Catheter Infection Paper

Introduction

The purpose of this paper is to provide research to support that infection, with urinary catheter use, is an ongoing issue, in many hospitals. Carter et al., 2014 defines a urinary catheter as an indwelling tube that runs through the urethra and into the bladder allowing for the passive drainage of urine from the bladder. A balloon at the inner end of the catheter is inflated with sterile water to hold the catheter in place. Catheterization is a sterile procedure, which if broken, could compromise the patient; however, catheter insertion may not be the only problem contributing to hospital-acquired infections. Studies have shown that indications for catheter use may not be medically necessary, also putting the patient

in danger for infection.
Problem
Indwelling catheters are often used for both medical and non-medical reasons and account for approximately one-third of all healthcare-associated infections in the United States, affecting nearly two million Americans (Greene et al., 2014) (Saint et al., 2014).

The annual cost of catheter-associated urinary tract infection (CAUT) is about three hundred and fifty million, in the United States (Saint et al., 2014). This cost affects the hospital, due to the fact that CAUTIs are preventable through nursing implementation and evidence- based practice. Catheter use is associated with physiologic complications, such as bladder calculi, bladder inflammation, and catheter-associated urinary tract infections. They can contribute to further complications, especially in older adults, leading to falls and delirium (Carter et al., 2014). The Centers for Disease Control and Prevention has specific guidelines that detail high priority recommendations for controlling catheter-associated infection prevention. Inserting catheters for only appropriate indications and leaving them in place for as long as medically necessary is their main concern and priority (Carter et al., 2014). The safety and comfort of the patient should be most important in the practice for all nurses when inserting and taking care of catheters. Unfortunately, this is not always the case, and the consequences of nursing implementation are left with the

patient.
Background
In an issue of Infection Control and Hospital Epidemiology, researchers compared and examined regional variation in the use and appropriateness of indwelling urinary catheters and catheter associated urinary tract infection (CAUTI) in both the ICU and non-ICU setting. They divided hospitals into four different regions according to the US Census Bureau (North-east, Midwest, South, and West). Baseline data on urinary catheter use, catheter appropriateness, and CAUTI were collected from participating units affiliated with the On the CUSP; Stop CAUTI initiative. Their study began in August of 2011, in acute care hospitals, and both clinical process and infection outcome were required to be reported (Greene et al., 2014).
Statistics
Data were collected from 443 ICU and 658 non-ICU units in 726 hospitals across 34 states.

The Northeast region consisted of 101 units (67 hospitals) from 4 states, the Midwest region consisted of 356 units (246 hospitals) from 9 states, the South region consisted of 433 units (271 hospitals) from 12 states, and the West region consisted of 211 units (124 hospitals) from 9 states. Across the participating units, catheter utilization was 31%. Utilization in the ICU at 61% was greater than the non-ICU at 20%. The West has the highest utilization in the non-ICU setting at 24% while the South had the highest utilization in the ICU at 63%. Compared with non-ICUs in the West, catheter utilization was significantly lower in non-ICUs in the Northeast (P=.001) and South (P=.007). Compared with ICUs in the West, catheter utilization was significantly higher in ICUs in all other areas: Northeast P =.02, Midwest P =.002, and South P <.001. Overall utilization did not vary by region after the hospitals characteristics were adjusted. Furthermore, several finding came from this nation study. It was found that catheter utilization remains common across the United States, with 20% in non-ICU settings and 61% in the ICU. Catheter appropriateness in the ICU was high across all regions, however; the study found that 30%-40% of catheters in the non-ICU setting may be placed without an appropriate indication. CAUTI rates were 2.5 per 1,000 catheter-days and did not differ by unit type.

The overall population based rate was 7.8 per 10,000 patient-days and was higher in the ICU, 4.9 per 10,000 patient-days, compared with the non- ICU, 5.2 per 10,000 patient-days (Greene et al., 2014).
Conclusions
It can be concluded that catheter use should be monitored more closely, in hospitals, to ensure patient safety. It is necessary to evaluate whether or not the patient needs a urinary catheter to prevent infection and complications. With proper nursing technique and implementation catheter associated infections could be eliminated.