According to Wilkinson, Treas, Barnett, and Smith patient safety is “the ability to coordinate and integrate the multiple aspects of quality within the care directly provided by nursing and across the care delivered by others in the setting” (Wilkinson, et. al, 2016). One of the main priorities for a nurse is to maintain the safety of their patients as well as themselves. They are the people that will be able to notify change and be the first to monitor for any risk hazards for a patient. If performed accordingly, safety precautions prevent the majority of accidents that happen in a healthcare setting. Some of the biggest debates in healthcare settings are nosocomial infections. Nosocomial infections are infections that are acquired in a hospital setting (Wilkinson, et. al, 2016). In these categories of infections falls Catheter-associated urinary tract infections (CAUTIs). These infections are at high risk in particular groups of people including the elderly and those in post-operative or intensive care units. Indwelling catheters, or Foley catheters, are of extreme help in the healthcare field aiding in bladder outlet obstruction, accurate measuring of urinary output, perioperative care, assisting in healing of perineal area wound, aiding the inability to be mobile, and to simply provide comfort (Fakih, Krein, Edson, Watson, Battles, & Saint, 2014). But the usefulness of the medical equipment usually is accompanied by the high risk of infection in a patient.
There are numerous risks that come with having an indwelling catheter in place. They include the appearance of multidrug resistance infections, local trauma, patient discomfort, immobility, and pressure ulcers and falls (Fakih, et. al., 2014). Eighty percent of nosocomial infections are the caused by indwelling Foley catheters and the risk for acquiring such infection increases by five percent for every day the catheter is in place (Underwood, 2015). This not only makes hospitalization longer and more expensive, but it puts an unnecessary toll on a person’s body, Jerri is a prime example. Jerri Allen went into the hospital after her 72nd birthday to finally have her hip replaced after enduring pain for so long. She successfully went through the procedure and was ready for rehabilitation after three days recovering. Just as she was about to get transferred over, she began to run a fever. After several tests it was concluded that she had a urinary tract infection (UTI) due to a bladder catheter having been in place for longer than it was supposed to be. Jerri went through antibiotics and was able to go home a few days later. But, only four days after being in her home her surgical site became swollen and began to have a discharge. She returned to the hospital and was admitted as an emergency surgical procedure to clean her incision. Her surgeon diagnosed her with a deep infection caused by the same organism that had caused her UTI seeding. It was a long journey afterwards with more surgeries to clean the wound and then a long recovery. Jerri went into depression. Medicare and her insurance did not cover her post infections and she was in a major financial problem (Iowa Healthcare Collaborative & Iowa Department of Public Health, 2011). Jerri’s situation was a major life turn from a health problem that was totally irrelevant from the procedure she was in for. It is only imaginable how much worse other stories are. So what are health care settings and professionals doing to prevent situations like these from occurring?
In efforts to reduce the occurrence of CAUTIs, a nationwide implementation of Comprehensive Unit-based Safety program to reduce CAUTI initiatives. This program is funded by the Agency for Healthcare Research and Quality and is led by a variety of healthcare facilities (Fakih, et. al, 2014). Three main practices to decrease the risks and numbers of CAUTIs include reducing Foley catheter use, removal of catheter when no longer needed, and an increase in sterile technique usage. Reducing catheter use is extremely necessary because many times a catheter is placed without an extreme need for it. They are used highly in vulnerable populations, such as the elderly, in order to reduce the work of ambulating a patient to the bathroom. Determining the need for a Foley catheter has distinct features such as the patient’s mobility status, consciousness, and critical care status. This program has strict criteria for Foley eligibility. This program resulted in 25% less catheter uses and 25% reduction in CAUTI rates (Fakih, et. al, 2014). Even when a catheter is in place the need for it needs to be reviewed consistently. A study performed by Lindsey Underwood critically states there is a significant drop in CAUTI when total catheter days were decreased. In order to improve the number of catheter days she states the need for reminder systems and a nurse-directed catheter removal protocol. Reminder systems work by reminding health professionals of a daily assessment for indwelling catheters to determine if the need is still in place. A nurse directed catheter removal protocol is designated for a nurse to be able to assess and determine status of removal. When a nurse-directed removal protocol was implemented, it showed a 70% decrease in CAUTIs (Underwood, 2015). The third main point is maintaining a sterile technique when inserting and while the catheter is in use. Underwood states that using a silver alloy catheter, not allowing the tubing to touch the floor, and securing the catheter to prevent it from hanging all decreased the amount of contamination (Underwood, 2015). It is highly necessary for an assessment to be taken in order to recognize if a patient qualifies for a Foley, simply because many times they are not necessary, and if placed, assess daily for the need. Catheters are not a device used to help decrease workload, but should only be used for a medical significance.
It is a nurse’s role to advocate for a patient, especially those vulnerable to medical decisions. As stated prior, implementing a nurse-directed catheter removal protocol can help significantly decrease the number of CAUTIs. Even if a protocol is not in place, a nurse is responsible for minimizing contamination of the catheter and assessing every day the catheter. This can help prevent situation like Jerri’s that was mentioned earlier and situations such as this nurses:
“My father died of a heart attack at age 39, and our mother raised my siblings and me. We were all close to mom; however, as the oldest she and I had a special bond. At age 46 she had undergone a mitral valve replacement and her aortic valve was replaced about 9 years later. She had survived a cardiac arrest and pulmonary artery rupture. When she was hospitalized with dehydration and acute kidney injury, we believed she would spend some time in the hospital and be discharged. Her kidney function improved with fluids, and her output was carefully monitored with a urinary catheter. She had a history of atrial fibrillation and her rate control medications were held. One day, her temperature soared to 102.8 F and her heart rate increased to 130 beats per minute. She developed sepsis, which placed further stress on her pulmonary and cardiovascular system. In June 2001 my mother died from complications related to a catheter associated urinary tract infection. She was 61 years old and I still miss her” (Townsend, Anderson, & Meeker, 2013).
It is of great sadness that people who are affected by unnecessary infections are affected in such big ways. The healthcare system as a whole can improve the outcomes of catheterization by avoidance and proper use.