NRS 433V Topic 1:  Introduction to Nursing Research: Literature Evaluation Table on Catheter-Associated Urinary Tract Infection (CAUTI) Prevention

NRS 433V Topic 1:  Introduction to Nursing Research: Literature Evaluation Table on Catheter-Associated Urinary Tract Infection (CAUTI) Prevention

NRS 433V Topic 1:  Introduction to Nursing Research: Literature Evaluation Table on Catheter-Associated Urinary Tract Infection (CAUTI) Prevention

 Introduction to Nursing Research: Literature Evaluation Table on Catheter-Associated Urinary Tract Infection (CAUTI) Prevention

Nursing Practice Problem (200-250 words): Hospital-acquired infections or HAIs continue to be a major problem in healthcare institutions even in the United States that has an advanced healthcare system. This is partly attributable to human factors since many considerations go into the decision whether to follow procedures or not. It is not because there is a shortage of infection-prevention protocols and procedures. Rather, it is more of an organizational culture thing and complacency by staff and management. Those organizations that have successfully curbed the occurrence of HAIs in significant proportions have organizational cultures that are friendly to change. They constantly change according to what the current evidence for practice is. In other words, they make use of interventions that are informed by published peer-reviewed scholarly evidence for efficacy. This is what evidence-based practice is all about (Melnyk & Fineout-Overholt, 2019). One of the most problematic HAIs in practice in hospitals and especially in acute care settings such as the intensive care unit (ICU) is catheter-associated urinary tract infections or CAUTI. These are hospital-acquired infections that affect those critically ill patients that have to be fitted with an indwelling Foley’s catheter. The catheter drains the bladder continuously but if not taken care of by frequent cleaning with an antiseptic, infection of the urinary tract occurs.

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PICOT Question: In critically ill patients at risk of catheter-associated urinary tract infections (CAUTI) in an acute care setting (P), does applying a nurse-driven bladder bundle (I) reduce the occurrence of CAUTI (O) compared to patients given the usual care (C) within a timeframe of 3 months (T)?

Table

Literature review table for qualitative and quantitative articles on CAUTI prevention

Criteria	Article 1	Article 2	Article 3
APA-formatted article citation with permalink	Brown, D.E., Eguia, S., Rodriguez, C., Conde, D., Josue, A.M., Kopecky, C.… & Zimmerman, C. (2016). Implementing CAUTI prevention bundle in the PACU. Journal of PeriAnesthesia Nursing, 31(4), e13. Doi:10.1016/j.jopan.2016.04.031. https://www.jopan.org/article/S1089-9472(16)30063-6/fulltext	Davies, P.E., Daley, M.J., Hecht, J., Hobbs, A., Burger, C., Watkins, L.… & Brown, C.V.R. (2018). Effectiveness of a bundled approach to reduce urinary catheters and infection rates in trauma patients. American Journal of Infection Control, 46(7), 758–763. Doi:10.1016/j.ajic.2017.11.032.  https://www.sciencedirect.com/science/article/abs/pii/S0196655317313081	Mody, L., Greene, M.T., Meddings, J., Krein, S.L., McNamara, S.E., Trautner, B.W.… & Saint, S. (2017). A national implementation project to prevent catheter-associated urinary tract infection in nursing home residents. JAMA Internal Medicine, 177(8), 1154. Doi:10.1001/jamainternmed.2017.1689. https://pubmed.ncbi.nlm.nih.gov/28525923/
How does the article relate to the PICOT question?	This article is in line with the PICOT statement as it is about CAUTI in patients admitted in the PACU and the role of nurses in managing the same.	The article is related to the PICOT question since it is about the part played by nurses in bundle implementation to reduce CAUTI rates.	This article is related to the PICOT statement as it tackles the issue of CAUTI in residential nursing homes.
Is the article qualitative, quantitative, or mixed methods? Justify your selection.	Qualitative prospective observational study. This is explained by the methodology	Quantitative retrospective review. This is expressly stated in the methodology section	Qualitative prospective study. Due to the method used to conduct the styudy
Purpose statement	To identify knowledge deficits in clinical nursing staff in relation to the CAUTI bundle	Comparing catheterization and CAUTI in the face of bundled intervention	To come up with, put into practice, and evaluate a particular intervention for the reduction of CAUTI
Research question(s)	Study was done to identify patients at risk of CAUTI, identify all components of a CAUTI prevention bundle, and identify critical elements of catheter maintenance amongst others.	Done to compare the rates of urinary catheterization and CAUTI preceding and after the use of a bundled intervention.	Quantitative study to assess an intervention aimed at reducing CAUTI.
Outcome(s)	Better compliance to preventive procedures by nurses	Reduced CAUTI rates by over 30%	A significant decrease in CAUTI infections
Setting (Where did the study take place?)	In a 32 bed PACU.	In an urban level 1 trauma center.	In community-based nursing homes in 48 states, Washington DC, and Puerto Rico.
Sample	A sample of 61 PACU nurses and 32 PACU patients (n = 93).	n=6,236	n=404
Method	Direct observation of patients with indwelling catheters, and a survey of 61 PACU nurses.	Retrospective cohort study of trauma patients from January 2013 to January 2015.	Prospective study of implementation between March 2014 to August 2016.
Key findings of the study and implications for nursing practice	Improved compliance and an increase in the number of nurses having knowledge about CAUTI prevention bundle. It will improve nursing practice in terms of preventing CAUTI.	The CAUTI rate reduced over 33% after implementation of the bundle. Better prevention of CAUTI in nursing practice.	There was a statistically significant decrease in CAUTI rate after implementation of intervention. CAUTI prevention strategies will be more evidence-based in practice.
Recommendations of the researcher	This article can be recommended to all PACU nurses as the knowledge is useful in the prevention of CAUTIs in their units.	This article can be recommended to all ICU nurses and others caring for acutely ill trauma patients, for prevention of CAUTI	This article can be recommended to all those taking care of the aged in residential homes. It can help tem reduce CAUTI rates

