Maribelle Burris and Dr. Katreena Merrill, Department of Nursing

Introduction:

Each year, about 98,000 preventable patient deaths occur in a hospital setting (Ramanujam, Abrahamson, & Anderson, 2008). Medical errors leading to patient deaths include, medication errors, patient falls, healthcare-associated infections, urinary tract infections, pressure ulcers, etc. (Teng, Dai, Shyu, Wong, Chu, & Tsai, 2009). These patient deaths are avoidable errors and are a direct measure of the healthcare system and individual healthcare facility’s quality. The burden of healthcare-associated infections is heavy, as 1 in every 20 patients has an infection related to hospital care, resulting in tens of thousands of deaths. Not only is this burdensome to patient families, but also to hospitals, as these infections cost the healthcare system billions of dollars each year (U.S. Department of Health & Human Services). This literature review is focused on medical errors related to hospital-acquired infections, specifically urinary tract infections as they account for nearly 40% of all healthcare-associated infections. Of these urinary tract infections, 80% are caused by urinary catheters, and about 1 in every 4 patients have a catheter placed during their hospitalization (University of Utah Healthcare, 2012). The purpose of this literature review is to analyze the effectiveness of current interventions in reducing catheter-associated urinary tract infections, as well as new interventions in the literature.

Methodology:

Research articles were found by using electronic databases including, MEDLINE, CINAHL, the Cochrane Library and Google Scholar. Articles were selected by title and review of the abstracts. All articles were published from 2008 to 2013 and in the English language.

Results:

Managing hospital-acquired infections is a priority concern for our healthcare system as healthcare providers are responsible for patient safety, wellness and quality of care. Factors influencing catheter-associated urinary tract infections include: sterility upon insertion, the proper use and assessment of securement devices, daily catheter cleansing while catheter is in place, keeping the drainage bag low, only using a catheter when properly indicated, and prompt removal of an inserted catheter. New literature suggests promising benefits of sterile periurethral cleansing in addition to the use of vitamin-D supplementation. However, more research is necessary to develop and implement interventions in order to further prevent and reduce catheter-associated urinary tract infections. The identification of the effectiveness of new and current interventions will aid healthcare providers and hospitals in implementing best practice, decreased costs for patients and hospitals, including medication and diagnostic tests, decreased length of stay and therefore decreased risk for further hospital-acquired infections, as well as decreased potential for patient morbidity and mortality.

Discussion/Conclusion:

Reducing and preventing hospital-acquired infections is a priority concern for our healthcare system. Every 1 in 20 patient’s has an infection related to hospital care, resulting in tens of thousands of deaths, and costs the healthcare system billions of dollars each year. Urinary tract infections account for nearly 40% of all healthcare-associated infections, 80% of which are caused by urinary catheters. About 25% of patients have a catheter placed during their hospitalization, so performing the best standards of care is necessary when working with catheterized individuals.

Pledging our commitment to patient care is not enough. Healthcare providers must actively seek for ways to improve patient care. Current interventions have proven to decrease the rates of catheter-associated urinary tract infections, however the overall goal is to completely eliminate them. This has not yet been achieved. Current standards include: sterility upon insertion, the proper use and assessment of securement devices, daily catheter cleansing while catheter is in place, keeping the drainage bag low, only using a catheter when properly indicated, and prompt removal of an inserted catheter. While keeping these standards in place, it is important to analyze new interventions in the literature that suggest promising benefits in the reduction of catheter-associated urinary tract infections.

Periurethral cleansing with the use of no-rinse bath wipes, as well as supplementation of vitamin- D, are two prospective interventions that appear beneficial. Periurethral cleansing with no-rinse bath wipes eliminates the use of contaminated hospital tap water and basins that could likely introduce microbes into the urinary tract. Vitamin-D supplementation in personalized and population specific doses may influence beneficial antimicrobial effects, more effective healing and improved overall immune health. However, more research is necessary to develop and implement these interventions and others, in order to further prevent and reduce catheterassociated urinary tract infections.

By eliminating catheter-associated urinary tract infections, the medical and diagnostic costs for patients and hospitals will greatly decrease, as well as patient length of hospital stay and therefore risks for further hospital-acquired infections, in addition to patient morbidity and mortality. All of these are again, a direct measure and reflection of the healthcare system and individual healthcare facility’s quality.

References

• Ramanujam, R., Abrahamson, K., & Anderson, J. (2008). Influence of workplace demands on nurses’ perception of patient safety. Nursing and Health Sciences, 10, 144-150. doi: 10.1111/j.1442-2018.2008.00382.x
• Sage Products (2010). Removal of basin baths to reduce catheter-associated urinary tract infections. Retrieved from: http://banthebasin.com/clinicals.cfm
• Teng, C., Dai, Y., Shyu Y., Wong, M., Chu, T., & Tsai, Y. (2009). Professional commitment, patient safety and patient-perceived care quality. Journal of Nursing Scholarship, 41(3), 301-309. doi: 10.1111/j.1547- 5069.2009.01289.x
• University of Utah Healthcare (2012). Catheter-Associated Urinary Tract Infection Prevention. University of Utah Newsletter, 1-4.
• U.S. Department of Health & Human Services (n.d.). Healthcare Associated Infections. Retrieved from http://www.hhs.gov/ash/initiatives/hai/index.html