Preventing Catheter Associated UTIs

Preventing Catheter Associated UTIs ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Preventing Catheter Associated UTIs I’m studying for my Health & Medical class and don’t understand how to answer this. Can you help me study? Preventing Catheter Associated UTIs South University NSG 6101 I will upload work from previous weeks to give you a foundation to build on. Please pay close attention to instructions and FOLLOW APA GUIDELINES. Week 4: Week 4 – W4 Assignment 2 Assignment 2: Research Proposal Draft By Monday, December 12, 2016 , write a (5–6 pages) paper addressing the sections below of the research proposal. This week you will submit the Literature Review section of your proposal. Each week you have been adding to your growing body of evidence to support your problem and proposed innovation to address the problem. The review of literature is a critical, analytical summary and synthesis of the current knowledge of your research topic. Thus it should compare and relate different theories, findings, etc., rather than just summarize them individually. Preventing Catheter Associated UTIs The following resources will help guide you (in addition to our course textbooks): http://writing.wisc.edu/Handbook/ReviewofLiterature.html http://www.duluth.umn.edu/~hrallis/guides/researching/litreview.html http://writingcenter.unc.edu/handouts/literature-reviews/ Writing the Literature Review: Step-by-Step Tutorial for Graduate Students: http://www.youtube.com/watch?v=2IUZWZX4OGI Writing the Literature Review (Part Two): Step-by-Step Tutorial for Graduate Students: http://www.youtube.com/watch?v=UoYpyY9n9YQ Submit your assignment to the W4: Assignment 2 Dropbox by Monday, December 12, 2016 . Assignment 2 Grading Criteria Maximum Points Literature reviewed represents current scholarly literature. 5 Literature reviewed represents a comprehensive review of the research topic. 5 Review of the literature is a critical, analytical summary. 5 Review of the literature illustrates a synthesis of the current knowledge of research topic. 10 Followed APA guidelines for writing style, spelling and grammar, and citation of sources. 5 Total: Preventing Catheter Associated UTIs 30 Throughout this course you will be developing drafts of various sections of the research proposal that is due in Week 10 . The drafts serve as an opportunity to address feedback from faculty as you prepare the proposal. Please click here to review the research proposal project guidelines and click here to review the required template. yates_indwelling_urinary_catherisation__what_is_best_practice.pdf purvis_cauti.pdf magers_using_evidence_based_practice_to_reduce_cauti.pdf johnson_nurse_driven_cauti_reduction.pdf holroyd_innovation_in_catheter_securemet.pdf Indwelling urinary catheterisation: what is best practice? Ann Yates Indwelling urinary catheterisation is a common procedure that is governed by best practice guidelines such as those provided by the National Institute of Health and Care Excellence (NICE), epic3 and the Royal College of Nursing. This article will look how these guidelines influence practice and also look at new innovations in catheter care. Key words: Indwelling urinary catheters? ? Catheter management? ? Best practice guidelines? ? Continence I ndwelling urinary catheterisation is a common clinical intervention undertaken by a competent health professional to relieve the symptoms of bladder dysfunction (Royal College of Nursing (RCN), 2012). There are justifiable reasons for the use of an indwelling catheter and it has been estimated that between 15 and 25% of hospitalised patients receive a urinary catheter during their stay (Schumm and Lam, 2010; Loveday et al, 2014). However, they are not without their complications, and these can include catheter–associated infections, tissue damage and bypassing and blockage. Due to these risks, catheters should only be used after all alternatives have been considered, and removed as soon as possible (Loveday et al, 2014). While there is variation in the route of entry for an indwelling catheter, namely urethral or suprapubic, the type of catheter and best practice with regards to maintenance care, i.e., drainage bags, valves and securing devices and patient information is relatively similar. Even though there are best practice guidelines with regards to catheter care and management, there is still confusion and debate within the nursing profession (Foxley, 2011).This article will discuss some of