NURS FPX 8030 Assessment 5 Creation of Policy or Procedure

Name

Capella University

NURS-FPX8030

Prof. Name

October, 2024

Hospital Policy Template

Subject/Title of Policy:

Infection Prevention and Control Policy for Catheter-Associated Urinary Tract Infections (CAUTIs) 

Purpose: 

CAUTIs pose a significant concern for patient safety in hospitals, among other healthcare facilities, where patients may have a high rate of catheter use (Krocová & Prokešová, 2022). There is an association between the incidence of CAUTIs and complex patient conditions, prolonged hospital stay periods, and elevated treatment expenses. The primary issue with CAUTIs is the inconsistent implementation of best practices related to catheter insertion and management. Extended catheter usage and unsanitary hygiene practices are some of the causes that have been brought out which lead to a high infection rate more often. Closing these gaps with a sound policy is urgently needed to improve patient safety and reduce the burden of CAUTIs in the hospital.

CAUTIs can be controlled by ensuring standardized protocols for catheter care. According to studies, sharp reductions in the occurrences of CAUTIs can be brought about by implementing standardized protocols for catheter care  (Shadle et al., 2021). From the guidelines and infection rates available, it is evident that catheter care, based on evidence-based practice, improves the outcomes. The revised PICO(T) question would then be as follows: In the patients who have a urinary catheter, how does implementing standardized catheter care practices (I) compared with usual care (C) reduce the occurrence of CAUTIs (O) in six months (T)? In this respect, the development of such a policy is important to ensure uniform implementation of evidence-based infection prevention practices, thus reducing incidences and improving patient safety as a whole.

Population Affected by the Policy: 

The policy will encompass all adult patients who need catheter use within their hospital stay in surgical, critical care and long-term care units. The interventions within the policy include those at high risk of developing CAUTIs due to prolonged usage of a catheter. Pediatric patients and those who do not need catheterization are excluded from this policy because its primary purpose is to minimize infection among adults who require catheterization.

Definitions: 

1. CAUTI: CAUTI is defined as a urinary tract infection that has begun in the patient who, at the onset of the infection, has had a urinary catheter in place for more than two days due to catheter entry of bacteria into the urinary tract (Rubi et al., 2022).
2. Urinary Catheter: This is a sterile flexible tube that may be introduced through the urethra into the bladder and left in place to provide easy access to drain the urine from a patient when it is impossible for them to urinate normally due to surgery, injury, or illness (Czwikla et al., 2023).
3. Catheterization: The procedure involved placing a urinary catheter in the bladder to allow for urine drainage (Reid et al., 2021).
4. Sterile Technique: It is a group of infection control practices that prevent contamination during clinical activities. Toilets and equipment are devoid of microorganisms  (Costa et al., 2020).
5. Intermittent Catheterization: A technique where the catheter is placed temporarily to drain the bladder, then removed later instead of catheterization for a long time (Engberg et al., 2020). 
6. Indwelling Catheter: It’s a catheter that is left inside the bladder for some time and often attached to a drainage bag through which urine will continue to drain out (Miranda et al., 2023).
7. Nosocomial Infection: This can be referred to as hospital-acquired infection, referring to an infection that a patient acquires during treatment in a medical facility not associated with his or her presenting condition (Firmansyah et al., 2020).
8. Bladder Irrigation: One procedure for flushing a bladder that either has some sort of obstruction or debris so it can be cleaned out, often on a patient with an indwelling catheter (Ziadeh et al., 2021).
9. Antimicrobial Resistance (AMR): Microorganisms, such as bacteria and viruses, can become resistant to antimicrobial medications, which once were effective in treating infections caused by them (Tandan et al., 2022).
10. Evidence-Based Practice (EBP): The best available current research evidence plus the patient’s preferences related to their care are combined with the practitioner’s clinical expertise for the process of making clinical decisions so that patients can achieve the best results possible in healthcare (Zammar, 2022).

Policy Statement:

 The organization is dedicated to implementing this CAUTI prevention policy within the next six months, thereby standardizing catheter usage practices in all the departments involved. The implementation of the policy will decrease infection rates by promoting evidence-based procedures in catheterization; employee training and improvement, and by being very stringent in terms of sterile techniques. This is in the hope that incidences of CAUTIs will be cut drastically, with desirable effects on patient outcomes as well as the general safety of patients affected (Katie, 2021). This project, in itself, promotes the organization’s commitment to high-quality, safe, and effective care for all patients.

Procedure:

1. Training of Health Professionals

• Timeline Period: Weeks 1-4.
• Description: Design and present required training for all the healthcare professional groups: physician, nursing, and allied health staff. The focus would be on providing the most recent evidence-based practice to prevent Catheter-Associated Urinary Tract Infections and urinary catheter appropriate care. Topics for the training would include hand hygiene, catheter insertion by sterile conditions, catheter maintenance procedures, and patient education.

Responsibilities:

• Training Coordinators: Design training documents, and handouts.
• Departmental Heads: Facilitate all staff in receiving the training course within the provided time frame.
• Resources to be Utilized: Training books, didactic materials, PPE for demonstration, and audio-visual facilities

2. Standardized Protocol Implementation

• Timeline Period: Week 5-8
• Action Plan Outline: Implement universal guidelines for catheterization with maintenance with an emphasis on the prevention of CAUTIs. Checklists at the time of catheterization will be implemented along with rigorous sterilization procedures and regular assessments about the catheter’s need and its condition daily. 

