PICOT QUESTION:
ADULT SELF
CATHETERIZATION
Purpose
Cather insertion and techniques associated risks
Evidence based strategies in catheter associated urinary tract infections
Self catheterization efficacy improvement through education
Methods of catheterization and their effectiveness in prevention of CAUTI’s
Strategies to ensure the reduction of occurrence and prevalence of CAUTI’s in
home and hospital setup
(Laan & Geerlings, 2019).
Introduction
CAUTI’s problem in long term use
Two techniques
Indwelling
Intermittent
Sterile and aseptic measures to be observed
Self catheterization training for caregivers and patients
Reduction of the occurrence of CAUTI’s in patients
Acquisition of prerequisite training on intermittent self catheterization.
(Gary et al., 2016, Nicolle, 2014)
Literature Review
Meddings, J., Saint, S., Krein, S. L., Gaico, E., Reichart, H., Hickner, A.,
Mody, L.
(2017).
Systematic review of interventions to reduce urinary tract infection in nursing
home
residents. Journal of Hospital Medicine, 12(5), 356-368.
Systematic literature review, abstracted study design
20 peer reviewed articles from Ovid MEDLINE, CINAHL, Cochrane library and
Embase and Web of science
Limited by poor combination for meta-analysis
Prevention of CAUTI’s though various means including intermittent insertion
(Meddings et al., 2017)
Literature Review
Lee, K.-C., Chao, Y.-F., Wang, Y.-M., & Lin, P.-c. (2015). A nurse–family
partnership intervention to increase the self‐efficacy of family caregivers and
reduce
catheter‐associated urinary tract infection in catheterized patients.
International Journal of Nursing Practice, 21(6), 771-779.
Relevance of collaboration between nurses and family caregiver
Qualitative randomized controlled study involving 92 participants
Control and randomized groups
Data collection using questionnaires, analysis using blinded analysts
Training reduced the incidence of CAUTI’s
Limited by the duration conducted and target group
(Lee, Chao, Wang, & Lin, 2015)
Literature Review
Meddings, J., Rogers, M. A., Krein, S. L., Fakih, M. G., Olmsted, R. N., & Saint, S. (2014).
Reducing
unnecessary urinary catheter use and other strategies to prevent catheter-associated
urinary
tract infection: An integrative review. BMJ Quality & Safety, 23(4), 277-289.
Qualitative systematic literature review
Reduction of unnecessary use of urinary catheter and implication
Provide evidence-based practices.
Databases used: MEDLINE and CINAHL 30 articles selected
Statistical ratios to show relationships unnecessary catheterization increased CAUTI’s
Intermittent catheterization prevention strategy
(Meddings et al., 2014)
Literature Review
Mota, E. C., & Oliveira, A. C. (2019). Prevention of catheter-associated urinary tract
infection: What is the gap in clinical practice? Texto
& Contexto –
Enfermagem, 28,
1-12.
Address the gap in clinical practice to prevent CAUTI’s
Qualitative observational study
Preset scripted questionnaire for data collection
Relationship between outcomes, prevention strategies
Catheter insertion, fixation, and poor hygiene lead to CAUTI’s
Limited by participant size
(Mota & Oliveira, 2019)
Literature Review
Parker, V., Giles, M., Graham, L., Suthers, B., Watts, W., O’Brien, T., & Searles, A.
(2017). Avoiding inappropriate urinary catheter use and catheter-associated
urinary tract
infection (CAUTI): A pre-post control intervention study. BMC
Health Services Research,
17, 1-9. doi:10.1186/s12913-017-2268-2
Avoiding inappropriate catheterization
Qualitative, phase-mixed method
500 participants based on bed capacity in two districts
Data collection questionnaires
Analysis on trends of catheterization and outcomes
Time consuming limitation
Inappropriate catheterization: High levels of CAUTI’s
(Parker et al., 2017)
Literature Review
Menegueti, M. G., Ciol, M. A., Bellissimo-Rodrigues, F., Auxiliadora-Martins, M., Gasper,
G. G.,
Canini, S. M., Laus, A. M. (2019). Long-term prevention of catheter-associated
urinary
tract infections among critically ill patients through the implementation of an
educational
program and a daily checklist for maintenance of indwelling urinary catheters.
