Running Head: NURSING PICOT QUESTION 1
NURSING PICOT QUESTION 6
PICOT Question Pape
Bo
ie Brown, RN, AND
NRS 493 Professional Capstone and Practicum
Grand Canyon University
11/02/2020
The PICOT Question
Patient Problem (P)
Catheter Associated Urinary Tract Infection (CAUTI)
Intervention (I)
Use of Antibiotics
Comparison (I)
Intermittent catheterization
Outcome (O)
Prevention and treatment of CAUTI
Time (T)
10 weeks
Identification of Clinical Problem Resulting into Positive Patient Outcomes
Catheter Associated Urinary Tract Infection (CAUTI) needs to be considered as one of the most common infections, which an individual might suffer from in a hospital. It would be essential to understand that the use of indwelling catheters has been identified as one of the most common causes of this infection.
This is majorly because indwelling catheter is a tube like apparatus, which is inserted into the urethra in order to facilitate the drainage of bladder. Therefore, it is evident that individuals or patients, which had undergone some sort of surgery and are unable to control their bladder, are at a higher risk of CAUTI. Infection causing agents such as bacteria and fungi might enter the urinary tract through catheter.
Catheter might be contaminated before the use or might get contaminated upon insertion, non-frequent emptying of the drainage bag, backward flow of urine from the catheter bag into the bladder, improper cleaning of the catheter tube and much more are some of the potential ways, which could lead to contamination of catheter; thus, facilitating CAUTI. Use of antibiotics is one of the most effective treatments for CAUTI; however, other alternative methods can also be used to prevent the infection, which is discussed below.
Description of Problem in Relation to:
1. Evidence-Based Solution
Pereira, Nguyen and Stevermer XXXXXXXXXXmentioned that bacterial and fungal agents from urine are responsible for urinary tract infection (UTI) and indwelling catheters, once inserted are not removed frequently. Thus, allowing infection-causing agents to grow and multiply leading to the development of CAUTI. Use of antibiotics such as nitrofurantoin, ciprofloxacin, cephalosporin and rimethoprim or sulfamethoxazole can significantly reduce the rate of CAUTI. Cai et al XXXXXXXXXXmentioned that use of antibiotics led to absolute risk reduction by 5.8%. Risk of CAUTI development was 5.8% higher within the control group compared to the group treated with antibiotics.
2. Nursing Intervention
Along with the use of antibiotics as a solution for CAUTI, replacing indwelling catheterization with intermittent catheterization can also help in reduction of CAUTI. McNeill XXXXXXXXXXsupported this argument through the fact that, intermittent catheterization involves the insertion of catheter only when required that is, few times a day in order to drain the bladder instead of leaving the catheter inside, which facilitate infection. Likewise, using two nurse check for a clean and sterile catheter insertion is also essential in order to avoid the growth of bacteria and fungi facilitating UTI.
3. Patient Care
Patient care would include taking care of the patients, which require catheter and maintenance of aseptic environment is one of the basic and non-negotiable requirements. Further, patient care also includes the provision of well trained for using the catheters among the post-operative patients. Prevention of inappropriate short-term catheter use along with nurse driven timey removal of catheters is required in order to prevent the development of CAUTI. Likewise, urinary catheter care during placement is also mandatory to prevent the development of CAUTI among post-operative patients.
4. Health Care Agency for CAUTI
It would be essential to understand that there is no specific agency designated for CAUTI because it is not a chronic disorder. However, Center for Disease Control and Prevention (CDC) has provided with some information related to CAUTI along with the prevention guidelines. Further, CDC has also provided with some guidelines in collaboration with other organizations for the development of guidelines for prevention of CAUTI and other infections (CDC, XXXXXXXXXXLikewise, the Agency for Healthcare Research and Quality (AHRQ) has also provided with the guidelines along with tool kits, which can used in hospitals to prevent the development of CAUTI among patients and to improve the safety culture at the unit (AHRQ, 2020).
5. Nursing Practice
As presented above also, improvements in nursing practice can surely prevent the development of CAUTI. There are three areas, which require improvements in order to reduce the rate of CAUTI and these are as followed. First nursing practice would be to assign only trained nurses for handling of catheter among postoperative patients in order to avoid any kind of infection. Further, prevention of inappropriate short-term catheter use is another nursing practice, which could be replaced by intermittent catheterization in order to avoid CAUTI. Provision of education bundles to nurses as well as at the hospital, units would allow creation of awareness regarding CAUTI and urinary catheter care during placement (Pashnik, Creta & Alberti, 2017).
