Assignment

CLC EBP Identification of Clinical Question

PICO Question

For patients on a Pediatric Intensive Care Unit at a hospital, does the implementation of a UTI prevention bundle reduce the future risk of a CAUTI compared to not implementing the bundle?

P- PICU patients

I- urinary tract infection (UTI) prevention bundle

C- not implementing the UTI bundle

O- reduction of catheter associated urinary tract infection (CAUTI) rates

Problem Statement

A unitary tract infection (UTI) refers to an inflammatory response of the urothelium when invaded by microorganism associated with the presence of bacteria in urine (Shergill  & Mundy, 2010).  A UTI should be distinguished from the mere presence of bacteria in the urinary stretch. A Catheter Associated Urinary Tract Infection (CAUTI) happens when a subject with the device shows two or more indications of a UTI (Parida & Mishra, 2013). The risk of acquiring a UTI depends on the methods of catheterization a doctor uses, the length of time a patient uses the catheter, the quality of catheter care offered, and the susceptibility of the patient. There is a steady relationship between the development of a UTI and period of use of catheterization (Gordon & Katlic, 2017). Due to the association between UTIs and CAUTIs, the research aims at determining whether the implementing a UTI prevention bundle reduces the risk of a CAUTI.

Catheter associated urinary tract infections (CAUTIs) are preventable in the hospital setting with the proper care and prevention strategies. CAUTIs can cause a longer hospitalization admission, increased costs, and even mortality (Davis, et. al., 2014). CAUTIs are ranked among the most common hospital-acquired infections in the ICUs (Amine, Helal , & Bakr, 2014). The daily risk of developing a CAUTI has been estimated to range between 3% to 7% and the risk escalates with prolonged catheterization period. The occurrence of CAUTIs is prevalent in the critical and intensive care units where there is widespread use of indwelling catheters. 

Research and quality improvement strategies have been implemented to prevent CAUTIs in Adult patients, while very little is known about the causes and prevention in Pediatric patients. Urinary Tract Infections are common in pediatric patients that are seen in the emergency rooms. If these UTIs are untreated they can lead to more severe conditions with the insertion of a urinary catheter. Urinary catheters increase the patients risk for infections due to the increase of bacteria traveling up the catheter into the bladder. Catheters can become blocked or can create urinary complications that can cause urine to be blocked in the bladder causing CAUTIs with every indwelling catheter.

Currently we have a lot of information on how to manage and prevent CAUTIs in Adult patient, while very little is known on how to treat and manage CAUTIs in pediatric patients. The research will look to understand how CAUTIs occur in pediatric patients and develop methods and processes on how to minimize and prevent CAUTIs in pediatric patients with the implementation of a prevention bundle. Failure to understand how to diagnoses and prevent CAUTIs in pediatric patients can be detrimental to the health of future pediatric patients.

References

Amine, A. E., Helal, M. O., & Bakr, W. M. (2014). Evaluation of an intervention program to

prevent hospital-acquired catheter-associated urinary tract infections in an ICU in a rural

Egypt hospital.  GMS Hygiene and Infection Control.

Black, M., Singh, V., Belostotsky, V., Roy, M., Yamamura, D., Gambarotto, K., & ... Kam, A. J.

(2016). Process Mapping in a Pediatric Emergency Department to Minimize Missed

Urinary Tract Infections.  International Journal Of Pediatrics , 1-4.

doi:10.1155/2016/2625870 Retrieved from

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=119493418&site=eds-live&scope=site

Carter, N. M., Reitmeier, L., & Goodloe, L. R. (2014). An Evidence-Based Approach To the

Prevention of Catheter-Associated Urinary Tract Infections. Urologic Nursing, 34(5),

238-245. doi:10.7257/1053-816X.2014.34.5.23

Davis, K. F., Colebaugh, A. M., Eithun, B. L., Klieger, S. B., Meredith, D. J., Plachter, N.,

& Coffin, S. E. (2014). Reducing catheter-associated urinary tract infections: a quality-

improvement initiative. Pediatrics, peds-2013. Retrieved from

http://pediatrics.aappublications.org/content/pediatrics/early/2014/08/06/peds.2013-3470.full.pdf

Gesmundo, M. (2016). "Enhancing nurses’ knowledge on catheter-associated urinary tract

infection (CAUTI) prevention." Kai Tiaki Nursing Research 7, no. 1: 32-40. CINAHL

Complete, EBSCOhost (accessed June 28, 2017). 

Gordon, D. A., & Katlic, M. R. (2017).  Pelvic Floor Dysfunction and Pelvic Surgery in the

Elderly: An Integrated Approach.  Berlin: Springer.

Parida, S., & Mishra, S. K. (2013). Urinary tract infections in the critical care unit: A brief

review.  Indian Journal of Critical Care Medicine, 370-374.

Shergill, I., & Mundy, A. R. (2010).  Viva Practice for the FRCS(Urol) Examination.  Abingdon:

Radcliffe Publishing.

Williams, L. (2016). Zeroing in on Safety: A Pediatric Approach to Preventing Catheter-

Associated Urinary Tract Infections. AACN Advanced Critical Care ,  27 (4), 372-378.

doi:10.4037/aacnacc2016297