L.Huffman_N494_M08.pptx - EVIDENCE BASED RESEARCH ON...

Unformatted text preview: EVIDENCE BASED RESEARCH ON CATHETER ASSOCIATED URINARY TRACT INFECTIONS LINDSAY HUFFMAN N494: ESSENTIALS OF NURSING RESEARCH 09/16/2018 INTRODUCTION • THIS PRESENTATION WILL DISCUSS A CLINICAL PROBLEM RELATED TO MY NURSING PRACTICE • THIS PRESENTATION WILL DISCUSS THE RESEARCH ASSOCIATED WITH CATHETER ASSOCIATED URINARY TRACT INFECTIONS (CAUTIS) • THIS PRESENATION WILL DISCUSS IMPLEMENTING MEASURES TO PREVENT A CAUTI • THE PRESENTATION WILL DISCUSS HOW TO IMPLEMENT THE CHANGES TO CURRENT PRACTICE • THE PRESENTATION WILL DISCUSS A CHANGE THEORY MODEL CLINICAL PROBLEM IN AN EFFORT TO REDUCE AND PREVENT CAUTIS, I RESEARCHED AND EVALUATED THE USE OF CHLORHEXIDINE FOR PATIENT BATHING AND COMPARED IT TO SOAP AND WATER USE IN FOLEY CATHETER CARE TO DETERMINE IF IT REDUCED CAUTIS IN THE ADULT INTENSIVE CARE UNIT (ICU) POPULATION. LITERATURE CRITIQUE • THE STUDY BY FINK ET AL.,(2012) REVEALED THAT THE USE OF AN ANTISEPTIC SUCH AS CHLORHEXIDINE (CHG) WAS USED ONLY 44% OF THE TIME PRIOR TO INSERTION OF INDWELLING CATHETERS WHEREAS SOAP AND WATER WERE USED OVER HALF OF THE TIME IN THE CURRENT NURSING PRACTICE. • THE NOTO ET AL., (2015) STUDY REVEALED THAT REPEATED USE OF CHLORHEXIDINE CAN LEAD TO ANTIMICROBIAL RESISTANCE. • THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC, 2016) FOUND THAT THE ROUTINE USE OF DECOLONIZATION USING TOPICAL ANTIMICROBIALS SHOULD BE LIMITED TO “HIGH PREVALENCE OUTBREAKS” IN SPECIAL-CARE UNITS. • INCREASING CLINICAL USE OF CHG RAISES THE CONCERN THAT ORGANISMS MAY DEVELOP RESISTANCE TO THE ANTISEPTIC AND TO OTHER ANTIMICROBIALS WITH REPEATED EXPOSURE. RESEARCHERS HAVE FOUND EVIDENCE SUGGESTING AN ASSOCIATION BETWEEN MINIMUM CONCENTRATIONS OF CHG AND RESISTANCE IN COAGULASE-NEGATIVE STAPHYLOCOCCI, GRAM-NEGATIVE BACILLI, AND A SELECTION OF MRSA ISOLATES IN HOSPITAL ICU'S (DENNY & MUNRO, 2017). LITERATURE CRITIQUE • ACCORDING TO AN ARTICLE BY DENNY AND MUNRO (2017), CHG CAN CAUSE MINOR REACTIONS WHEN A PATIENT COMES IN CONTACT WITH IT SUCH AS SKIN IRRITATION, ITCHING, OR BURNING. CHG CAN ALSO CAUSE MORE IRREVERSIBLE DAMAGE SUCH AS CORNEAL INJURIES AND CORNEAL SCARRING WITH INADVERTENT EXPOSURE DURING CHG BATHING. • THE STUDY BY RUPP ET AL., (2012) STATES THERE IS NO SIGNIFICANCE BETWEEN THE USE OF CHLORHEXIDINE BATHING AND THE REDUCTION OF (CAUTIS) WHEN COMPARED WITH NONANTIMICROBIAL BATHING. CAUTI PREVENTION IMPLEMENTATION ENGAGE AND EDUCATE • ORGANIZE A HEALTH CARE TEAM COMMITTED IN PATIENT SAFETY CONTROL PRACTICES • INCORPORATE TOOLS TO BETTER IDENTIFY AND ADDRESS KEY CHALLENGES, FOR EXAMPLE THE CAUTI GUIDE TO PATIENT SAFETY [GPS] IDENTIFY MENTORS TO EDUCATE HEALTHCARE TEAM ON ALL FACETS OF FOLEY CATHETER USE INCLUDING PATIENT EDUCATION, STERILE TECHNIQUE FOR INSERTION, MAINTENANCE, AND REMOVAL PROTOCOLS (FLETCHER ET AL., 2016) IMPLEMENTATION Execute "ABCDE" of prevention of CAUTI's as outlined by the Joint Commission based on evidence-based practice research Adherence to general infection control principles (hand hygiene, surveillance and feedback, aseptic insertion, proper maintenance, education) is important. Bladder