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Clinical Governance and Practice Development

Table of Contents

Introduction.

Potential clinical problem..

Clinical question.

PICOT format

Justification.

Conclusion.

References.

Introduction to Clinical Governance and Practice Development

The CAUTI (Catheter-associated urinary tract Infection) has become one of the most severe clinical concerns for the catheter patients (Barbadoro et al., 2015). The study conducted by Letica-Kriegel et al., (2019) found nearly 12% of the patients who have gone through catheter insertion for 30 days are likely to be subjected to CAUTI. The advancement of clinical science has contributed to discover silver impregnated urinary catheters and Foley which has bacteriostatic tubing system. Though the silver impregnated urinary catheters are cost-effective, and reduces bacteremia, it is still required to discover whether the catheter is able to reduce the occurrence of CAUTI to an extent or not. The purpose of the paper is to construct a searchable question on the effectiveness of silver impregnated urinary catheters in terms of CAUTI and find the information to enhance outcomes of EBP.

Potential Clinical Problem

Generally, CAUTI happens when bacteria, through the urinary catheter; enters to the urinary track and causes infection in the urinary system of the patient (Blondal et al., 2016). According to Melo (2016) CAUTI is the development of pathogenic biofilm as a result of Proteus, UPEC, Pseudomonas, Klebsiella, Enterobacter rarely Candida and another various opportunistic organisms. To Roy, & Riley, (2019) numerous factors cause CAUTI, such as when the catheter is not regularly cleaned, urine flows backward to bladder, the catheter becomes contaminated after insertion or the bacteria gets on the catheter. Regardless of any factor causing CAUTI, it is always found to be a severe clinical problem as it has adverse impact on both physical and psychological health of the patient (Fakih, et al., 2017). As suggested by Letica-Kriegel et al., (2019) CAUTIs can result in severe and unmanageable complications, such as endocarditis or sepsis. CAUTI is the reason behind more than 13,000 deaths per annum in US in case of the acute care patients (Letica-Kriegel et al., 2019). It disrupts the urinary system by affecting bladder, ureters, urethra, and kidney. Due to recurrence, it results in nosocomial infection. Apart from these, CAUTI discomforts the patients, creates delirium in the older aged people, agitation and feelings of withdrawal. Clinical nursing is not only associated to cure the clinical concerns of the patients, but it also involves caring patients, supporting them, screening their health and coordinate with the patients for faster recovery. Thereby, CAUTI is a major clinical problem, which needs to be addressed effectively. Herter, & Kazer, (2010) recommended hydrogel or Silicone catheters for the patients using catheter for 14 days. Zhu, Wang, Li, & Yuan, (2019) suggested silver impregnated catheters are effective in reducing infections among patients for long term catheter usage. Thereby, it calls for attention to examine the effectiveness of the silver impregnated catheters in catheter patients whose catheter insertion period is 30 days to enhance patient care.

Clinical Question

PICOT Format

P

Patient / Population

The catheter patients who have gone through catheter

I

Intervention

silver impregnated urinary catheters and Foley

C

Comparison to intervention

Compared to the regular indwelling urinary catheters

O

Outcome to be measured

In reducing the occurrence of CAUTI by 50%

T

Time

Catheter insertion period of 30 days

Suggested question

In catheter patients, does the silver impregnated urinary catheters compare with regular indwelling urinary catheters effectively work in reducing occurrences of CAUTI by 50%?

Table: PICOT question

Justification

The question allows examining the competence and efficacy of silver impregnated urinary catheters over the regular catheters. It will enable to discover the mechanism of Silver against the prevention of bacteria even if the catheter is used for ling period. The question is answerable, and it compares the action of different types of catheters, which will allow selecting the best intervention for patients and enhancing evidence based nursing practices.

Conclusion on Clinical Governance and Practice Development

In conclusion, CAUTI is found to be a serious clinical problem which creates urinary issues, discomfort of patients, decreases the recovery rates and even causes deaths. Though there are various catheters available for short term till 14-15 days, very few catheters are there to support the 30 days period. The PICOT question has been developed which attempts to find the effectiveness of silver impregnated urinary catheters compared to the regular indwelling urinary catheters in reducing occurrences of CAUTI, specifically when a patient undergoes catheter insertion for 30 days. After answering the question, it is expected that the clinical staffs will be able to offer most suitable intervention and clinical care to the patients.

References for Clinical Governance and Practice Development

Barbadoro, P., Labricciosa, F. M., Recanatini, C., Gori, G., Tirabassi, F., Martini, E., & ... Prospero, E. (2015). Catheter-associated urinary tract infection: Role of the setting of catheter insertion. American Journal Of Infection Control, 43(7), 707-710. doi:10.1016/j.ajic.2015.02.011

Blondal, K., Ingadottir, B., Einarsdottir, H., Bergs, D., Steingrimsdottir, I., Steindorsdottir, S., & ... Hafsteinsdottir, E. (2016). The effect of a short educational intervention on the use of urinary catheters: a prospective cohort study. International Journal For Quality In Health Care, 28(6), 742-748. doi:10.1093/intqhc/mzw108

Fakih, M. G., Groves, C., Bufalino, A., Sturm, L. K., & Hendrich, A. L. (2017). Definitional change in NHSN CAUTI was associated with an increase in CLABSI events: evaluation of a large health system. Infect Control Hosp Epidemiol38, 685-9.

Herter, R., & Kazer, M. W. (2010). Best practices in urinary catheter care. Home Healthcare Now28(6), 342-349.

Letica-Kriegel, A. S., Salmasian, H., Vawdrey, D. K., Youngerman, B. E., Green, R. A., Furuya, E. Y., ... & Perotte, R. (2019). Identifying the risk factors for catheter-associated urinary tract infections: a large cross-sectional study of six hospitals. BMJ open9(2), e022137.

Melo, L. D., Veiga, P., Cerca, N., Kropinski, A. M., Almeida, C., Azeredo, J., & Sillankorva, S. (2016). Development of a phage cocktail to control Proteus mirabilis catheter-associated urinary tract infections. Frontiers in microbiology7, 1024. doi: https://doi.org/10.3389/fmicb.2016.01024

Roy, S. M., & Riley, M. A. (2019). Evaluation of the potential of colicins to prevent extraluminal contamination of urinary catheters by Escherichia coli. International journal of antimicrobial agents54(5), 619-625. doi: https://doi.org/10.1016/j.ijantimicag.2019.07.004

Zhu, Z., Wang, Z., Li, S., & Yuan, X. (2019). Antimicrobial strategies for urinary catheters. Journal of Biomedical Materials Research Part A107(2), 445-467.

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