Roles and Responsibilities:

• Clinical Teams: The care teams should follow the standard guidelines and checklist at the time of placing and maintenance of the catheter.
• Nursing Staff: Assess the catheter sites at least once daily and inform patients about potential signs of infection.
• Supplies Needed: Kits for central lines, checklists for protocols, and sterilization supplies.

3. Monitoring and Auditing

• Timeline: Weeks 9-12
• Description: A good monitoring system should follow through on the adherence to the new protocols, areas of lapse, and where improvements are needed. This monitoring system could also include scheduled catheter insertions and maintenance audits that also give prompt feedback to the different health care teams about their compliance level.

Responsibilities: 

•  Infection Control Team: Conduct an audit of data and collect compliance data, report on your findings to stakeholders.
• Supervisors: Check and correct compliance violations as soon as possible.
• Supply Needed: Audit tools, forms for gathering data, and reporting software

4. Continuous Quality Improvement

• Timeline: Week 13 onwards
• Description: Establish a framework to continuously improve quality. This framework may, for example, include regular meetings where the infection rates are discussed, problems faced, and protocols updated as a result of these problems. Ensure there is constant feedback from staff and patients as part of the process of changing procedures. The responsibilities will include:
• Quality Improvement Committee: Organize review meetings and recommend changing the protocols when necessary.
• Healthcare Providers: Attend feedback sessions and are involved in the quality improvement process. 
• Supplies Needed: Agenda for meeting, protocols, updated, and infection rate statistics

5. Outcome Evaluation

• Time: End of Month 6 ;
• Activity: Compare the impact of introducing the policy regarding CAUTI rates at baseline and after new procedures. Compare the incidence of CAUTIs to find out if the new procedures have reduced the number of infections.  ;

Responsibilities 

• Infection Control Team: Analyze the data collected and create a report on the findings and results. 
• Executive Leadership: Read the report, making informed decisions about future actions and changes in policy, if necessary. 
• Supplies Needed: Statistical software, CAUTI rate data, templates for reporting.

NURS FPX 8030 Assessment 5 References:

Costa, R., Montenegro, H. R., Silva, R. N., & Almeida, A. J. (2020). The role of central sterile supply department nursing team members: an integrative review. Escola Anna Nery, 24, e20190316. https://www.scielo.br/j/ean/a/QnTJBVXYgLKwPQCJgpmzbZp/?lang=en

Czwikla, J., Wandscher, K., Helbach, J., Maximilian, F., Schmiemann, G., & Hoffmann, F. (2023). Prevalence of indwelling urinary catheters in nursing home residents: systematic review. International Journal of Nursing Studies, 145, 104555–104555. https://doi.org/10.1016/j.ijnurstu.2023.104555

Engberg, S., Clapper, J., McNichol, L., Thompson, D., Welch, V. W., & Gray, M. (2020). Current evidence related to intermittent catheterization. Journal of Wound, Ostomy & Continence Nursing, 47(2), 140–165. https://doi.org/10.1097/won.0000000000000625

Firmansyah, A., Lismayanti, L., & Kurniawan, D. (2020). Overview of nurse’s knowledge about nosocomial infection: literature review. JURNAL VNUS, 2(2), 79–90. https://doi.org/10.52221/jvnus.v2i2.154

Katie, R. (2021). Strategies to decrease CAUTI rates in hospitalized patients: an integrative review. Scholars Crossing. https://digitalcommons.liberty.edu/doctoral/3156/

Krocová, J., & Prokešová, R. (2022). Aspects of prevention of urinary tract infections associated with urinary bladder catheterization and their implementation in nursing practice. Healthcare, 10(1), 152. https://doi.org/10.3390/healthcare10010152

Miranda, M. Q., Rosa, M. R., Castro, M. C., Fontes, C. B., & Bocchi, S. M. (2023). Nursing protocols to reduce urinary tract infection caused by indwelling catheters: an integrative review. Revista Brasileira de Enfermagem, 76(2). https://doi.org/10.1590/0034-7167-2022-0067

Reid, S., Brocksom, J., Hamid, R., Ali, A., Thiruchelvam, N., Sahai, A., Harding, C., Biers, S., Belal, M., Barrett, R., Taylor, J., & Parkinson, R. (2021). British Association of urological surgeons (baus) and Nurses (baun) consensus document: management of the complications of long-term indwelling catheters. BJU International, 128(6). https://doi.org/10.1111/bju.15406

Rubi, H., Mudey, G., & Kunjalwar, R. (2022). Catheter-associated urinary tract infection (CAUTI). Cureus, 14(10). https://doi.org/10.7759/cureus.30385

Shadle, H. N., Sabol, V., Smith, A., Stafford, H., Thompson, J. A., & Bowers, M. (2021). A bundle-based approach to prevent catheter-associated urinary tract infections in the intensive care unit. Critical Care Nurse, 41(2), 62–71. https://doi.org/10.4037/ccn2021934

Tandan, M., Thapa, P., Maharjan, P., & Bhandari, B. (2022). Impact of antimicrobial stewardship program on antimicrobial resistance and prescribing in nursing home: a systematic review and meta-analysis. Journal of Global Antimicrobial Resistance. https://doi.org/10.1016/j.jgar.2022.02.002

Zammar, A. M. A. (2022). Nurses’ knowledge and attitude regarding evidence-based practice: an integrative review. Open Journal of Nursing, 12(02), 103–112. https://doi.org/10.4236/ojn.2022.122007

Ziadeh, T., Chebel, R., Labaki, C., Saliba, G., & Helou, E. E. (2021). Bladder instillation for urinary tract infection prevention in neurogenic bladder patients practicing clean intermittent catheterization: A systematic review. Urologia Journal, 039156032110498. https://doi.org/10.1177/03915603211049883