Picot Statement final Draft

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Literature Evaluation Table

Student Name: Tina McKane

Tim,

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June

Summary of Clinical Issue:

A catheter associated urinary tract infection (CAUTI) is one of the most commonly hospital acquired infections according to emerging research. Even with the best precautionary measures, the chances of developing this infection are about 9% for catheterized patients. About 9% to24% of these patients develops CAUTI. A good number of hospitalized patients have a urinary catheter increasing the risk of developing CAUTI. In addition, healthcare institutions are penalized for having more than expected CAUTIs making them experience significant financial impacts. CAUTI risk is associated to the dwell time of the catheter. The rate of development of the bacterium causing CAUTIs for catheterized patients is about 4%-7% in a day.

However, this risk approaches 100% if the patients remain with the indwelling urinary catheter for more than thirty days. The recognition that about 75% of CAUTIs can be preventable has resulted in the development of multiple strategies to reduce development of CAUTIs in the healthcare setting. These interventions include simple approaches such as removing urinary catheters that are no longer needed and avoiding placing unneeded urinary catheters. Health care professionals are responsible for taking care of the patients having urinary catheters in the healthcare setting and are therefore important in preventing the development of CAUTIs.

PICOT Question: In the Management of CAUTI patients (P), how effective is staff education and regular monitoring of CAUTI cases (I) compared to maintenance of a closed urinary drainage system (C) in preventing the development of CAUTIs (O) for the period of hospital stay (T)?

Criteria	Article 1	Article 2	Article 3
APA-Formatted Article Citation with Permalink	Meddings, J., Manojlovich, M., Ameling, J. M., Olmsted, R. N., Rolle, A. J., Greene, M. T., ... & Saint, S. (2019). Quantitative Results of a National Intervention to Prevent Hospital-Acquired Catheter-Associated Urinary Tract Infection: A Pre–Post Observational Study. Annals of Internal Medicine, 171(7_Supplement), S38-S44. Retrieved from https://annals.org/aim/fullarticle/2752410	Parker, V., Giles, M., Graham, L., Suthers, B., Watts, W., O’Brien, T., & Searles, A. (2017). Avoiding inappropriate urinary catheter use and catheter-associated urinary tract infection (CAUTI): a pre-post control intervention study. BMC health services research, 17(1), 314. Retrieved from https://link.springer.com/article/10.1186/s12913-017-2268-2	Huis, A., Schouten, J., Lescure, D., Krein, S., Ratz, D., Saint, S., ... & Greene, M. T. (2020). Infection prevention practices in the Netherlands: results from a National Survey. Antimicrobial Resistance & Infection Control, 9(1), 1-7. Retrieved from https://aricjournal.biomedcentral.com/articles/10.1186/s13756-019-0667-3
How Does the Article Relate to the PICOT Question?	This article analyzes the effect of a multimodal initiative on CAUTI in hospitals with high burden of health care–associated infection (HAI)	This article analyzes ways in which IDC usage rates can be reduced by reducing inappropriate urinary catheterization and duration of catheterization.	This study aimed to examine the extent to which acute care hospitals have adopted recommended practices to prevent catheter-associated urinary tract infection (CAUTI).
Quantitative, Qualitative (How do you know?)	This is a quantitative study because data is collected using structured research instruments and is presented in form of numbers.	This is a quantitative study as it uses randomized controlled trial as the research design.	This is a quantitative study because data is presented in form of numbers and researchers compare various variables to determine the outcome.
Purpose Statement	To investigate the effect of a multimodal initiative on CAUTI in hospitals with high burden of health care–associated infection (HAI)	To reduce IDC usage rates by reducing inappropriate urinary catheterization and duration of catheterization.	To examine the extent to which acute care hospitals in the Netherlands have adopted recommended practices to prevent catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), ventilator-associated pneumonia (VAP), and Clostridioides difficile infection (CDI).
Research Question	What are the effects of a multimodal initiative on CAUTI in hospitals with high burden of health care–associated infection (HAI)?	How can IDC usage rates be reduced by reducing inappropriate urinary catheterization and duration of catheterization?	What is the extent to which acute care hospitals in the Netherlands have adopted recommended practices to prevent catheter-associated urinary tract infection (CAUTI)?
Outcome	With the use of multimodal initiative, the risks of health care associated infections can reduce significantly.	A sample size calculation has indicated that 500 patients per Health District would be sufficient to detect a 40% fall (15 to 9%) in relative IDC insertion rates with a power of 0.8 and alpha 0.05	Surveillance systems for monitoring CAUTI, CLABSI, VAP, and CDI were present in 17.8, 95.4, 26.2, and 77.3% of hospitals, respectively
Setting (Where did the study take place?)	Acute care, long-term acute care, and critical access hospitals,	Hospitals in NSW, Australia	Acute care hospitals in the Netherlands
Sample	387hospitals	4- four acute care hospitals	47 hospitals
Method	Prospective, national, nonrandomized, clustered, externally facilitated, pre–post observational quality improvement initiative	multiple pre-post control intervention design using a phased mixed method approach	Written interview
Key Findings of the Study	This multimodal intervention yielded no substantial improvements in CAUTI or urinary catheter utilization.	Hospital-wide and multi-hospital interventions help to reduce urinary catheter use and the development of CAUTI.	Most Dutch hospitals report regular use of recommended practices for preventing CLABSI and CDI.
Recommendations of the Researcher	Future studies should focus on how to improve the prevention of CAUTI.	More studies need to be conducted on the topic to provide ways in which integrated approaches can be used to prevent CAUTI.	Future studies should focus on the importance of using integrated approaches to the prevention of CAUTI

