Adult self Catheterization

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.

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