Implementing a Nurse-Driven Protocol to Reduce Catheter-Associated Urinary Tract Infections in a Long-Term Acute Care Hospital

Study on the prevention and nursing intervention of infection after flap transfer for hand trauma

To analyze the factors associated with infection after flap transfer for hand trauma and use them to develop nursing strategies and observe the effects of their application. Eighty-two patients admitted to our hospital for flap transfer for hand trauma from January 2020 to May 2020 were selected for the retrospective analysis. Logistic regression analysis was performed to analyze the factors associated with postoperative infections to develop care strategies. Another 88 patients admitted for flap transfer for hand trauma from September 2020 to June 2021 were retrospectively analyzed and divided into the observation (n = 44) and control groups (n = 44) according nursing strategies that they received. The operative time, intraoperative bleeding, incision healing time, first postoperative time to get out of bed on their own and hospital stay were compared between the 2 groups. The patients postoperative adverse effects and flap survival rates were also counted. visual analogue score, total active motion, manual muscle test, Barthel index, self-rating anxiety scale, self-rating depression scale scores were used to assess patients pain, hand function recovery and psychology before and after treatment. Logistic regression analysis manifested that postoperative bed rest time, affected limb immobilization, and pain were independent factors affecting postoperative infection after flap transfer (P < .05). After using targeted care strategies, the observation group had dramatically shorter operative time, intraoperative bleeding, incision healing time, time to first postoperative bed release on their own, and hospital stay, less postoperative pain and adverse effects, and higher flap survival rate than the control group (P < .05). Total active motion, manual muscle test, and Barthel index were higher in the observation group than in the control group after treatment, while self-rating anxiety scale and self-rating depression scale scores were lower than in the control group (P < .05). Finally, total satisfaction was higher in the observation group than in the control group (P < .05). Postoperative bedtime, fixation of the affected limb, and pain are independent factors affecting postoperative infection after flap transfer for hand trauma. Implementing infection prevention care strategies based on these factors can effectively improve the safety of flap transfer, reduce the possibility of infection, and shorten the recovery period of patients, which has high clinical application value.

Rounding and Quick Access Education to Reduce Catheter-Associated Urinary Tract Infections

PURPOSE/OBJECTIVES

The acute care division of a tertiary medical center experienced a 167% increase in catheter-associated urinary tract infections, with 2 inpatient surgical units accounting for 67% of infections. A quality improvement project was implemented to address the infection rates on the 2 inpatient surgical units. The aim was to reduce catheter-associated urinary tract infection rates by 75% in the acute care inpatient surgical units.

DESCRIPTION OF THE PROJECT/PROGRAM

A survey identified educational needs of staff, with response data informing the development of a quick response code containing resources for prevention of catheter-associated urinary tract infections. Champions rounded on patients and audited maintenance bundle adherence. Educational handouts were disseminated to increase compliance with bundle interventions. Outcome and process measures were tracked on a monthly basis.

OUTCOME

Infection rates decreased from 1.29 to 0.64 per 1000 indwelling urinary catheter days, catheter utilization increased 14%, and maintenance bundle compliance was 67%.

CONCLUSION

The project enhanced quality care through the standardization of preventive practices and education. The data reflect a positive effect on catheter-associated urinary tract infection rates from increased awareness of the nurse's role in the prevention process.

Improving Nurses’ Knowledge about Prevention of Catheter Acquired Urinary Tract Infections in Intensive Care Units

BACKGROUND: Lack of knowledge about causes and strategies to prevent catheter-acquired urinary tract infections (CAUTIs) requires an intervention that focuses on providing all evidence-based information to decrease the incidence of CAUTIs in admitted intensive care units (ICU) patients. Improving the nurses’ knowledge will eventually help in the reduction of CAUTIs. AIM: We aimed to investigate the improving nurses’ knowledge about prevention of catheter acquired urinary tract infections in intensive care units. METHODS: The present study is a h ealth system-operational research, pre-test–post-test design with a control arm study. The study was conducted in two ICU units in one of the University hospitals, Cairo, Egypt, involving a total sample of 42 nurses. Self-administered questionnaires were used to assess nurses’ knowledge about CAUTIs. The intervention was implemented through on job educational training sessions to nursing staff. Cochran Q was used to test the effect of the intervention on a satisfactory level of knowledge. RESULTS: Knowledge score improved from 61.4 ± 14.1 in pre-test to 90.5 in the early post-test (EP) test done after 1 week to 91.3 in late post-test ( LP) done after 1 month among nurses of the intervention ICU (p < 0.001). The percentage of nurses reporting a satisfactory level of knowledge significantly increased from 13.3% in the pre-test to 90% and 93.3% in follow-up (EP and LP, respectively) in the intervention ICU (p < 0.05) CONCLUSION: The implemented training and education strategy used were effectively improved ICU nurses’ knowledge concerning CAUTI.