 

Criteria	Article 4	Article 5	Article 6
APA-formatted article citation with permalink	Ravi, P.R., & Joshi, C. (2019). Role of “bladder care bundle” and “infection control nurse” in reducing catheter-associated urinary tract infection in a peripheral hospital. Journal of Marine Medical Society, 20(2), 116-121. Doi: 10.4103/jmms.jmms_8_18. http://www.marinemedicalsociety.in/article.asp?issn=0975-3605;year=2018;volume=20;issue=2;spage=116;epage=121;aulast=Ravi	Rhee, C., Phelps, M.E., Meyer, B., & Reed, W.G. (2016). Viewing prevention of catheter-associated urinary tract infection as a system: Using systems engineering and human factors engineering in a quality improvement project in an academic medical center. The Joint Commission Journal on Quality and Patient Safety, 42(10), 447–461. Doi: 10.1016/s1553-7250(16)42060-x. https://www.sciencedirect.com/science/article/abs/pii/S155372501642060X	Witwer, M., Dobbins, G., Uher, C., & McFarren, M.D. (2019). Auditing CAUTI best practices bundle adherence in a 24-bed neurovascular/cardiovascular/intensive care unit. American Journal of Infection Control, 47(6), S30. Doi: https://doi.org/10.1016/j.ajic.2019.04.062. https://www.sciencedirect.com/science/article/abs/pii/S0196655319302901
How does the article relate to the PICOT question?	This article relates to the PICOT in that it addresses the reduction of CAUTI by using catheter care bundle.	This article relates to the PICOT question in that it is about measures aimed at reducing CAUTI rates.	This article is related to the PICOT question as it talks about the lowering of CAUTI rates by using care bundle.
Is the article qualitative, quantitative, or mixed methods? Justify your selection.	Qualitative study	Quantitative prospective study	Quantitative study
Purpose statement	To assess the efficacy of CAUTI care bundle and infection control nurse in the reduction of CAUTI rates in a regional hospital	To determine if systems engineering and human factors engineering can help reduce rates of CAUTI	To reduce CAUTI rates by conducting audits of CAUTI bundle compliance
Research question(s)	How to determine the effectiveness of a CAUTI care bundle together with an infection control nurse in lowering the incidence of CAUTI in a hospital	How to use systems engineering to study prevention of CAUTI	How to reduce CAUTI rates by conducting audits of CAUTI bundle compliance
Outcome(s)	Reduced CAUTI rates	Drop in CAUTI rates by 81.5%	CAUTI rate reduction was almost significant but did not turn out to be statistically significant
Setting (Where did the study take place?)	A zonal hospital	A 610-bed academic medical center	A Minnesota hospital ICU
Sample	n = 834	n=610	Not clear
Method	An initial baseline or observational phase of 8 months followed by an implementation phase of 21 months	Use of systems engineering (SE) and human factors engineering (HFE) to lower rates of CAUTI	The Joint Commission’s CAUTI tracer technology was used to conduct three audits per week on patients with indwelling catheters. CAUTI incidence is tracked periodically and verbal feedback is given
Key findings of the study and implications for nursing practice	The catheter care bundle together with staff education managed to lower the CAUTI rates by 60.64 episodes per 1,000 catheter days. Nurses will be better informed on how to use the care bundle to prevent CAUTI.	From baseline, both SE and HFE managed to lower CAUTI rates by a whopping 81.5%. Evidence-based practice (EBP) will be better used to lower CAUTI rates.	Association between adherence to the full bundle and CAUTI rates approached significance but did not reach the same. Findings inform and enrich EBP.
Recommendations of the researcher	The article would be recommended to any healthcare facility wanting to improve the quality of its care	This article is to be recommended to any healthcare facility that seeks to implement quality improvement in the area of nosocomial infections	The article is to be recommended to all ICUs in healthcare facilities using CAUTI care bundle

