Running head: LITERATURE EVALUATION TABLE 1

Literature Evaluation Table

Sara Emalee Pate

Grand Canyon University: NRS 493

November 14, 2020

LITERATURE EVALUATION TABLE 2

Literature Evaluation Table

Student Name: Sara Emalee Pate

Change Topic : This change project topic is on nurse-driven protocols that will decrease catheter
associated urinary tract infections (CAUTI’s). Within a hospital setting many adult patients
develop a catheter associated urinary infection due to catheters being left in for long period of
times and not reassessed for the needs of the catheter. This increases the risk of catheter
associated urinary tract infections (CAUTI’s) for patients and could prolong their stay in the
hospital increasing hospital cost and turning the infection into a hospital acquired infections.
Implementing a nurse driven protocol for the removal of urinary catheters and management
versus current practices will help reduce catheter associated urinary tract infections (CAUTI).
Using an improved protocol for the use and need of these catheters can not only reduce the
length of time the catheters are left in place, but it can help reduce the number of catheter
infections in patients throughout when the protocol is used correctly. Possible even decreasing
the number of catheters that are used for non-appropriate reasons for catheter placement. These
articles help support the nurse-driven protocol and the reasons for CAUTI’s within a hospital
setting.

Criteria Article 1 Article 2 Article 3 Article 4

Author, Journal (Peer- Fox, C., Wavra, Hernandez, M., Ferguson, A. Letica-Kriegel,
Reviewed), and T., Drake, D. King, A., & (2018). A. S.,
Permalink or Working A., Mulligan, Stewart, L. Implementing a Salmasian, H.,
Link to Access Article D., & Bader, (2019). CAUTI Vawdrey, D.
M. K. (2015). Catheter- Prevention K., & Perotte,
Use of a patient associated Program in an R. (2019).
hand hygiene urinary tract Acute Care Identifying the
protocol to infection Hospital risk factors for
reduce (CAUTI) Setting. Urolog catheter-
hospital- prevention and ic Nursing associated
acquired nurses’ urinary tract
infections and checklist infections: a
improve documentation https://lopes.id large cross-
nurses’ hand of their m.oclc.org/logi sectional study
washing. indwelling n?url=https:// of six hospitals.
American catheter search.ebscoho BMJ Open,
Journal of management st.com/login.as 9(2).
Critical Care, practices. px?
24(3), 216-224. Nursing Praxis direct=true&db
in New =ccm https://bmjopen
Zealand, 35(1), &AN=1336459 .bmj.com/conte
29. 74&site=edsive nt/9/2/e022137.
LITERATURE EVALUATION TABLE 3

http://ajcc.aacnj &scope=site&c abstract

ournals.org/con ustid=s8333
tent/24/3/216.s https://lopes.id 196&groupid=
hort m.oclc.org/logi main&profile=
n?url=https:// eds1
search.ebscoho
st.com/login.as
px?direct=true
&db=edo&AN
=137860401&s
ite=eds-
live&scope=sit
e&custid=s833
3196&
groupid=main
&profile=eds1

Article Title and Year Use of a Catheter- Implementing a Identifying the

Published Patient Hand associated CAUTI risk factors for
Hygiene urinary tract Prevention catheter-
Protocol to infection Program in an associated
Reduce (CAUTI) Acute Care urinary tract
Hospital- prevention and Hospital infections
Acquired nurses’ Setting. (2018) (2019)
Infections and checklist
Improve documentation
Nurses’ Hand of their
Washing indwelling
(2015) catheter
management
practices.
(2019)
LITERATURE EVALUATION TABLE 4

Research Questions Research Research Research Research

(Qualitative)/Hypothesi Question-The Question-Will Question- Question- The
s (Quantitative), and impacts of introducing an Implementing risk factors for
Purposes/Aim of Study regular hand indwelling an interactive CAUTIs, a
washing among catheter CAUTI large cross-
health management prevention sectional study.
professionals in checklist before educational
preventing catheter use program
hospital- decrease enhance the
acquired CAUTI nurse’s
infections. development knowledge on
and improve the appropriate
Objective- To nursing quality use of the Objectives:
investigate if of care for indwelling To examine
regular hand patients? urinary catheter how the risk for
hygiene and reduce the developing
reduces Objective- To incidence of CAUTIs
hospital- implement a CAUTI’s changes over
acquired checklist before time.
diseases and catheter
whether it placement Additionally, to
improves giving reason assess whether
compliance rate to why it is the time one
among the indicated Objective- stays with a
nurses in an possible Implement a a catheter from
ICU.p45 preventing program that insertion has
inappropriate will enhance effects on
insertion. the knowledge development of
of nurses on CAUTI.
catheters and To ascertain if
how to prevent development of
catheter CAUTIs varied
associated according to
urinary tract risk factors
infections such as age,
(CAUTIs). sex, patient
type (surgical
vs. medical)
and
comorbidities.
LITERATURE EVALUATION TABLE 5

Design (Type of Quantitative Quanititative- Quantitative Qualitative

Quantitative, or Type Mixed method
of Qualitative)

Setting/Sample Patients and Public hospital Southeastern Urban

nurses within in Auckland, region of the academic and
the selected New Zealand. United States referral health
hospital 50 nurses system of over
settings. within two 2500 beds.
surgical units.