ultrasound may avoid indwelling catheterization. Condom catheters or other alternatives to an indwelling catheter such as intermittent catheterization should be considered in appropriate patients. Do not use the indwelling catheter unless you must! Early removal of the catheter using a reminder or nurse-initiated removal protocol appears warranted. CHANGE CURVE MODEL FOR IMPLEMENTATION • THE FIRST STAGE IN THE CHANGE CURVE MODEL IS STAGNATION • LACK OF RESOURCES OR INEFFECTIVE LEADERSHIP CAN CAUSE STAGNATION • IN THIS MODEL, THE STAFF DO NOT FEEL A NEED TO PREVENT CAUTIS BECAUSE THEY FEEL COMFORTABLE IN THE WAY THAT THEY HAVE ALWAYS PERFORMED CATHETER CARE • BY ESTABLISHING A UNIT BASED COUNCIL, OR BRINGING CAUTI PREVENTION TO THE COUNCIL, THE UNIT CAN OVERCOME THIS STAGE (CHRISTENSON, 2015) DUCK’S CHANGE CURVE MODEL • PREPARATION STAGE • THE STAFF MAY BE UNEASY WITH NEW CAUTI PREVENTION METHODS BEING INTRODUCED • A UNIT BASED COUNCIL CAN HELP REDUCE THE UNEASINESS BY HOLDING INFORMATIONAL SESSIONS REGARDING THE NEW CAUTI PREVENTION BUNDLES • IMPLEMENTATION STAGE: • THE COUNCIL WILL ENSURE THE STAFF IS EDUCATED ON THE IMPORTANT OF DAILY CHLORHEXIDINE BATHS ON PATIENTS WITH URINARY CATHETERS. • THE UNIT BASED COUNCIL WILL SHOW STAFF EVERY STEP OF THE PROCESS AND PROVIDE THE MATERIALS NEEDED TO ENSURE THE STAFF SUCCEEDS. (CHRISTENSON, 2015) DUCK’S CHANGE CURVE MODEL • DETERMINATION • UNIT STAFF WILL SEE THE RESULTS OF DAILY CHLORHEXIDINE BATHS • THE RESULTS MAY NOT BE EASILY SEEN AND THE STAFF MAY QUESTION THE VALIDITY OF DAILY CHG BATHS • THE UNIT BASED COUNCIL WILL NEED TO KEEP A VISUAL OR CHART SHOWING THE DECREASE IN CAUTIS ON THE UNIT • FRUITION: • STAFF WILL TRULY SEE A DECREASE IN CAUTS ON THE UNIT • THE STAFF WILL GET BEHIND THE POLICY CHANGE • THE STAFF FEELS THEIR EFFORTS ARE ACHIEVING THE DESIRED RESULTS OF CAUTI REDUCTION (CHRISTENSON, 2015) BARRIERS • LACK OF SUPPORT FROM LEADERSHIP IT WAS DETERMINED THAT PHYSICIANS ARE NOT AWARE OF NURSING PRACTICES IN CAUTI PREVENTION, INFORMATIONAL OR EDUCATIONAL POSTERS ARE USUALLY POSTED IN NURSE BREAK ROOMS WHERE PHYSICIANS ARE NOT LIKELY TO SEE IT; AND MEDICAL DIRECTORS DID NOT COMMUNICATE INFORMATION TO OTHER PHYSICIANS. EVIDENCE SUGGESTS BETTER ENGAGING PHYSICIANS AND THE HEALTH CARE TEAM IN PATIENT SAFETY INITIATIVES. • LACK OF ORGANIZATIONAL INFRASTRUCTURE HOSPITALS OFTEN HAVE HIGHER PATIENT TO STAFF RATIOS, WHICH LEADS TO THE STAFF FEELING THAT THEY DO NOT HAVE TIME TO PERFORM THE CATHETER CARE NEEDED TO PREVENT CAUTIS. HOSPITALS ALSO LACK THE RESOURCES TO AUDIT THE CAUTI PREVENTION BUNDLES, MAKING IT DIFFICULT TO KNOW IF STAFF ARE PERFORMING THE BUNDLES, OR PERFORMING THEM CORRECTLY. (FLETCHER ET AL., 2016) (BALL, MURRELLS, RAFFERTY, MORROW, & GRIFFITHS, 2013) INTERNAL EVIDENCE • CLINICAL EXPERTISE OF STAFF NURSES AND CERTIFIED NURSES ASSISTANTS • UNITS IN THE SAME HOSPITAL WITH FAVORABLE OUTCOMES OF GIVING DAILY CHLORHEXIDINE BATHS • UNITS IN HOSPITAL IMPLEMENTING THE SAME PROJECT AND HAVING THE SAME OUTCOMES CONCLUSION • MORE STANDARDIZED CAUTI PREVENTION BUNDLES AND CONSENSUS THROUGHOUT THE HOSPITAL ON WHAT THE SPECIFIC ACTIONS IN THE BUNDLES SHOULD