these issues. Clinical indications for catheterisation Urinary catheters are used for a variety of reasons (Box 1 and Box 3) and should only be used when absolutely necessary and when all other options have been considered and rejected (Pratt et al, 2007). Individuals should be risked assessed for any foreseeable complications before insertion (RCN, 2012) and also for any contraindications to a particular type of catheter insertion (Box 2 and Box 3). Ann Yates, Director of Continence Services, Cardiff and Vale University Health Board, Lansdowne Hospital Accepted for publication: April 2016 S4 Urinary catheterisation is a frequent intervention that affects individuals in all care settings. It has been estimated that 15– 25% of hospitalised patients have a urinary catheter during their stay (Saint and Chenoweth, 2003) and approximately 80% of all hospital-acquired infections will be catheter-associated urinary tract infections (CAUTIs). Between 20% and 30% develop bacteriuria (Pratt et al, 2007) of which 2–6% develop symptoms of a CAUTI (Loveday et al, 2014). Approximately 3% of individuals with a CAUTI develop life-threatening secondary infections when mortality rates range from 10–33% (Shuman, 2010; Chang et al, 2011). Preventing Catheter Associated UTIs Prevalence of long-term catheterisation in the adult population is approximately 0.03– 0.07%, rising to 0.5% in those over 75 and 2% in those over 85 years-old (Evans et al, 2000). The daily risk of a catheterised patient developing bacteriuria is 3–6% and increases the longer the catheter is in situ (Loveday et al, 2014). Catheterisation can cause physical and psychological discomfort and has been shown to delay discharge from hospital, resulting in financial burden to the health service. Loveday et al (2014) estimated costs of £99 million per year, with an estimated cost per episode of £1968. However, there are no robust economic assessments. Catheter selection There are many types of urinary catheters and selection depends on patient assessment, which should include any allergy or sensitivity, especially to latex (Elvy and Colville, 2009), reason for catheterisation and length of time in situ (Table 1). It is recommended that the smallest size gauge (measured by Charriere (Ch) scale or Fench Gauge(Fg) scale) to have adequate drainage for clear urine be used, so normally a size 12–14 Ch is the preferred size for either male or female patients. However, if there is not clear urine drainage, Table 1 provides guidance for what Ch should be used (European Association of Urology Nurses (EAUN), 2012). The use of larger Ch sizes is rare in community settings and should be avoided unless there is a specific recognised clinical indication, as they can cause complications such as bypassing and urethral trauma (Loveday et al, 2014). Suprapubic catheters should be no smaller than a size 16 due to abdominal pressure on the catheter material. There are a number of different Foley balloon catheters (Table 1) available, namely coated latex, all silicone, polytetrafluoroethylene (PTFE) coated, hydrogel silicone or latex coated, silver coated and nitrofurazone coated. British Journal of Nursing, 2016, (Urology Supplement) Vol 25, No 9 © 2016 MA Healthcare Ltd ABSTRACT Acute/chronic retention Patients with voiding difficulties due to neurological disorders ?? Need for accurate measurements of urinary output in critically ill patients ?? Perioperative use in selected surgical procedures ?? Irrigate the bladder, i.e. following prostate surgery ?? Bypass an obstruction, i.e. enlarged prostate/stricture ?? Administer drugs directly into bladder, i.e. cytotoxic therapy ?? Carry out bladder function tests ?? Improve comfort for end-of-life care ?? To maintain skin integrity, i.e. 3–4 degree pressure damage/incontinence-associated dermatitis (IAD) ?? To relieve incontinence only after all other conservative strategies have failed ?? ?? Source: Adapted from RCN, 2012 and EAUN, 2012 Box 2. Contraindications for urethral catheterisation ?? ?? Acute prostatitis Suspicion of urethral trauma Source: EAUN, 2012 Box 3. Indications and contraindications for suprapubic catheterisation in addition to Box 1 Indications ?? Acute/chronic retention not able to be adequately drained by urethral catheter ??Preventing Catheter Associated UTIs Preferred by patients, i.e. wheelchair users, sexual issues ?? Acute proststitis: obstruction, stricture, abnormal urethral anatomy ?? Pelvic trauma ?? Complications of long-term urethral