Aspects of Prevention of Urinary Tract Infections Associated with Urinary Bladder Catheterisation and Their Implementation in Nursing Practice

In the case of the prevention of catheter-associated urinary tract infections (CAUTI) related to healthcare provision, high-quality and comprehensively provided nursing care is essential. Implementation of preventive strategies is based on recommended procedures, and the introduction of whole sets of measures has been shown to be effective. The objective of this research is to find out whether the providers of acute bed care have implemented the steps of CAUTI prevention, and specifically which measures leading to improved quality of care in the area of urinary infections are already in place. To determine this, we carried out quantitative research. Data were collected using a questionnaire-based investigation; we used two non-standardised and one standardised questionnaire, and the respondents were general nurses in management positions (n = 186). The results revealed that result-related CAUTI indicators are monitored by only one-third of the respondents, and records of catheterisation indication are not kept by 17.3% of general nurses. The results of the research showed deficiencies in the monitoring of CAUTI outcome and process indicators, and a weakness of the implemented preventive measures is the maintenance of catheterisation documentation. Periodic CAUTI prevention training is not implemented as recommended. It is positive that there are well-working teams of HAI prevention experts in hospitals.

Interventions Within the Scope of Occupational Therapy to Address Preventable Adverse Events in Inpatient and Home Health Postacute Care Settings: A Systematic Review

IMPORTANCE

Practitioners need to be familiar with, and involved in, managing quality-related adverse events in postacute care.

OBJECTIVE

To determine interventions within the scope of occupational therapy that address preventable adverse events in adult postacute inpatient and home health settings.

DATA SOURCES

Articles published from January 1995 through 2019 identified through searches of MEDLINE, PsycINFO, CINAHL, OTseeker, and Cochrane databases. Study Selection and Data Collection: Articles were collected, evaluated, and analyzed by two independent reviewers. They were assessed and synthesized with a goal of informing clinical practice.

FINDINGS

Twenty-four articles were included in the review. Of the 10 Centers for Medicare & Medicaid Services preventable adverse events, 6 were addressed: diabetes management (n = 2), dysphagia (n = 5), infection control (n = 1), pressure ulcers (n = 6), falls (n = 5), and discharge management (n = 5). There was strong strength of evidence that exercise programs should, when appropriate, be implemented in both inpatient and home health settings to decrease the risk of falls. There was moderate strength of evidence that practitioners could consider implementing a facility wide evidence-based pressure ulcer program; providing multidisciplinary rehabilitation and swallow strengthening exercises for dysphagia; implementing a multidisciplinary, multicomponent falls program; and using a manualized depression intervention in home health to decrease hospital readmission.

CONCLUSIONS AND RELEVANCE

The review highlights the importance of preventable adverse events and of occupational therapy practitioners acknowledging and managing these events to enhance health outcomes and to control health care costs. What This Article Adds: Many interventions typically performed by occupational therapy practitioners address preventable adverse events. The review highlights the importance of practitioners being aware of this category of impairment or injury.

Managing complications associated with the use of indwelling urinary catheters

The insertion of an indwelling urethral urinary catheter is an invasive procedure that is commonly undertaken in healthcare settings. However, there are several risks and potential complications associated with these devices, so their use should be avoided where possible. It is important that nurses are equipped with the necessary knowledge and skills not only to assess if a patient requires a catheter, but also to minimise the risk of associated complications and to understand how these can be managed. This article discusses some of the common complications that can occur with the use of indwelling urinary catheters, including: catheter-associated urinary tract infections; catheter blockages; encrustation; negative pressure; bladder spasm and trauma; and, in men, paraphimosis. It also explains the steps that nurses can take to reduce the risk of these complications and how to manage them effectively.

Optimising Interventions for Catheter-Associated Urinary Tract Infections (CAUTI) in Primary, Secondary and Care Home Settings

Catheter-associated urinary tract infections (CAUTI) are common yet preventable. Healthcare professional behaviours, such as reducing unnecessary catheter use, are key for preventing CAUTI. Previous research has focused on identifying gaps in the national response to CAUTI in multiple settings in England. This study aimed to identify how national interventions could be optimised. We conducted a multi-method study comprising: a rapid review of research on interventions to reduce CAUTI; a behavioural analysis of effective research interventions compared to national interventions; and a stakeholder focus group and survey to identify the most promising options for optimising interventions. We identified 37 effective research interventions, mostly conducted in United States secondary care. A behavioural analysis of these interventions identified 39 intervention components as possible ways to optimise national interventions. Seven intervention components were prioritised by stakeholders. These included: checklists for discharge/admission to wards; information for patients and relatives about the pros/cons of catheters; setting and profession specific guidelines; standardised nationwide computer-based documentation; promotion of alternatives to catheter use; CAUTI champions; and bladder scanners. By combining research evidence, behavioural analysis and stakeholder feedback, we identified how national interventions to reduce CAUTI could be improved. The seven prioritised components should be considered for future implementation.