Criteria	Article 4	Article 5	Article 6
APA-Formatted Article Citation with Permalink	Carter, E. J., Pallin, D. J., Mandel, L., Sinnette, C., & Schuur, J. D. (2016). Emergency department catheter-associated urinary tract infection prevention: multisite qualitative study of perceived risks and implemented strategies. infection control & hospital epidemiology, 37(2), 156-162. Retrieved from https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/emergency-department-catheterassociated-urinary-tract-infection-prevention-multisite-qualitative-study-of-perceived-risks-and-implemented-strategies/8A6263415F32FB876EEED70C7E269654	Carter, E. J., Pallin, D. J., Mandel, L., Sinnette, C., & Schuur, J. D. (2016). A qualitative study of factors facilitating clinical nurse engagement in emergency department catheter-associated urinary tract infection prevention. JONA: The Journal of Nursing Administration, 46(10), 495-500. Retrieved from https://journals.lww.com/jonajournal/Abstract/2016/10000/A_Qualitative_Study_of_Factors_Facilitating.4.aspx	Fletcher, K. E., Tyszka, J. T., Harrod, M., Fowler, K. E., Saint, S., & Krein, S. L. (2016). Qualitative validation of the CAUTI Guide to Patient Safety assessment tool. American journal of infection control, 44(10), 1102-1109. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S0196655316302930
How Does the Article Relate to the PICOT Question?	This study explores various strategies for reducing the risk of CAUTIs in the healthcare setting.	This article explores the actions of nurse leaders that facilitated clinical nurses' active involvement in emergency department (ED) catheter-associated urinary tract infection (CAUTI) prevention programs.	This article explores the need for CAUTI guide to patient safety (GPS) to prevent CAUTI
Quantitative, Qualitative (How do you know?)	This is a qualitative study because semi structured interviews were used to collect data.	This is a qualitative study because semi structured interviews were used to collect data.	This is a qualitative study because semi structured interviews were used to collect data.
Purpose Statement	To describe the motivations, perceived risks for CAUTI acquisition, and strategies used to address CAUTI risk among EDs that had existing CAUTI prevention programs.	To explore the actions of nurse leaders that facilitated clinical nurses' active involvement in emergency department (ED) catheter-associated urinary tract infection (CAUTI) prevention programs.	To qualitatively validate The CAUTI guide to patient safety (GPS)
Research Question	Does early-adopting emergency departments (ED) redesigned workflows minimizes catheter use and ensure proper insertion technique?	What are the actions of nurse leaders that facilitated clinical nurses' active involvement in emergency department (ED) catheter-associated urinary tract infection (CAUTI) prevention programs?	What is the effectiveness of CAUTI guide to patient safety (GPS) in preventing CAUTI?
Outcome	ED CAUTI prevention was perceived to differ from CAUTI prevention in the inpatient setting.	Clinical nurses are best positioned to examine urinary catheter insertion workflow and to suggest improvements in avoiding use and improving placement and maintenance.	Nurse managers found the GPS helpful and complete. There was higher agreement between nurse managers and unit nurses than with physicians.
Setting (Where did the study take place?)	Six diverse hospitals	6 emergency departments	4 medical intensive care units and 4 medical-surgical units
Sample	52 participants	52 participants	49 participants
Method	Semi structured interviews	Semi structured interviews	Semi structured interviews
Key Findings of the Study	Early-adopting EDs redesigned workflow to minimize catheter use and ensure proper insertion technique	The prevention of CAUTI is an important opportunity for nurse leaders to engage clinical nurses in meaningful improvement efforts	GPS is comprehensive and may be best used to stimulate discussions between stakeholders to address key issues.
Recommendations of the Researcher	Assessment of ED workflow is necessary to identify and modify local practices that may increase CAUTI risk.	The researchers suggest nurse leaders should focus on how urinary catheters expose patients to potential harm to engage clinical nurses in CAUTI prevention,	The current healthcare structures need to be changed to accommodate GPS.