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

Student Name

Western Governors University 

D219 Scholarship in Nursing Practice

Prof. Name

Date

Review of Evidence-Based Practice to Decrease CAUTIs

Impact of the Problem on the Patient

Catheter-associated urinary tract infections (CAUTIs) continue to be a significant and preventable source of patient harm in U.S. hospitals. Research shows that approximately 15% to 25% of hospitalized patients receive an indwelling urinary catheter during their stay, with about 75% of hospital-acquired urinary tract infections (HAUTIs) linked directly to catheter use (Shadle et al., 2021). The presence of these catheters increases the risk of bacterial colonization and subsequent infection, which often results in longer hospital stays, increased rates of morbidity and mortality, and elevated treatment costs—estimated at around $14,000 per patient (Shadle et al., 2021).

Patients suffering from CAUTIs frequently endure symptoms such as pain, fever, and discomfort. Moreover, these infections can lead to severe complications, including sepsis, which prolong recovery times and adversely affect patients’ quality of life. Hence, preventing CAUTIs is critical not only for enhancing clinical outcomes and patient satisfaction but also for reducing avoidable healthcare expenses. Implementing rigorous infection control measures safeguards patients and promotes a culture of safety and quality within healthcare settings.

Impact of the Problem on the Organization

From an organizational perspective, CAUTIs are classified as hospital-acquired infections (HAIs) and must be reported to entities such as the National Healthcare Safety Network (NHSN) and the Centers for Medicare & Medicaid Services (CMS). These infections influence hospital performance metrics, affect reimbursement rates, and can jeopardize accreditation status (Rubi, Mudey, & Kunjalwar, 2022).

Hospitals allocate substantial resources towards infection control, ongoing staff education, and surveillance programs aimed at lowering CAUTI rates. Achieving reductions aligns with national patient safety goals and value-based purchasing programs, which provide financial incentives for improved outcomes and reduced readmission rates. Consequently, lowering CAUTI incidences enhances institutional reputation, operational efficiency, and cost-effectiveness through reduced penalties and shorter inpatient durations.

B.1 What Are the PICO Components?

B.2 What is the Evidence-Based Practice Question?

What evidence-based strategies can healthcare providers implement to reduce the incidence of hospital-acquired catheter-associated urinary tract infections (CAUTIs)?

A. Research Article

C.1 What is the Background of the Study?

Palloto et al. (2019) performed a randomized controlled trial (RCT) to evaluate if daily bathing with 4% chlorhexidine gluconate (CHG) decreases hospital-acquired infections in intensive care units (ICUs). The study was driven by evidence suggesting that CHG lowers microbial colonization and limits transmission of multidrug-resistant organisms, thereby potentially reducing CAUTIs and ventilator-associated pneumonia (VAP).

C.2 What Methodology Was Used?

This single-blind, parallel-group RCT took place from August 2015 to April 2016 in ICU and post-cardiac surgery ICU (PC-ICU) settings. Adult patients aged 18 or older, admitted for at least one night, were randomly assigned to either a CHG bathing group or a control group receiving standard bathing care (Palloto et al., 2019).

C.3 What is the Level of Evidence?

According to the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model, this study represents Level I evidence, which is the highest quality level reflecting strong research design.

C.4 How Was the Data Analyzed?

Data analysis was conducted using R statistical software. Tests for normal distribution included the Kolmogorov–Smirnov test, and group comparisons were performed with Mann–Whitney and chi-square tests with Yate’s correction. Statistical significance was set at p < 0.05 (Palloto et al., 2019).

C.5 Were Ethical Considerations Addressed?

Ethical approval was granted by the institutional review board. Written informed consent was obtained from patients capable of consenting, with waivers used when necessary. Patients unable to consent initially were re-consented when possible, following the Declaration of Helsinki guidelines (Palloto et al., 2019).

C.6 What Quality Rating Did the Study Receive?

This research earned a Grade A (High Quality) rating on the JHNEBP appraisal tool, indicating strong design, ethical adherence, and trustworthy statistical analysis.

C.7 What Were the Results and Conclusions?

The study found that daily CHG bathing significantly reduced hospital-acquired infections, including CAUTIs and VAP, without increasing adverse events or mortality. Over the study duration, 108 infections occurred in 91 patients, with CAUTI rates dropping to 4.9 per 1,000 patient-days (Palloto et al., 2019). These results confirm the effectiveness and safety of daily CHG bathing in ICU environments.

C.7.a How Does This Align with the EBP Question?

The findings support the evidence-based practice question, demonstrating that daily CHG bathing is an effective intervention to lower CAUTI rates in hospitalized patients (Palloto et al., 2019).

D. Non-Research Article

D.1 What is the Background of This Review?

Gyesi-Appiah, Brown, and Clifton (2020) conducted an integrated systematic review investigating the risks linked to short-term urinary catheter use. The review showed that the risk of urinary tract infection increases by approximately 3–7% each day a catheter remains in place.

D.2 What Type of Evidence Was Synthesized?

The review compiled evidence from 12 primary studies published between 2013 and 2018, focusing on urinary catheter duration and related complications (Gyesi-Appiah et al., 2020).

D.3 What is the Level of Evidence?

Based on the JHNEBP model, this integrative review is classified as Level V evidence, representing a synthesis of non-experimental studies.

D.4 What Quality Rating Did the Review Receive?

The review was rated Grade B (Good Quality), reflecting a thorough search strategy and methodological rigor. Databases searched included CINAHL, Medline, and the British Nursing Index (Gyesi-Appiah et al., 2020).

D.5 What Did the Authors Recommend?

The authors stressed the importance of removing urinary catheters promptly when no longer medically needed. Early catheter removal emerged as a key intervention for reducing CAUTI rates, reinforcing the rationale for this evidence-based practice question.

E. What Practice Change is Recommended?

Both the research and review articles advocate for daily chlorhexidine bathing combined with timely catheter removal to effectively reduce CAUTI incidence. Implementing a comprehensive infection prevention bundle—featuring staff education, regular audits, and compliance monitoring—is essential for sustained improvements. Demonstrating clinical benefits alongside cost savings will help gain support from stakeholders and healthcare leadership.

E.1 Who Are the Key Stakeholders?

E.2 What Are the Barriers to Implementation?

Major challenges include high nursing workloads, which may delay catheter removal, patient comfort preferences, and clinical uncertainty about when catheter discontinuation is appropriate. These factors can reduce adherence to prevention protocols.

E.3 What Strategies Can Overcome These Barriers?

Hospitals can address barriers by offering education on infection prevention benefits, promoting daily interdisciplinary safety huddles, enhancing team communication, and establishing feedback systems. Recognizing staff compliance and tracking performance metrics also encourage sustained engagement (Palloto et al., 2019; Gyesi-Appiah et al., 2020).

E.4 What Indicators Should Be Used to Measure Outcomes?

Regular monitoring of these indicators provides objective evidence of progress and guides ongoing quality improvement.

Conclusion

CAUTIs pose a significant yet avoidable healthcare issue that adversely affects both patient health and organizational performance. Evidence robustly supports that combining daily chlorhexidine gluconate bathing with prompt catheter removal leads to substantial reductions in CAUTI rates among hospitalized patients. Continued multidisciplinary collaboration, patient engagement, and vigilant monitoring are vital to sustaining these improvements and ensuring high-quality, safe care delivery.

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.

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

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

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.