D219 PA – Evidence-Based Practices to Reduce CAUTIs in Nursing

D219 PA – Evidence-Based Practices to Reduce CAUTIs in Nursing

Student Name

Western Governors University

D218 Intrapersonal Leadership and Professional Growth

Prof. Name:

Date

Review of Evidence-Based Practice to Decrease CAUTIs

Impact of the Problem on the Patient

Catheter-associated urinary tract infections (CAUTIs) remain a significant cause of preventable harm in hospitalized patients across the United States. Approximately 15–25% of hospitalized patients receive a urinary catheter during their stay, and nearly 75% of hospital-acquired urinary tract infections (HAUTIs) are attributed to catheter use (Shadle et al., 2021). The presence of indwelling catheters increases the risk of infection, leading to longer hospital stays, increased morbidity and mortality, and a substantial rise in healthcare costs—estimated at around $14,000 per hospitalization (Shadle et al., 2021).
Patients affected by CAUTIs may experience additional complications such as sepsis, discomfort, and a decline in quality of life. Preventing CAUTIs is therefore essential not only for improving clinical outcomes but also for enhancing patient satisfaction and reducing financial burdens.

Impact of the Problem on the Organization

From an organizational perspective, CAUTIs are categorized as hospital-acquired infections (HAIs) and are reportable to both the National Healthcare Safety Network (NHSN) and the Centers for Medicare & Medicaid Services (CMS). These infections negatively impact hospital performance metrics, reimbursement rates, and accreditation standings (Rubi, Mudey, & Kunjalwar, 2022).
Healthcare institutions invest considerable resources in implementing infection prevention programs, staff education, and surveillance systems to mitigate CAUTI rates. Reducing these infections not only promotes patient safety but also aligns with value-based purchasing initiatives that financially reward hospitals for improved patient outcomes and reduced readmission rates.

B.1 Identify the PICO Components

B.2 Evidence-Based Practice Question

What evidence-based interventions can be implemented to decrease the number of hospital-acquired catheter-associated urinary tract infections (CAUTIs)?

A. Research Article

Daily Bathing with 4% Chlorhexidine Gluconate in Intensive Care Settings: A Randomized Controlled Trial

C.1 Background Introduction

Palloto et al. (2019) conducted a randomized controlled trial (RCT) in 2019 to examine whether daily bathing with 4% chlorhexidine gluconate (CHG) could effectively prevent hospital-acquired infections in intensive care units (ICUs). The study was motivated by growing evidence suggesting that CHG reduces bacterial colonization and infection transmission in critical care settings.

C.2 Methodology

This single-blind, parallel-group RCT was conducted from August 2015 to April 2016 in both an ICU and a post-cardiac surgery ICU (PC-ICU). Adult patients (≥18 years old) admitted for at least one night were eligible for inclusion. Participants were randomly assigned to either the CHG intervention group or the standard-care control group (Palloto et al., 2019).

C.3 Level of Evidence

According to the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model, this RCT qualifies as Level I evidence, representing the highest level of research reliability.

C.4 Data Analysis

Data analysis was performed using R statistical software, with statistical significance determined at p < 0.05. Normality of variables was tested using the Kolmogorov-Smirnov test, while comparisons between groups were made using the Mann-Whitney test and chi-square test with Yate’s correction (Palloto et al., 2019).

C.5 Ethical Considerations

The trial received approval from the institutional ethics committee. Written informed consent was obtained from all capable patients, while incapacitated patients were enrolled through a consent waiver. Once capable, patients were re-consented to confirm participation, in accordance with the Declaration of Helsinki (Palloto et al., 2019).

C.6 Quality Rating

Based on the JHNEBP model, the study was graded A for high quality due to its rigorous design, ethical integrity, and statistical reliability.

C.7 Analysis of Results and Conclusions

The study revealed that daily CHG bathing significantly reduced HAIs, including CAUTIs and ventilator-associated pneumonia (VAP), without increasing mortality or adverse events. Over the study period, 108 HAIs occurred among 91 patients, with CAUTI rates reduced to 4.9 per 1,000 patient-days (Palloto et al., 2019).
While CHG bathing did not entirely eliminate infections, it was shown to be an effective and safe preventive measure in high-risk ICU populations.

