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UROLOGIC NURSING / November-December 2018 / Volume 38 Number 6273Annette Ferguson, DNP, MSN, RN, CNE,is an Associate Professor, Marshall University School of Nursing, Huntington, WV.Implementing a CAUTI Prevention Program in an Acute Care Hospital SettingAnnette FergusonHealthcare-associated infections are the most common complication of an inpatient hospi-talization (Agency for Healthcare Research and Quality, 2015). Catheter-associated urinary tract infections (CAUTIs) are the fourth leading cause of health-care-associated infections in acute care hospitals in the United States (Magill et al., 2014). A CAUTI is a urinary tract infection that occurs in a patient who has (or had) an indwelling urinary catheter in place at the time of or within 48 hours prior to the onset of infection. According to the Centers for Disease Control and Prevention (CDC) (2012), 15% to 25% of patients who are admit-ted to the hospital will have a urinary catheter inserted at some point during their stay, placing them at risk of developing a CAUTI. Annually, an estimated 13,000 deaths are attributed to CAUTIs. In addition, they are the leading cause of secondary bloodstream infections, with a mortality rate of approximately 10% (CDC, 2012). The impact of CAUTIs to the patient and the healthcare sys-tem include patient discomfort, increased mortality, longer length of hospital stay, and high-er healthcare costs. The average cost to treat a single patient with a CAUTI is estimated to be $758 with an annual cost of over $340 billion in the United States (Centers for Medicare and Medi -caid Services [CMS], 2016). Currently, no costs associated with the treatment of a CAUTI are reimbursable; they must be absorbed by the healthcare entity. This practice dates back to 2008, when CMS identified CAUTI as a hospital-acquired condition, thus prompting hospitals across the country to implement CAUTI prevention programs. A health-care organization that continues to experience CAUTIs may be penalized through a reduction in Medicare payments. Robust, cost-effective interventions designed to reduce the negative outcomes and burden of CAUTIs are imper-ative. A CAUTI can occur in multi-ple ways during urinary catheteri-zation and may include the migra-tion of bacteria from the urethra, rectum, or vagina; contamination from healthcare provider hands; a break in the sterile field during catheter insertion; or from manip-ulation of the collection system (CDC, 2012). The risk of bacteri-uria (bacteria in the urine) from an indwelling urinary catheter is 3% to 10% per day and reaches 100% after 30 days (Seckel, 2013). Therefore, one major risk factor for a CAUTI is having an indwelling urinary catheter in place for an extended period. Additional risk factors include a disconnection of the drainage sys-tem and having lesser-trained pro-fessionals insert urinary catheters (CDC, 2012). Nurses can play a key role in preventing CAUTIs among hospitalized patients, and subsequently, impact the out-comes and burden of CAUTIs by adhering to evidence-based prac-tice guidelines.
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