catheterisation ?? Complex urethral or abdominal surgery ?? Faecally incontinent patients who continually soil their urethral catheter Contraindications ?? Known or suspected carcinoma of the bladder ?? Absence of easily palpable bladder or ultrasonographically localised distended urinary bladder ?? Previous lower abdominal surgery ?? Coagulopathy (until corrected) ?? Ascites ?? Prosthetic devices in lower abdomen Source: EAUN, 2012 Latex Made from natural rubber, latex is flexible but can cause discomfort due to high-surface friction and vulnerability to rapid encrustation. It is restricted to short-term use only and has implications for allergic reactions (EAUN, 2012). Latex is commonly avoided if possible. Silicone One hundred percent silicone is hypoallergenic and so induces the least allergic response (Loveday et al, 2014). It has a relatively large lumen and reduced tendency to encrustation, which increases risk of displacement and balloon at greater risk of ‘cuffing’, where the balloon does not lie fully flat after deflation to the catheter and causes ridges that can result in trauma and damage (both urethral or supra pubic) on removal (EAUN, 2012). Silicone should always be used in patients with identified latex allergy. PTFE coated This catheter is still latex based but is coated with PTFE. This coating was developed to protect the urethra/suprapubic S6 site from uncoated latex and is smoother than latex so helps prevent encrustation. However, the catheter is latex based and can still cause latex allergies. Developed to protect the urethra from uncoated latex, it remains a latex-based catheter but is coated with PTFE and is smoother than latex so helps prevent encrustation. Hydrogel coated Hydrogel coated catheters are soft, hydrophilic and biocompatible; they reduce friction and urethral irritations (EAUN, 2012). Silver coated Silver-alloy catheters are either latex or silicon hydrogel catheters than have a thin layer of silver alloy coated onto the catheter. Evidence suggests that these catheters are clinically effective in reducing the incidence of CAUTIs (Pellowe, 2009; Loveday et al, 2014) during short-term catheterisation Preventing Catheter Associated UTIs (Tenke et al, 2008; EAUN, 2012; Loveday, 2014). Nitrofurazone coated Antibiotic–impregnated catheters may decrease the frequency of asymptomatic bacteriuria in short-term catheterisation, however, there is no evidence that these catheters decrease symptomatic infection so should not be routinely recommended (EAUN, 2012). Catheter lengths Catheters are available in three lengths: ?? Standard: 40–44 cm ?? Female: 23–26 cm ?? Paediatric: 30 cm. Standard length is appropriate for immobile female patients but should always be used in male patients. The use of a female-length catheter in a male patient can lead to the balloon being inflated in the urethra, leading to serious complications including haematuria, penile swelling, urinary retention, haemorrhage and impaired renal function (National Patient Safety Agency, 2009). Insertion risks Around 60% of healthcare-associated infections are related to catheter insertion and the financial burden of CAUTI on the NHS has been estimated as £99 million per year with estimated cost per episode of £1968 (Loveday et al, 2014). To assist in reducing these infections, there are published guidelines based on up-to-date evidence-based practice in infection control (epic 3) (Loveday et al, 2014) (Box 4) and the National Institute for Health and Care Excellence (NICE) (2012) for infection control.These documents were underpinned by the Essential steps to safe, clean care: reducing healthcare-associated infections (Department of Health (DH), 2006) and High impact intervention. Urinary catheter care bundle (DH, 2010). Professionals should adhere to the correct technique for insertion outlined by the Aseptic No Touch Technique (ANTT) organisation (2012). A summary of insertion tips is in Box 3. British Journal of Nursing, 2016, (Urology Supplement) Vol 25, No 9 © 2016 MA Healthcare Ltd Box 1. Indications for urethral catheterisation Short term Left in situ for up to 7 days Catheter (PVC), specialised catheters Medium term Left in situ for up to 28 days Polytetrafluoroethylene (PTFE), silver alloy, hydrogel, nitrofurazone impregnated Long term Up to a maximum of 12 weeks Silicone–elastomer, Hydrogel, All silicone, All silicone with open tip and integral balloon, Dover silver catheter Charriere (Ch) sizes (EAUN, 2012) 10 Ch: Clear urine, no debris, no grit (encrustation) 12–14 Ch: Clear urine, no grit or debris, used for initial catheterisation 16 Ch: Urine that contains mild debris, grit or particles. Cloudy urine, light haematuria, small clots or suprapubic (while rare it is still clinically indicated by EAUN if there is debris etc) only in very rare cases would a 16 Ch be used urethrally 18 Ch: Moderate to heavy grit, moderate to heavy debris, haematuria with moderate clots 20–24 Ch: Haematuria with moderate to heavy clots, and above. Very cloudy, very heavy grit and debris,need for flushing (Robinson, 2006; EAUN, 2012). Preventing Catheter Associated UTIs None of these should be considered for urethral use due to bladder neck trauma and urethral damage/trauma There is also no good evidence to suggest that size 20–24 urethral catheters aid with haematuria following prostate surgery Source: Yates A, 2012 Box 2. EPIC 3 Guidance for catheter insertion Assess the need for catheterisation; avoid if possible and consider alternatives Ensure professionals are trained and competent in procedure ?? Document the reason for insertion, the continuing need and/or date of removal ?? Catheterisation is an aseptic procedure, which includes personal protective equipment ?? Clean urethral meatus before insertion with appropriate fluid, e.g. sterile normal saline (check local policy) using correct wiping technique (there is no evidence of an advantage in using aseptic preparations) ?? Use an appropriate lubricant from a single-use container to minimise urethral trauma/infection (see local policy) ?? Selection of catheters—smallest gauge that will allow free drainage, material will depend on patient assessment and duration of catheterisation (Table 1) ?? Select drainage option—sterile closed urinary system or catheter valve ?? ?? Source: DH, 2006; Loveday et al, 2014 Box 3. Catheter insertion quick tips Be competent in the skill of insertion ?? Assess the reason for catheterisation ?? Be aware of length of time catheter required and remove as soon as possible ?? Be aware of any allergies, e.g., latex ?? Use smallest appropriate Ch to promote free drainage ?? Use balloon no larger than 10 ml unless for heamostatis in post-urological procedure (EAUN, 2012) ?? Use standard length for all males and immobile females ?? Document all information relating to catheter selection/insertion ?? Drainage devices Drainage-device selection will depend on the reason for catheterisation, duration and patient preference. Care of the drainage system is one of most important aspects in reducing the risk of acquiring a urinary tract infection. There are two main types of drainage equipment: drainage bags and catheter valves. Choice of device will be based on: ?? Patient choice ?? Required bag capacity ?? Tube length required S8 Tap design Placement and ease of use for individual based on dexterity, mobility and cognitive ability ?? Bladder capacity for catheter valves (this is discussed in valve section). It is imperative that drainage bags are sterile and kept as a closed system and the bag is changed in line with the manufacturer’s recommendations usually every 5–7 days. Drainage bags come in three different lengths: direct, short tube and long tube; and three different capacities, which are most commonly used: 350 ml, 500 ml and 750 ml. There are also specialist bags available on prescription. If a 2-litre bag is required overnight for extra capacity drainage, it is imperative that the ‘link system’ is used. This system requires the 2-litre bag to be attached to the outlet drainage tube of the bag connected to the catheter and disposed of when disconnected in the morning. ?? ?? Catheter valves Catheter valves (Figure 1) have gained popularity and offer patients comfort, independence and a convenient way to manage their catheter (Fader et al, 1997;Yates et al, 2012). Preventing Catheter Associated UTIs However, catheter valves are not suitable for all patients and certain factors should be considered when advising or selecting a valve.These include the individual’s cognitive ability to understand bladder function, manual dexterity to manipulate the valve, bladder sensation to avoid over distention of the bladder, mobility and bladder capacity. The same precautions should be taken as when changing a valve for drainage bags, which is recommended every 5–7 days as outlined by the product license and manufacturer’s instructions. Infection-control procedures should also be adhered to when connecting to an overnight drainage bag or when emptying the catheter. Hand hygiene and manipulation When catheters are manipulated, hand hygiene and decontamination should be undertaken before and after each episode. If not undertaken by the patient, gloves should be worn: ‘Decontaminate hands and wear a new pair of clean non-sterile gloves before manipulating each patient’s catheter. Decontaminate hands immediately following the removal of gloves.’ Loveday et al, 2014 Emptying the bag Drainage bags should always be positioned below the bladder and should be secured either by retaining straps or a supporting system.The bag should be emptied frequently enough to prevent reflux and maintain urine flow (NICE, 2012; Loveday et al, 2014). If a patient is on irrigation or having IV fluids they would need to be reviewed more frequently than every 3–4 hours.This should be calculated by the clinician looking after the individual and adjusted to their clinical presentation. Loveday et al (2014) state that the bag should be emptied when three-quarters full. Dougherty and Lister (2015) recommended that the outlet tap should be cleaned with 70% isopropyl alcohol swab before opening or closing the tap. If catheter bags are emptied by a British Journal of Nursing, 2016, (Urology Supplement) Vol 25, No 9 © 2016 MA Healthcare Ltd Table 1. Lifespan of indwelling urinary catheters and recommended Charriere sizes Box 4. Urinary catheter continuing care principles Hand hygiene and decontamination should be done immediately before and after each episode of patient contact using the correct hand hygiene technique and examination gloves ?? Routine personal hygiene is all that is required to maintain meatal hygiene or as stated in local policy ?? Urine samples must be obtained from a sampling port, using aseptic technique ?? Catheters should be connected to a sterile closed urinary drainage system or catheter valve ?? A link system should be used to facilitate overnight drainage to keep the original system intact ?? Connection should not be broken unless for a good clinical reason e.g. changing the bag according to the manufacturer’s recommendations ?? Preventing Catheter Associated UTIs Bags should be positioned below the level of the bladder but not on the floor to prevent reflux or contamination ?? Bags should be emptied frequently enough to maintain flow and prevent reflux. This will depend on the patient’s output—Loveday et al (2014) recommend when threequarters full. Use a separate and clean container for each patient and avoid contact between drainage tap and container ?? Do not add antiseptic or antimicrobial solutions to drainage bags ?? Bladder instillations should not be used to prevent catheter infections ?? Healthcare personnel must be trained in catheter insertion and maintenance ?? Patients and relatives should be educated about their role in prevention of UTIs ?? Review the individual’s need for catheter daily ?? Figure 2. Urinary securing straps Source: NICE, 2012; Loveday et al, 2014 Figure 1. Catheter valve carer or professional, clean non-sterile gloves and protective aprons must be used and a separate clean container should be used for each patient. Contact between the receptacle and the bag drainage tap should be avoided. Use the sampling port and an aseptic technique such as ANTT to obtain a catheter sample of urine (Loveday e al, 2014). Support and securing devices The catheter and drainage bag should be well supported to prevent traction on the catheter and ensure the balloon is not S10 pulled into the bladder neck (Yarde, 2015). Support systems come in the form of straps (Figure 2) or sleeves (Figure 3). Straps do have disadvantages as they tend to work loose and slide down, thereby not giving full support.There may also be difficulties maintaining hygiene of straps; there is a lack of any guidance with regards to tension of application and they can irritate the skin (Yates, 2013). Fixation devices should be used in conjunction with catheter-securing devices. They come in two forms, strap or adhesive (Figure 4). They are designed to secure the urinary catheter without placing tension on the urethra or abdominal tissues. Patients should be assessed for the most appropriate product and for ease of application and removal (Yates, 2013). British Journal of Nursing, 2016, (Urology Supplement) Vol 25, No 9 © 2016 MA Healthcare Ltd Figure 3. Urinary securing sleeve (25–35 ml/kg/day), amount of fluid loss, patient’s food intake and patient’s … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10