References
AHRQ, XXXXXXXXXXToolkit for Reducing CAUTI in Hospitals Retrieved from https:
www.ahrq.gov/hai/tools/cauti-hospitals/index.html
Cai, T., Cocci, A., Verze, P., Rizzo, M., Palmieri, A., Liguori, G., ... & Wagenlehner, F. M XXXXXXXXXXThe use of oral Fosfomycin-trometamol in patients with catheter-associated urinary tract infections (CAUTI): new indications for an old antibiotic? Journal of Chemotherapy, 30(5), XXXXXXXXXX
CDC, XXXXXXXXXXCatheter-associated Urinary Tract Infections (CAUTI) Retrieved from https:
www.cdc.gov/hai/ca_uti/uti.html
McNeill, L XXXXXXXXXXBack to basics: How evidence-based nursing practice can prevent catheter-associated urinary tract infections. Urologic Nursing, 37(4), XXXXXXXXXX
Pashnik, B., Creta, A., & Alberti, L XXXXXXXXXXEffectiveness of a nurse-led initiative, peer-to-peer teaching, on organizational CAUTI rates and related costs. Journal of Nursing Care Quality, 32(4), XXXXXXXXXX
Pereira, S., Nguyen, L., & Stevermer, J. J XXXXXXXXXXPURLs: A simple way to reduce catheter-associated UTIs. The Journal of Family Practice, 63(5), E10
Running head: Capstone Project 1
Capstone Project 8
Capstone Project Topic Selection and Approval
Bo
ie Brown, RN, AND
NRS 493 Professional Capstone and Practicum
Grand Canyon University
11/01/2020
Question 1
Problem
A urinary bundle (UTI) includes any part of the urinary system, including the urethra, bladder, ureters, and kidney. UTIs are the most notable kind of clinical administration related infection according to the Public Medical services Wellbeing Organization (NHSN). Among the UTIs acquired in the hospital, roughly 76% are related to a urinary catheter. Between 10-20% of hospitalized patients who get urinary catheters during their crisis, remains in place after discharge. The most critical factor for a catheter-related urinary tract infection (CAUTI) is drawn out usage of the urinary catheter (Hollenbeak, & Schilling, 2018).
Intervention
Five segment intervention: (I) two nurse check for a sterile insertion of catheter (ii) a bedside catheter update; (iii) multidisciplinary instructive mission; (iv) organized catheter request with a set care plan; and (v) convention for post-catheter expulsion care.
Quality initiative
An observational examination should be coordinated to assess the impact of a CAUTI to improve quality counteraction group including the establishment of wide normal urinary catheter expansion and backing practices. Step by step review of catheter needs, plus a study of all CAUTIs should be implemented.
Educational need
The motivation behind this undertaking is to build up a training program for basic consideration on preventing CAUTIs, along the lines diminishing CAUTIs in patients.
Question 2
Context
Today, CAUTIs stay one of the essential drivers of nosocomial contamination (CDC, XXXXXXXXXXRegardless of progressively forceful endeavours to decrease the pervasiveness of CAUTIs, cu
ent evaluations demonstrate that half of the all hospitalized patient getting indwelling catheter don't have the relating documentations concerning the use of proof-based measures for this clinical choice (Weldons, XXXXXXXXXXThe enlisted attendants (RN) in the undertaking's on critical care units were new to utilizing proof-based packs to direct their practices, fundamentally under the watchful eye of patient who have an indwelling catheter. The latest rules from the Medical services Contamination Control Practices Warning Advisory group focused on the requirement for contamination counteraction by restricting both the utilization of catheters, and the term of utilization to diminish the quantity of nosocomial urinary lot contaminations (UTI; Weldon, 2013).
Question 3
Urinary lot disease ascribed to the utilization of an inhabiting urinary catheter is one of the most well-known contaminations obtained by patients in medical care offices. As biofilm eventually collects on these gadgets the significant determinant for the advancement of bacteriuria is the span of catheterization. While the extent of bacteriuric subjects who create indicative contamination is low, the high recu
ence of the utilization of indwelling urinary catheters implies there is a considerable weight attributing to these diseases. Catheter-obtained urinary contamination is the hotspot for about 20% of scenes of medical care gained bacterium in intense consideration offices, in over half in long haul care offices (Maharjan, et al, 2018).
Question 4
Urinary plot diseases are regular in women, and numerous women experience more than one contamination during their lifetimes. Danger factors explicit to women include:
· Female life systems. A lady has a more limited urethra than a man does, which a
eviates the separation that microbes must venture out to a
ive at the bladder.
· Sexual movement. Explicitly dynamic women will in general have more UTIs than do women who aren't expressively unique. Having another sexual associate also grows the likelihood of infection.
· Particular sorts of contraception. Women who use stomachs for contraception, and as women who use spermicidal pros may be at higher risk.
· Menopause. After menopause, a diminish of estragon causes changes in the urinary parcel that make woman more powerless against defilement.
Question 5
Significations
The undertaking may impact understanding fulfilment, quiet results, unit adequacy, and operational strengthening. The consequences of the exploration may be applied to the units and floors other than the CCU region. Different clinics and medical care destinations inside the intense and long-haul region of the wellbeing framework can utilize the task's outcome to forestall CAUTI. Cautious utilization of preventive measures can prompt better understanding of results. Maintaining proof-based conventions can definitively diminish the event of inhabiting catheterization in hospitals (Paridas and Mishras, 2013) Preventing medical care related disease in general and CAUTIs explicitly has emerged as a need in the US, with government organizations playing an essential function in this exertion. CAUTIs was the first hospital-acquired issue chosen by the Habitats for Government Health Care and Medicaid’s Administrations in 2008 as the balance for the disavowal of extra instalment to clinics (Holy person et al., 2017).
Question 6
CAUTIs are appropriate to nursing practice since attempts to thwart CAUTIs by nursing staff can achieve certain patient outcomes. The CDC XXXXXXXXXXhighlighted that CAUTIs can achieve a wide group of disa
ays for hospitalized patients, including prostatitis, epididymitis, and orchitis in folks, and cystitis, pyelonephritis, gram-negative bacteraemia, endocarditis, verte
al osteomyelitis, septic joint agony, endophthalmitis, and meningitis. These traps can change into raised patient burden,