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C361 Task 2
4 C. Research Articles and Search StrategyKeywords utilized in the search for research articles with the identified problem are: catheter associated urinary tract infection, hospital acquired infections, bundle methods and prevention of CAUTI, reimbursement methods and HAIs, nosocomial infections, evidence based practice, and sterile techniques for insertion of indwelling catheters. Using the keywords listed above, the results of the search were variant. The search that resulted in the articles with the most pertinent information, had a total of 670 articles between the years 2013 and 2018. Using additional keywords and other filters, the search was narrowed down after reviewing nearly 30 articles. Research articles reviewed included 8 quantitative studies, 7 qualitative studies, 4 separate guidelines for quality improvement, 2 case control studies, 3 randomized clinical trials, and 2 studies using meta-analysis. The first article chosen to include in this report is titled, “Including Catheter-Associated Urinary Tract Infections in the 2008 CMS Payment Policy: A Qualitative Analysis”. The study is a qualitative research design and utilizes evidence level III. The researchers analyzed data from the CMS and the policy to deny reimbursement for CAUTIs and the effect on hospitals. The author mentions of all HAIs, 40% of those are related to CAUTIs. The author makes an important observation linking quality care to reimbursement. (Palmer et al., 2013) The next article chosen is a quantitative research design. Evidence level III. It is titled, “Successful strategy to decrease indwelling catheter utilization rates in an academic medical intensive care unit.” The authors of this study used a multidisciplinary approach to combat the incidences of CAUTI among ICU patients. Physicians, residents, and nurses were all included in C361 Task 2
5 the implementation of CAUTI reduction strategies. At the beginning of the study, the rate for CAUTIs was noted at 5.27. Authors implemented a specific set of diagnosis criterion in which an IUC was to be utilized. After successful implementation of strategies including: intermittent catheterization, specialty beds for immobile patients, and cleansing agents, they were able to reduce the incidence rate to 1.75, nearly 67%. Authors emphasized the importance of a multidisciplinary approach when attempting to reduce incidence rates of HAIs including CAUTIs. (Gupta, S. S. et al, 2017) The next article chosen is a quality improvement article. It is a non-research article, material level V. The article is titled, “The Effect of Implementing a Comprehensive Unit-Based Safety Program on Urinary Catheter Use”. Discussion is based around quality improvement initiatives related to indwelling urinary catheter use. The objective of this study was to measure the effects of a specific intervention to reduce or prevent CAUTIs through the implementation of quality improvement strategies. The author was able to utilize this Comprehensive Unit-Based Program (CUSP) to reduce CAUTIs by nearly 19%. (Underwood, L. 2015)