Methods: New hand Data was Pre- and post- N/A

Intervention/Instrumen hygiene gathered using survey on how
ts protocol the self- the educational
administered program
Daily Urinary worked
Catheter
Maintenance
Checklist
(adopted from
CDC evidence-
based
guidelines
implemented in
various
hospitals all
over the US
and developed
for use in this
research. p.33
Nurses were
educated on
how to use the
new checklist
during the pre-
intervention
phase. The
checklist
contains
procedure-
specific
evidence-based
care practices
LITERATURE EVALUATION TABLE 6

under sub-
headings that
reflect the
components of
a CAUTI
prevention
bundle. The
checklist sub-
headings are
appropriate
catheter
indications,
hand hygiene,
catheter
insertion
technique,
catheter
maintenance,
and catheter
removal. p33
Analysis Measurement Statistical Catheter- Systematic
of hand- analysis of the associated analysis of
washing rate that the urinary tract occurrence of
compliance and checklist infection CAUTI among
effects on reduced (CAUTI) patients who
infection rates. CAUTI’s regular have
monitoring. catheterization.
Key Findings A hand hygiene The audit When Many patients
protocol findings reviewing what who had
contributes to indicated the the nurse’s catheterization
reductions in majority of statements developed
hospital- indwelling when CAUTIs.
acquired catheters (82%) interviewed is
infection rates. were removed surprising on
within 24 hours the knowledge
of surgery and they gained
the checklists form the
had the educational
appropriate program. Many
date of removal were unaware
and signature. of the
Nurses requirements
assessed the for the use or
patient’s need of a
catheter need urinary
LITERATURE EVALUATION TABLE 7

daily and catheter,

standard appropriate
precautions cleaning
were utilized technique,
for each protocols to
catheter follow, and the
removal. p.39 proper
According to securement for
the audit the Foley
findings, two catheter.p78
patients were
discharged with
an indwelling
catheter. There
was no
documentation
of why the
catheter was
not removed
and if the
catheter was
for long term
use. p.39

Recommendations Hospitals Recommendati Expansion of Doctors should

should adopt a on for the the study always reduce
hand washing researcher throughout the the days that
protocol for would be to hospital patients spend
patients and identify the facility. Many with in-
nurses to reasons of why of these dwelling
reduce the patients patients could catheters.
hospital- would need a have come
acquired Foley catheter from higher
infections. and the reasons acuity care
for units with the
noncompliance Foleys in place
of some of the before getting
nurses within on the units
the study. that were
interviewed.
Research the
nursing schools
in the area to
see what is
taught within
LITERATURE EVALUATION TABLE 8

the curriculum
this will
provide an
understanding
of the
misunderstandi
ngs with the
nursing staff.

Explanation of How the Hand hygiene This article It gives an idea It focuses on
Article Supports is essential introduces a on how to how the
EBP/Capstone Project among health CAUTI bundle implement a number of days
professionals for nurses to program to that one spends
taking part in use before the nurses and how with a catheter
the use of foley well it will contributes to
catheterization catheters. This work on development of
process to bundle had a reducing the CAUTI.
prevent checklist seeing CAU.
transmission of if patients met
hospital- the
acquired requirements
infections. for a Foley, for
it to be
removed, and
indications on
the reason for
the Foley to
stay in.

Criteria Article 5 Article 6 Article 7 Article 8

Author, Journal (Peer- Ballard, J. P. Mody, L., Saint, S., Gesmundo, M.

Reviewed), and (2018). Meddings, J., Greene, M. T., (2016).
Permalink or Working HOUDINI Edson, B. S., Krein, S. L., Enhancing
LITERATURE EVALUATION TABLE 9

Link to Access Article Impacts on McNamara, S. Rogers, M. A., Nurses’