References

Brown, D.E., Eguia, S., Rodriguez, C., Conde, D., Josue, A.M., Kopecky, C.… & Zimmerman, C. (2016). Implementing CAUTI prevention bundle in the PACU. Journal of PeriAnesthesia Nursing, 31(4), e13. https://doi.org/10.1016/j.jopan.2016.04.031 

Davies, P.E., Daley, M.J., Hecht, J., Hobbs, A., Burger, C., Watkins, L.… & Brown, C.V.R. (2018). Effectiveness of a bundled approach to reduce urinary catheters and infection rates in trauma patients. American Journal of Infection Control, 46(7), 758–763. https://doi.org/10.1016/j.ajic.2017.11.032 

Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice, 4^th ed. Wolters Kluwer.

Mody, L., Greene, M.T., Meddings, J., Krein, S.L., McNamara, S.E., Trautner, B.W.… & Saint, S. (2017). A national implementation project to prevent catheter-associated urinary tract infection in nursing home residents. JAMA Internal Medicine, 177(8), 1154. https://doi.org/10.1001/jamainternmed.2017.1689

Ravi, P.R., & Joshi, C. (2019). Role of “bladder care bundle” and “infection control nurse” in reducing catheter-associated urinary tract infection in a peripheral hospital. Journal of Marine Medical Society, 20(2), 116-121. https://doi.org/10.4103/jmms.jmms_8_18

Rhee, C., Phelps, M.E., Meyer, B., & Reed, W.G. (2016). Viewing prevention of catheter-associated urinary tract infection as a system: Using systems engineering and human factors engineering in a quality improvement project in an academic medical center. The Joint Commission Journal on Quality and Patient Safety, 42(10), 447–461. https://doi.org/10.1016/s1553-7250(16)42060-x

Witwer, M., Dobbins, G., Uher, C., & McFarren, M.D. (2019). Auditing CAUTI best practices bundle adherence in a 24-bed neurovascular/cardiovascular/intensive care unit. American Journal of Infection Control, 47(6), S30. https://doi.org/10.1016/j.ajic.2019.04.062

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For this assignment, you will create a clinical guiding question know as a PICOT question. The PICOT question must be relevant to a nursing practice problem.

Use the “Literature Evaluation Table” to complete this assignment. Prior to starting the “Literature Evaluation Table,” complete the following:

Select a nursing practice problem of interest to use as the focus of your research. Start with the patient population and identify a clinical problem or issue that arises from the patient population.
Following the PICOT format, write a PICOT question in your selected area of interest. The PICOT question should be applicable to your proposed capstone project (the project students must complete during their final course in the RN-BSN program of study).
Conduct a literature search to locate six research articles focused on your selected nursing practice problem of interest. Note: This literature search should include three quantitative and three qualitative peer-reviewed research articles to support your nursing practice problem. A mixed methods article can qualify towards meeting a qualitative or quantitative methodology.
Articles must be published within the last 5 years, appropriate for the assignment criteria, and relevant to nursing practice.

The PICOT question and six peer-reviewed research articles you choose will be utilized for subsequent assignments. The PICOT question will also provide a framework for your capstone project.