Follow Nurse Daniel as your process mentor in the weekly Illustration section of the lesson.   Star Point 1: Discovery (Identify topic and practice issue) Topic and Practice Issue:The chosen topic is hospital-acquired infections, with a specific focus on catheter-associated urinary tract infections (CAUTIs) and their high incidence on an acute rehabilitation unit. Rationale for Topic Selection:The issue of healthcare-associated infections (HAIs), particularly CAUTIs, is critical as these infections are largely preventable. Investigating CAUTIs is essential because, despite the predictability of such infections, they remain a prevalent issue. By educating nurses about the causes and symptoms of HAIs, we can adopt more proactive approaches in treatment plans. Unlike falls, which can be unpredictable, HAIs such as CAUTIs can be mitigated through consistent and proper care practices. Ensuring the regular and thorough cleaning of the perineal area and limiting the duration of indwelling catheters are vital steps in preventing these infections. Urinary tract infections (UTIs) are among the most common hospital-acquired infections, with approximately 80% linked to indwelling urinary catheters. CAUTIs contribute to prolonged hospital stays, increased morbidity and mortality, and higher healthcare costs, with around 13,000 deaths annually associated with these infections. Star Point 2: Summary (Evidence to support need for a change) Practice Problem and PICOT Question:The practice problem involves the improper cleaning of the perineal area in patients with indwelling catheters and the extended, unnecessary use of these catheters. PICOT Question:In patients with an indwelling catheter on an acute rehabilitation unit (P), does cleansing the perineal area every eight hours (I) compared to routine daily cleansing (C) reduce the incidence of catheter-associated urinary tract infections (O) over a six-month period (T)? Systematic Review:Interventions to improve professional adherence to guidelines for prevention of device-related infections. Reference:Flodgren, G., Conterno, L.O., Mayhew, A., Omar, O., Pereira, C.R., & Shepperd, S. (2013). Interventions to improve professional adherence to guidelines for prevention of device‐related infections. Cochrane Database of Systematic Reviews, 2013(3), Art. No.: CD006559. https://doi.org/10.1002/14651858.CD006559.pub2 Additional Sources:

  • Nurse-Driven CAUTI Prevention Algorithm: An article on nurse-driven CAUTI prevention offers relevant insights into decreasing CAUTI occurrences in hospitals, covering the history, costs, and prevention methods, as well as an algorithm designed to reduce CAUTI prevalence.
  • Educational Tool on CAUTI Causes and Perineal Care: An article detailing the causes of CAUTI and the correct methods for perineal care.
References: Main Findings and Strength of Evidence:The systematic review revealed insufficient evidence to strongly support the proposed interventions due to small sample sizes and inadequate reporting. The overall strength of the evidence was weak, highlighting the need for further research to determine the most effective interventions for CAUTI prevention. Evidence-Based Solutions:
  • CAUTI Prevention Tool by the American Nurses Association: This tool focuses on reducing CAUTI through fewer catheter insertions, timely removal, and proper maintenance and post-removal care.
Reference:American Nurses Association. (2009). Streamlined Evidence-Based RN Tool: Catheter Associated Urinary Tract Infection (CAUTI) Prevention. Retrieved from https://www.nursingworld.org/globalassets/practiceandpolicy/innovation–evidence/clinical-practice-material/cauti-prevention-tool/anacautipreventiontool-final-19dec2014.pdf Star Point 3: Translation (Action Plan) Care Standards and Protocols:
  • Education: Staff education on infection prevention, recognizing UTI symptoms, and proper catheter care is essential.
  • Criteria for Catheter Use: Establish clear criteria for when indwelling catheters are necessary, using the CAUTI Prevention Tool.
  • Procedures: Follow protocols for catheter insertion, maintenance, and removal, including hand hygiene, aseptic techniques, securing tubing, maintaining sterility, and proper documentation.
Reference:The Joint Commission. (2017). Requirements for the Catheter-Associated Urinary Tract Infections (CAUTI) National Patient Safety Goal for Hospitals. Retrieved from https://www.jointcommission.org/assets/1/6/R3_Cauti_HAP.pdf Stakeholders and Their Roles:
  • Nurse Leader: Leads the trial, ensuring the project’s success and managing day-to-day operations.
  • Nurse Manager: Oversees the trial and assists the Nurse Leader.
  • Unit Nurses: Assist in implementing the change process and provide bedside care.
  • Patient: Consents to participate in the trial and helps identify CAUTI symptoms.
Nursing Role in the Change Process:As the Nurse Leader, my role is to ensure that all necessary supplies, education, and documentation are in place throughout the trial. Unit nurses are responsible for catheter placement, daily care, and specimen collection. They also play a key role in diagnosing suspected CAUTI cases. Stakeholders by Position:
  • MD (Doctor of Medicine)
  • DO (Doctor of Osteopathic Medicine)
  • Nurse Educator
  • RN (Registered Nurse)
  • CNA (Certified Nursing Assistant)
  • Nurse Manager
These stakeholders are crucial for implementing the change process, from ordering catheters to providing daily care and ensuring that policies are followed. Cost Analysis:A cost-effectiveness analysis will be conducted to evaluate the costs and health outcomes of the intervention. The finance department will determine the budget for the project, while the quality control department will ensure adherence to policies and procedures. Reference:Jamison, D. T., Breman, J. G., Measham, A. R., et al. (2006). Priorities in Health. The International Bank for Reconstruction and Development / The World Bank. Available from https://www.ncbi.nlm.nih.gov/books/NBK10253/ Star Point 4: Implementation Permission and Planning:Permission to conduct the trial begins with hospital management. Coordination with the finance department is necessary to allocate resources, and quality assurance will monitor compliance with policies. Cooperation from unit nurses and patient consent are also required. Staff Education Plan:Coordination with nurse educators is essential for educating staff on CAUTI prevention. This includes refresher courses, in-person education, and online learning modules, ensuring accessibility for all shifts. Implementation Timeline:The change process will occur over six months, beginning with staff education and followed by the trial of patients who consent to participate. Measurable Outcomes:Outcomes will be measured by tracking the number of CAUTI incidents, related medication use, and catheterizations over six months. Forms for Recording:Forms for recording include documentation of staff education, patient consent forms, and records of perineal and catheter care. Self-assessments for staff readiness and understanding will also be used. Available Resources:Resources include extra catheter care supplies and educational materials for staff and patients. Stakeholder Meetings:Meetings with stakeholders will occur weekly during the first month and bi-monthly for the remainder of the trial to discuss progress and make necessary adjustments. Star Point 5: Evaluation Outcome Reporting:Outcomes will be reported in staff rooms as data reports. A final meeting will discuss the trial’s effectiveness, and the data will be presented to management for further consideration. Next Steps:The information from the trial will guide ongoing changes to CAUTI prevention practices. Successful strategies will be integrated into standard care protocols to continue reducing CAUTI incidents.