Utilization and E., & Saint, S. Ratz, D., & Knowledge on
Infection Rates (2015). Faulkner, K. Catheter-
-- A Enhancing (2016). A Associated
Retrospective resident safety program to Urinary Tract
Quality by preventing prevent Infection
Improvement healthcare- catheter- (Cauti)
Initiative. Urol associated associated Prevention. Ka
ogic infection: a urinary tract i Tiaki Nursing
Nursing, 38(4), national infection in Research, 7(1),
184–191. initiative to acute care. 32.
https://doi- reduce New England
org.lopes.idm.o catheter- Journal of
clc.org/10.7257 associated Medicine,
/1053- urinary tract 374(22), 2111-
https://lopes.id
816X.2018.38. infections in 2119. m.oclc.org/logi
4.184 nursing homes. n?url=
Clinical https://search.e
Infectious https://www.nej bscohost.com/l
Diseases, m.org/doi/full/1 ogin.aspx
61(1), 86-94. 0.1056/NEJMo ?
https://lopes.id a1504906 direct=true&db
m.oclc.org/logi =edo&AN=119
n? https://academi 345448&
url=https://sear c.oup.com/cid/ site=edslive&s
ch.ebscohost.co article/61/1/86/ cope=site&cust
340565 id=s8333196&
m/login.aspx?
groupid=main
direct=true&db &profile=eds1
=ccm&AN=13
1366580&site=
eds-
live&scope=sit
e&custid=s833
3196&groupid
=main&profile
=eds1
LITERATURE EVALUATION TABLE 10

Article Title and Year HOUDINI Enhancing A Program to Enhancing

Published Impacts on resident safety Prevent Nurses’
Utilization and by preventing Catheter- Knowledge on
Infection Rates healthcare- Associated Catheter-
-- A associated Urinary Tract Associated
Retrospective infection: a Infection in Urinary Tract
Quality national Acute Care Infection
Improvement initiative to (2016) (Cauti)
Initiative. reduce Prevention
(2018) catheter- (2016)
associated
urinary tract
infections in
nursing homes.
(2015)
LITERATURE EVALUATION TABLE 11

Research Questions Research Hypothesis- Hypothesis- Research

(Qualitative)/Hypothesi Question- preventing Management of Question-
s (Quantitative), and Using the healthcare catheter- Enhancing
Purposes/Aim of Study nurse-driven associated associated nursing
HOUDINI diseases urinary tract knowledge in
protocol significantly
infection catheter
checklist for enhances (CAUTI) associated
removal of resident safety.
depends on urinary tract
Foley catheter many aspects infection will
when no longer such as prevent
intended will it
Objective- appropriate infections with
decrease the Preventing catheter use, proper
number of healthcare- proper strategies for
catheters associated maintenance, care and
associated infection (HAI) aseptic protocol will
urinary tract is one of the insertion, and decrease the
infections best ways of other socio- development of
enhancing adaptive CAUTI’s.
resident safety factors, such as
Objective- or older adults behavioral and
Implementing a in nursing cultural Objective- To
nurse-driven homes. changes in enhance
protocol for hospital nursing
nurses to use units.p2111 knowledge on
will overall the proper
reduce the Objective- To strategies to
incidence of identify some provide care
catheter- of the factors for those who
associated that contribute have catheters.
urinary tract to reduction of
infection CAUTI cases.
(CAUTI).
Design (Type of Qualitative- Systematic Cohort study Quantitative
Quantitative, or Type Retro-study review data were
of Qualitative) analyzed using
a paired t-test,
a parametric
procedure of
testing
differences in
group means.
Setting/Sample Midwestern 500 nursing 926 units in The study was
regional med- homes in all 50 603 hospitals in conducted in
ical center states. 32 states, New Zealand
within the Puerto Rico in two post-
LITERATURE EVALUATION TABLE 12

United States. and the District operative wards

Those patients of Columbia. of a surgery
who had and center.
would possible 14 nurses with
need urinary patient loads.
catheters
Methods: Data was Reducing Avoiding the A pre-test and
Intervention/Instrumen obtained from a catheter- unnecessary post-test were
ts de-identified associated use of an administered to
database limit urinary tract urinary evaluate the
to the patient infection catheters by nurse’s
care days, (CAUTI) considering and knowledge
catheter days, through using about catheter
catheter reduction of alternative management
utilization unnecessary urine-collection and CAUTI
ratios, and catheter methods prevention. The
number of use.p86 test consisted
CAUTIs. This of 25 multiple-
data was choice
compared pre- questions
and post- adapted from
intervention. CAUTI tests
Post- published by
intervention Schneider in
being the 2012 and,
comprehension Dumont and
of the Wakeman in
HOUDINI 2010. p36
protocol among Additional
the staff and questions
placed into relevant to the
use.p54 research setting
were also
incorporated
and answers
were
referenced to
complete the
tool. The final
tool was
piloted through
nurses in other
wards and
changes were
made to
LITERATURE EVALUATION TABLE 13

