 41(12), pp.1178-1181.created a nurse-driven protocol that was tested at a 300-bed teaching hospital, to see if it was possible to reduce the utilization of catheters in addition to reducing CAUTI rates. The test ran over a 36-month period and resulted in a 50% reduction in the use of catheters and a 74% reduction in the instance of CAUTIs facility wide. They noted that certain units had lower or higher instances based on their reduction efforts. The protocol required elements tied to the physician’s insertion order, including insertion criteria, documentation included in physician notes, and bi-weekly unit feedback regarding the rates of use and CAUTIs across multiple discipline areas. By having everyone involved, and using the nurse’s advocacy position during feedback, they were able to substantially cut back on the overuse of foley catheters, which decreased CAUTI rates. This journal article is on the older end of acceptable, but it is still very valid. Despite being right at 5-years old, the information included in this study can easily be replicated, and the length of the study in addition to the impressive reduction rates of both catheter use and CAUTI rates makes it a valid source to consider. The length of the study shows that this is sustainable, and not just a short-term fix, and the reduction rates show that this method works. The article is written by an M.D. and two RNs who are all in the Department of Infectious Diseases and Infection Prevention at Stamford Hospital. Using individuals from different areas of practice allows for a well-rounded journal article with regards to the differences in practices. I chose this article, as well at the Stroshal, J. K. (2014) article, because they both include methods that can easily be established at different facilities. This is important, because any individual, from a new grad nurse to a UAP, can take these journal articles to others within their facility and suggest a change to improve the care of their patients. Preventing these infections is possible, and by finding evidence-based practice that can be implemented elsewhere is vital to the care and safety of patients everywhere. Reducing the instance of infection by even one patient is incredibly important.