C.7.a Alignment to the EBP Question

This research directly aligns with the EBP question, supporting CHG bathing as an evidence-based intervention that reduces CAUTI prevalence among hospitalized patients (Palloto et al., 2019).

D. Non-Research Article

Short-Term Urinary Catheters and Their Risks: An Integrated Systematic Review

D.1 Background Introduction

Gyesi-Appiah, Brown, and Clifton (2020) conducted an integrated systematic review to evaluate the risks associated with short-term urinary catheterization. Their analysis found a strong correlation between catheter duration and infection risk, estimating that the probability of developing a UTI increases by 3–7% each day the catheter remains in place.

D.2 Type of Evidence

The authors synthesized evidence from 12 studies (2013–2018) that focused on urinary catheter use and its related complications.

D.3 Level of Evidence

According to the JHNEBP model, the review represents Level V evidence—integrative and systematic literature review.

D.4 Quality Rating

The article was rated as Grade B (Good Quality) due to its systematic search methodology using databases such as CINAHL, Medline, and the British Nursing Index (Gyesi-Appiah et al., 2020).

D.5 Authors’ Recommendations

The authors strongly recommended removing urinary catheters as soon as they are no longer medically required. This approach aligns with the EBP question by demonstrating that reduced catheter duration leads to a measurable decline in CAUTI rates.

E. Recommended Practice Change

Both research and non-research findings support the implementation of daily CHG bathing and early catheter removal as effective strategies to minimize CAUTI risk. A multifaceted infection prevention bundle—including staff education, auditing, and consistent adherence monitoring—should be adopted to sustain improvements.
Demonstrating the cost-effectiveness and clinical benefits of these strategies can help engage stakeholders and promote organizational adoption.

E.1 Key Stakeholders

E.2 Barrier to Implementation

A major barrier to implementing CHG bathing and early catheter removal is staff workload and convenience bias. When staffing levels are low, nurses may delay catheter removal for efficiency, while some patients may prefer catheters for comfort and mobility reasons.

E.3 Strategies to Overcome Barriers

To address these challenges, hospitals should implement educational programs emphasizing infection prevention benefits, conduct daily safety huddles, and encourage multidisciplinary collaboration. Transparent communication and feedback mechanisms can sustain motivation and accountability (Palloto et al., 2019; Gyesi-Appiah et al., 2020).

E.4 Indicators to Measure Outcomes

Outcome measurement should include:

• Chart audits for CHG bath documentation and catheter duration.

• Tracking CAUTI incidence per 1,000 catheter-days.

• Monitoring readmission and reimbursement rates through CMS and NHSN databases.

Sustained monitoring of these metrics provides quantitative evidence of intervention success and supports ongoing quality improvement initiatives.

Conclusion

CAUTIs represent a major preventable cause of morbidity in acute care hospitals. Implementing daily CHG bathing protocols alongside timely catheter removal has been shown to significantly reduce infection rates. Collaboration among healthcare professionals, patient engagement, and continuous quality monitoring are critical for long-term success in decreasing CAUTIs and improving patient outcomes.

References

Gyesi-Appiah, E., Brown, J., & Clifton, A. (2020). Short-term urinary catheters and their risks: An integrated systematic review. British Journal of Nursing, 29(9), S16–S22.

Palloto, C., Fiorio, M., De Angelis, V., Ripoli, A., Franciosini, E., Quondam Girolamo, L., Volpi, F., Iorio, P., Francisi, D., Tascini, C., & Baldeli, F. (2019). Daily bathing with 4% chlorhexidine gluconate in intensive care settings: A randomized controlled trial. Clinical Microbiology and Infection, 25(6), 705–710.

D219 PA – Evidence-Based Practices to Reduce CAUTIs in Nursing

Rubi, H., Mudey, G., & Kunjalwar, R. (2022). Catheter-associated urinary tract infection (CAUTI). Cureus, 10(8), e10023.

Shadle, H. N., Sabol, V., Smith, A., Stafford, H., Thompson, J. A., & Bowers, M. (2021). A bundle-based approach to prevent catheter-associated urinary tract infections in the intensive care unit. Critical Care Nurse, 41(2), 62–71.