BE PHYSICIAN EDUCATION ON STANDARD CAUTI PREVENTIONS PRACTICES • MORE INTENSIVE EDUCATION REGARDING CAUTI PREVENTION INCLUDING THE IMPORTANCE OF BUNDLES • NURSE AUTONOMY ON PROMPT REMOVAL OF THE CATHETER • TRAINING AND UTILIZING CAUTI NURSE AMBASSADORS TO ROUND AND EDUCATE THE STAFF AND PATIENTS ON CAUTI PREVENTION (SCANLON ET AL., 2017) REFERENCES BALL, J. E., MURRELLS, T., RAFFERTY, A. M., MORROW, E., & GRIFFITHS, P. (2013). ‘CARE LEFT UNDONE’ DURING NURSING SHIFTS: ASSOCIATIONS WITH WORKLOAD AND PERCEIVED QUALITY OF CARE. BRITISH MEDICAL JOURNAL OF QUALITY AND SAFETY,23(2), 116125. DOI:10.1136/BMJQS-2012-001767 CENTERS FOR DISEASE CONTROL AND PREVENTION [CDC]. (2017). CATHETER-ASSOCIATED URINARY TRACT INFECTIONS. RETRIEVED FROM CENTERS FOR DISEASE CONTROL AND PREVENTION [CDC], (2016). MANAGEMENT OF MULTIDRUG-RESISTANT ORGANISMS IN HEALTHCARE SETTINGS (2006) RETRIEVED FROM: CHRISTENSEN, D. (2015). THE HEALTH CHANGE TRAJECTORY MODEL. ADVANCES IN NURSING SCIENCE, 38(1), 55-67. DX.DOI.ORG/10.1097 DENNY, JANETTE, & MUNRO, CINDY L., (2017). CHLORHEXIDINE BATHING EFFECTS ON HEALTH-CARE-ASSOCIATED INFECTIONS. BIOLOGICAL RESEARCH FOR NURSING 19(2), 123-136. DOI: 10.1177/1099800416654013 FINK, R., GILMARTIN, H., RICHARD, A., CAPEZUTI, E., BOLTZ, M., & WALD, H. (2012). INDWELLING URINARY CATHETER MANAGEMENT AND CATHETER-ASSOCIATED URINARY TRACT INFECTION PREVENTION PRACTICES IN NURSES IMPROVING CARE FOR HEALTHSYSTEM ELDERS HOSPITALS. AMERICAN JOURNAL OF INFECTION CONTROL,40(8), 715-720. DOI:10.1016/J.AJIC.2011.09.017 FLETCHER, K.E., TYSZKA, J.T., HARROD, M., FOWLER, K.E., SAINT, S.,& KREIN, S.L., (2016). QUALITATIVE VALIDATION OF THE CAUTI GUIDE TO PATIENT SAFETY ASSESSMENT TOOL. AMERICAN JOURNAL OF INFECTION CONTROL 44, 1102-09.RETRIEVEDFROM: REFERENCES NOTO, M.J., DOMENICO, H.J., BYRNE, D.W., TALBOT, T., RICE, T.W., BERNARD, G.R., & WHEELER, A.P. (2015). CHLORHEXIDINE BATHING AND HEALTHCARE-ASSOCIATED INFECTIONS: A RANDOMIZED CLINICAL TRIAL. THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 313 (4),369-378.DOI:10.1001/JAMA.2014.18400. RUPP, M. E., CAVALIERI, R. J., LYDEN, E., KUCERA, J., MARTIN, M., FITZGERALD, T., . . .VANSCHOONEVELD, T. C. (2012). EFFECT OF HOSPITAL WIDE CHLORHEXIDINE PATIENT BATHING ON HEALTHCARE-ASSOCIATED INFECTIONS. INFECTION CONTROL & HOSPITAL EPIDEMIOLOGY,33(11), 1094-1100. DOI:10.1086/668024 SAFDAR, N., CODISPOTI, N., PURVIS, S., & KNOBLOCH, M.J. (2016). PATIENT PERSPECTIVES ON INDWELLING URINARY CATHETER USE IN THE HOSPITAL. AMERICAN JOURNAL OF INFECTION CONTROL 44, E23-E24. RETRIEVED FROM: TO AN EXTERNAL SITE. SAINT, S., OLMSTED, R.N., FAKIH, M., KOWALSKI, C.P., WATSON, S.R., SALES, A.E., & KREIN, S.L. (2009). TRANSLATING HEALTH CAREASSOCIATED URINARY TRACT INFECTION PREVENTION RESEARCH INTO PRACTICE VIA BLADDER BUNDLE. THE JOINT COMMISSION JOURNAL ON QUALITY AND PATIENT SAFETY 35(9) 449-455. SCANLON, K.A., WELLS, C.M., WOOLFORDE, L., KHAMERAJ, A., & BAUMGARTEN, J. (2017). SAVING LIVES AND REDUCING HARM: A CAUTI REDUCTION PROGRAM. NURSING ECONOMIC$, 35(3), 134-141. WAKNINE, Y. (2013). HOSPITAL INFECTIONS COST BILLIONS, STUDY SHOWS. RETRIEVED NOVEMBER 03, 2017, FROM ...
View Full Document