Medicine
(Baltimore), 98(8), 1-6. doi:10.1097/MD.0000000000014417
Qualitative quasi-experimental study
Prevent occurrence of CAUTI’s through intermittent catheterization and other strategies
12 year period for the study.
Datacollected using questionnares
Training reduced number of CAUTI’s in patients
Limited by the duration of study.
(Menegueti et al., 2019)
Comparison
Hygiene and safety measures in catheter insertion
Multifactorial approach to prevention of CAUTI’s
Education and training on self-catheterization
Avoidance of inappropriate catheterization
Proper hygiene and maintenance
Proper insertion technique to maintain sterility and aseptic
(Meddings et al., 2014; Health Quality Ontario, 2019)
Contrast
Differing durations of study
Methodology
Critically bed ridden patient require indwelling catheter
Varying data analysis methods utilized
Different outcomes and themes highlighted in regards to CAUTI’s
(Health Quality Ontario, 2019)
Picot Question
Problem involves rampant CAUTI’s
Associated with poor insertion technique and break of asepsis
Increased Incidence and Prevalence rates
How well to address the problem to minimize infections
Training and prerequisite requirements from nurses to patient and
family for self-catheterization.
(Laan & Geerlings, 2019).
Application Plan
Application of evidence-based practices.
Provide solutions to research questions
improve quality of healthcare and patient safety
Methodology: Qualitative, systematic literature analysis and review
Phenomenological research study design
Views and perspectives collected and analyzed.
(Health Quality Ontario, 2019; Laan & Geerlings, 2019)
Application Plan
Criterion for selection of articles for review,
Terminologies used to search for the articles
Data sources including MEDLINE, CINAHL, Elsevier, Cochrane library, Web of Science, and
Ovid
Meta-analysis of the data collected
Systematic review of literature in articles
Total of 20 articles selected
(Meddings et al., 2014).
Application Plan
Data analysis through systematic review
Data analysis software
Quantifiable and measurable data from questionnaires and other articles
Assessment of the strategies utilized and impact made on outcomes
Indicate role of training and education
(Meddings et al., 2017)
Application Plan
Reduction of prevalence and incidence of CAUTI’s
Reduction in the inappropriate and unnecessary catheterization of patients
Self catheterization efficacy
Promotion of the safety measures and hygiene
Duration of the stay with catheter reduced.
Risk reduction
(Nicolle, 2014).
Impact in Practice
Provision of evidence-based practices
Improved healthcare
Selfcare efficacy
Reduction of CAUTI’s
Proper hygiene
Preference for intermittent catheterization
(Health Quality Ontario, 2019).
Conclusion
Education and training on self catheterization
Intermittent catheterization more effective at home than in critical care hospitals and scenarios.
Hygiene important determinant of CAUTI prevalence
Decreased infection with implementation of prevention strategies
(Health Quality Ontario, 2019).
References
Gary, D., Nussel, R., Cruz, A., Kane, G., Toomey, M., Bay, C., & Ostovar, G. A. (2016).
Effects
of
a catheter-associated urinary tract infection prevention campaign on infection rate, catheter
utilization, and health care workers’ perspective at a community safety net hospital. American
Journal of Infection Control, 44(1), 115-116. doi: 10.1016/j.ajic.2015.08.011
Health Quality Ontario. (2019). Intermittent catheters for chronic urinary retention: A health t
echnology assessment. Ontario Health Technology Assessment Series, 19(1), 1-153.
Laan, B. J., & Geerlings, S. E. (2019). Non-antibiotic prevention strategies against catheter-
associated urinary tract infections. The Lancet, 19(6), P562-P564.
Lee, K.-C., Chao, Y.-F., Wang, Y.-M., & Lin, P.-c. (2015). A nurse–family partnership
intervention to increase the self‐efficacy of family caregivers and reduce
catheter‐associated
urinary tract infection in catheterized patients. International
Journal of Nursing Practice,
21(6),
771-779.
Meddings, J., Rogers, M. A., Krein, S. L., Fakih, M. G., Olmsted, R. N., & Saint, S. (2014).
Reducing unnecessary urinary catheter use and other strategies to prevent
catheter-associated
urinary tract infection: An integrative review. BMJ Quality &
Safety, 23(4), 277-289.