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Distill your evidence-based project into one searchable idea.

The problem my evidence-based quality improvement project will address is the prevention of CAUTIs among hospitalized patients in critical care units through the implementation of hand hygiene and the use of CAUTIs checklists. What is the effectiveness of CAUTI care bundles on patient outcomes among hospitalized patients?

Concept list

1. Effectiveness of CAUTIs care bundles
2. Prevention of CAUTIs
3. CAUTIs care bundles
4. CAUTIs in critical care units

Create a concept/synonym table

Conduct a search and create a reference list.

Fauziah, W., Rochana, N., & Juniarto, A. Z. (2020). The Effect of Catheter Associated Urinary Tract Infection (CAUTI) Bundle of Care: A Systematic Review. https://www.scitepress.org/PublishedPapers/2018/82059/82059.pdf

Hernandez, M., King, A., & Stewart, L. (2019). Catheter-associated urinary tract infection (CAUTI) prevention and nurses’ checklist documentation of their indwelling catheter management practices. Nursing Praxis in New Zealand, 35(1). https://www.researchgate.net/profile/Monina-Hernandez/publication/340445613_.pdf

Menegueti, M. G., Ciol, M. A., Bellissimo-Rodrigues, F., Auxiliadora-Martins, M., Gaspar, G. G., da Silva Canini, S. R. 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: A quasi-experimental study. Medicine, 98(8). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6407993/

Nassikas, N. J., Monteiro, J. F. G., Pashnik, B., Lynch, J., Carino, G., & Levinson, A. T. (2020). Intensive care unit rounding checklists to reduce catheter-associated urinary tract infections. Infection Control & Hospital Epidemiology, 41(6), 680-683. https://www.researchgate.net/profile/Gerardo-.pdf

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://aacnjournals.org/ccnonline/article-abstract/41/2/62/31408/A-Bundle-Based-Approach-to-Prevent-Catheter

Soundaram, G. V., Sundaramurthy, R., Jeyashree, K., Ganesan, V., Arunagiri, R., & Charles, J. (2020). Impact of care bundle implementation on incidence of catheter-associated urinary tract infection: a comparative study in the intensive care units of a tertiary care teaching hospital in South India. Indian Journal of Critical Care Medicine: Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine, 24(7), 544. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7482344/

Van Decker, S. G., Bosch, N., & Murphy, J. (2021). Catheter-associated urinary tract infection reduction in critical care units: a bundled care model. BMJ Open Quality, 10(4), e001534. https://bmjopenquality.bmj.com/content/bmjqir/10/4/e001534.full.pdf

Select one of the articles that closely informs evidence-based quality improvement projects.

Background: Removing an indwelling urinary catheter as soon as possible is the cornerstone of catheter-associated urinary tract infection (CAUTI) prevention. However, implementing this measure may be challenging in clinical settings. To evaluate the impact of implementing a healthcare workers’ (HCWs) educational program and a daily checklist for indwelling urinary catheter indications among critical patients on the incidence of CAUTI.

Methods: This was a quasi-experimental study performed in a general intensive care unit of a tertiary-care hospital over a 12 years period from January 1, 2005, to December 31, 2016. Rates of urinary catheter use and incidence density of CAUTI have been evaluated monthly following the Centers for Disease Control and Prevention (CDC) criteria throughout the study period. Phase I (2005–2006) was the pre-intervention period. In phase II (2007–2010), HCWs’ routine training on CAUTI prevention was performed twice a year. In phase III (2011–2014), we implemented a daily checklist for indwelling urinary catheter indications in addition to the biannual training. In phase IV (2015–2016), the biannual training was replaced by training only newly hired HCWs, and the daily checklist was maintained.

Results: The mean rate of urinary catheter utilization decreased from phase I to phase IV (73.1%, 74.1%, 54.9%, and 45.6%, respectively). Similarly, the incidence density of CAUTI decreased from phase I to phase IV (14.9, 7.3, 3.8, and 1.1 per 1000 catheter days, respectively).

Conclusions: HCWs’ education and daily evaluation of indwelling urinary catheter indications were highly effective in reducing the rates of catheter utilization as well as the incidence density of CAUTI.

Describe the Study in your Own Words

The study by Menegueti et al. (2019) is a quantitative study that evaluated the impact of implementing healthcare workers’ education programs and daily checklists for indwelling urinary catheters on the incidence of CAUTIs among critical care patients. The study adopted a quasi-experimental design and was conducted over 12 years in an intensive care unit. The participants included patients admitted to an intensive care unit in a tertiary hospital. The study was carried out in four phases. Phase I was the preintervention period; the phase II healthcare worker training program was introduced. Phase III involved the implementation of checklists, and phase IV, maintained checklists and a training program. Researchers found that urinary catheter utilization decreased from 73.1% in Phase I to 45.6% in Phase IV. CAUTIs decreased from 14.9 per 1000 catheter days in Phase 1 to 1.1 per 1000 catheter days in Phase IV.

Why the Study was Selected

The study by Menegueti et al. (2019) was selected because it uses almost similar interventions that the quality improvement project seeks to introduce. The proposed project will focus on introducing checklists and hand hygiene practices to reduce the incidence of CAUTIs; therefore, the study is a suitable guide for implementing it. The target population for this study included patients admitted to intensive care units, which is the same as the target population for the proposed improvement project. Also, the purpose of the study is similar to that of the proposed project.

Outcomes: List and define the outcomes associated with the proposed improved practice.

Clinical practice:

To identify whether the new practice has improved clinical practice, I will measure adherence to CAUTIs care bundle strategies such as hand hygiene and use of checklists before implementing the new practice and compare it to adherence to CAUTIs care bundle strategies after implementation of the new practice.

Patient outcomes:

To identify whether the new practice has improved clinical practice, I will measure the incidence of CAUTIs before implementing the new practice and compare it to the incidence of CAUTIs after implementation of the new practice.

System/organization outcomes:

To identify whether the new practice has improved clinical practice, I will measure the length of hospital stay due to CAUTIs and compare it to the length of hospital stay due to CAUTIs after the implementation of the new practice

Time

The proposed study will be carried out for eight weeks.

PICOT question: Among patients admitted in critical/intensive care units, how do the introduction of catheter checklists and hand hygiene practices compare to the routine care practices affect the incidence of CAUTIs within eight weeks?

Evidence-based practice: PICOT worksheet

Patient/population/problem.

The problem that the project seeks to address is the increase in CAUTIs in the facility among the patients admitted to the critical care units. CAUTIs have been on the rise, necessitating the implementation of appropriate procedures to reduce the incidence of infections. CAUTIs are associated with increased mortality rates, longer hospital stays, increased cost of healthcare, and higher morbidity rates. Therefore, it is critical to address this problem to improve patient outcomes.

Interventions

The proposed interventions will include introducing catheter checklists and other CAUTI care bundles, such as hand hygiene Catheter checklists, which include instructions on how the nurses should insert and remove the catheters to minimize the risk of CAUTIs. Using the checklists, nurses ensure that all recommended procedures are followed, reducing the incidence of CAUTIs. The intervention will also enforce other practices, such as hand hygiene, to reduce the risk of CAUTIs.

Comparisons

The comparison will include the current practices in the facility. The facility uses regular care procedures, and no strict procedures are followed. There is no specific procedure for catheter insertion or removal in the facility. Therefore, most procedures are carried out based on how the nurses were taught or oriented.

References

Menegueti, M. G., Ciol, M. A., Bellissimo-Rodrigues, F., Auxiliadora-Martins, M., Gaspar, G. G., da Silva Canini, S. R. 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: A quasi-experimental study. Medicine, 98(8). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6407993/