The American Nurses Association, the Centers for Medicare and Medicaid Services' Partnership for Patients, and the Centers for Disease Control and Prevention, in an initiative to reduce catheter-associated urinary tract infections (CAUTIs), together convened an expert panel to develop an assessment and decision-making tool for nurses and other clinicians to use at the bedside to determine the best way to provide care. The tool, a one-page guidance, was presented to nurses at the ANA's National Quality Conference earlier this year and is also available on the ANA website (www.nursingworld.org).
“Nurses can have a big influence on reducing urinary tract infections, since they are continually assessing patients to minimize the use of urinary catheters, and have sharp assessment and decision-making skills that will be enhanced by this concise guidance,” ANA President Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, said in a news release.
CAUTIs are the most commonly reported hospital-acquired condition, with more than 560,000 patients developing one each year—which extends hospital stays, increases health care costs, and increases patient morbidity and mortality, the ANA release notes.
This tool was designed to assist clinicians in determining whether a urinary catheter is appropriate to insert; recommending alternative treatments for urinary retention and incontinence; evaluating indicators for timely catheter removal to prevent harm; and following a checklist on catheter insertion and cues for essential maintenance and post-removal care.
“Regardless of practice location, having one patient with a CAUTI is too many; prevention of infections results in shorter stays and limited re-admissions,” Carol J. Bush, BS, RN—a member of OT's Editorial Advisory Board who is a Nurse Navigator & Consultant at Midwest Cancer Alliance—University of Kansas Cancer Center—said in an email. “This tool lays out interventions based on clinical evidence to allow for safer care of patients with urinary catheters and to support the removal of catheters as soon as they are no longer medically necessary.
“I could see this tool being most effective when paired with system-wide procedures which give oncology nurses autonomy to manage patients with catheters. I think it would be useful to inform the work of an interdisciplinary quality improvement team.”
In Terms of Patients with Cancer
Also commenting via email for this article, Tracy Wyant, RN-BC, AOCN, CHPN, Oncology Clinical Specialist in the Oncology Nursing Society Education Department and DNP-Clinical Expert Student at The Ohio State University College of Nursing, noted that many patients with cancer experience myelosuppression following treatment, which increases their susceptibility to infection—and those patients needing urinary catheterization are therefore at a higher rate of developing CAUTIs.
Additionally, intravesical chemotherapy—often a treatment option for patients with some types of bladder cancer, according to the National Comprehensive Cancer Center guidelines—is administered through short-term bladder catheterization in both perioperative and postoperative settings, she added.
“The CAUTI Prevention Tool developed in collaboration between the ANA, CMS, and CDC is a useful resource for health care organizations and nursing professionals caring for oncology patients with compromised immunity or receiving intravesical chemotherapy,” she said. “The tool's evidence-based strategies and algorithms guide nursing assessment and decision-making aimed at preventing catheter-related infections and complications.”
The tool was developed by a technical expert panel of nursing clinical experts, which included members of the American Geriatric Society, the American Hospital Association Health Research and Education Trust—Agency for Healthcare Research and Quality, the American Nurses Association, the Association of perioperative Registered Nurses, the Academy of Medical-Surgical Nurses, the Association of Rehabilitation Nurses, the Centers for Disease Control and Prevention, the National Database of Nursing Quality Indicators, Partnership for Patients (funded by the Centers for Medicare and Medicaid Services), the Society of Urologic Nurses and Associates, and Wound, Ostomy and Continence Nurses Society, as well as content experts from MedStar Health and the University of Rochester.
The panel conducted a review of evidence-based guidelines, existing CAUTI reduction tools, and focused literature to develop the tool, which incorporates best practices based from the CDC's 2009 “Guideline for Prevention of Catheter-Associated Urinary Tract Infections.”
The tool incorporates an algorithm to determine if a urinary catheter is appropriate based on nursing screening and assessments, as well as alternatives for retention and incontinence; timely removal; and a checklist on catheter insertion, cues for essential maintenance and post-removal care.
Fourteen hospitals participated in a pilot program to test and refine the CAUTI-reduction approach. Data from that pilot program will be published in the Journal of Wound, Ostomy, and Continence Nursing, though a date has not yet been specified, according to the ANA.