improve tool
reliability. The
tests were
administered
immediately
before and after
the education
session to
improve study
validity.p38
Analysis Analysis of Content Statistical Statistical
individuals analysis of how analysis analysis
who needed reduced use of
catheters with urinary
the nurse using catheters
the HOUDINI reduces cases
protocol and of CAUTI.
the developed
or reduction of
CAUTI after
implementation
Key Findings With this Reduction in There were few When
protocol in the number of CAUTI cases evaluating the
place the urinary catheter for patients in nurse’s
numbers where days reduces ICU compared knowledge in
not much cases of to non-ICU each section for
different. CAUTI. ones. CAUTI
Meaning the knowledge and
protocol did management
reduce the nurses scored
infection, but it low. Catheter
didn’t make maintenance
any new cases procedures
occur during (mean score of
the time of 5.4 out of 8),
investigation. and catheter
removal (mean
score of 1.1 out
of 2). p.38 This
data that was
collected shows
where protocol
should be in
place for the
removal and
LITERATURE EVALUATION TABLE 14

maintenance of
these catheters
as many nurses
are not aware
of the proper
education on
preventing
CAUTI’s. p38
Recommendations Recommendati Hospitals Proper Recommendati
on for this should always surveillance is on for this
study would be work towards necessary to study would be
extend the reducing reduce CAUTI that the nurses
study time for inappropriate cases for receive regular
cultural catheter use. If patients with in-service
changes on the other options in-dwelling education,
unit for the are available, catheters. appropriate
protocol to catheter use When patients catheter care
really take should be the are regularly policies and
place. Given last option. monitored, protocols
this time it will Furthermore, CAUTIs are should be
allow for nurses should always put aligned with
nurses to reduce the under control. evidence-based
withhold the number of days guidelines,
protocol when one stays CAUTI
correctly and with the surveillance
fully with each catheter if and
patient. appropriate. improvement
Also, how p86 program.
many patients
did this
protocol
identify Foleys
to be removed
earlier than
they may have
been removed
before as this
data could help
identify when
CAUTI’s could
have happened
from catheters
staying in for
too long
before.
LITERATURE EVALUATION TABLE 15

Explanation of How the This article The article is Assesses the This article
Article Supports focuses on the also about essence of focuses on
EBP/Capstone use of the catheterization surveillance in evaluation of
HOUDINI and reducing cases the impact of
protocol and development of as well as a catheter-
the impacts on CAUTI. It severity of associated urin
utilization and focuses on the CAUTI. Most ary tract infecti
the infection need for importantly, it on (CAUTI)
rate decrease appropriate examines how education
that it has on catheter use, regular package on
those who have and how monitoring of nurse’s
required reduction of patients with knowledge of
urinary catheter days in-dwelling indwelling cath
catheters. reduces CAUTI catheter can eter manageme
cases. Most help in nt.
importantly, it preventing
focuses on how CAUTIs.
CAUTI cases
can be
minimized by
appropriate use
of catheters.

References

Ballard, J. P. (2018). HOUDINI Impacts on Utilization and Infection Rates -- A Retrospective

Quality Improvement Initiative. Urologic Nursing, 38(4), 184–191. https://doi-

org.lopes.idm.oclc.org/10.7257/1053-816X.2018.38.4.184

Ferguson, A. (2018). Implementing a CAUTI Prevention Program in an Acute Care Hospital

Setting. Urologic Nursing, 38(6), 273–302. https://doi-

org.lopes.idm.oclc.org/10.7257/1053-816X.2018.38.6.273

Fox, C., Wavra, T., Drake, D. A., Mulligan, D., & Bader, M. K. (2015). Use of a patient hand

hygiene protocol to reduce hospital-acquired infections and improve nurses’ hand

washing. American Journal of Critical Care, 24(3), 216-224.

LITERATURE EVALUATION TABLE 16

Gesmundo, M. (2016). Enhancing Nurses’ Knowledge on Catheter-Associated Urinary Tract

Infection (Cauti) Prevention. Kai Tiaki Nursing Research, 7(1), 32.

Hernandez, M., King, A., & Stewart, L. (2019). Catheter-associated urinary tract infection

(CAUTI) prevention and nurses’ checklist documentation of their indwelling catheter

management practices. Nursing Praxis in New Zealand, 35(1), 29.

Letica-Kriegel, A. S., Salmasian, H., Vawdrey, D. K., & Perotte, R. (2019). Identifying the risk

factors for catheter-associated urinary tract infections: a large cross-sectional study of six

hospitals. BMJ Open, 9(2).

Mody, L., Meddings, J., Edson, B. S., McNamara, S. E., & Saint, S. (2015). Enhancing resident

safety by preventing healthcare-associated infection: a national initiative to reduce

catheter-associated urinary tract infections in nursing homes. Clinical Infectious

Diseases, 61(1), 86-94.

Saint, S., Greene, M. T., Krein, S. L., Rogers, M. A., Ratz, D., & Faulkner, K. (2016). A

program to prevent catheter-associated urinary tract infection in acute care. New England

Journal of Medicine, 374(22), 2111-2119.