Paper Two

Running Head: POLICY ANALYSIS 1

Assignment #2 EXAMPLE

Policy Analysis

POLICY ANALYSIS

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Analyze a problematic or dated health care policy, explaining its primary purpose and

effectiveness.

Hospital-acquired infections (HAI) can cause serious complications in patients during

their hospital stay, HAI is also associated with an increase in the length of hospital stay, higher

cost in stay and some extreme cases can even cause death. "Approximately 720,000 healthcare-

associated infections (HAIs) occur annually in the United States (U.S.) and the medical costs

associated with treating these HAIs can exceed 9 billion dollars annually" (Stouse 2015).

Catheter-Associated Urinary Tract Infections (CAUTI) are infections associated with indwelling

urinary catheters (UC), also known as Foley catheters. An indwelling urinary catheter (UC) is

defined in Policy C-193 "as a drainage tube that is inserted into the urinary bladder through the

urethra, is left in place, and is connected to a drainage bag (including leg bags). These devices

are also called Foley catheters". The purpose of indwelling urinary catheters: to monitor

critically ill patients requiring hourly Ins and Outs, assisting with wound healing in incontinent

patients, bladder obstruction or acute urinary retention, lumbar epidurals, prolonged

immobilization (e.g. pelvic fractures, trauma, unstable thoracic and lumbar spine surgeries or

injuries), urological surgery or any surgery that consists of structures within the genitourinary

tract and colorectal structures, bladder trauma and/or undergoing abdominal pressure

monitoring or a patient at end of life measures.

CAUTI is the most common type of healthcare-associated infection and is preventable

through the limited use of indwelling urinary catheters (UC), proper insertion methods, and

diligent maintenance practices. Due to the high infection rates associated with indwelling urinary

catheters (UC) C-193, CAUTI PREVENTION policy is being analyzed.

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Determine the issues the selected policy poses as it is written and any related ramifications.

“CAUTIs account for approximately 35% to 40% of all HAIs in the U.S. and cost health

care organizations $150 to $450 million annually to treat. Every day an indwelling catheter

remains in place, the risk for infection increases 3% to 5%, and each CAUTI event can extend a

patient’s length of stay an additional 0.5 to 1.0 hospital days”(Strouse 2015). Also, health care

organizations are not reimbursed for hospital-acquired infections, and hospitals can even be

penalized with Medicare reductions.

Policy C-193, CAUTI Prevention, was written 10/1/2013 and was last revised 11/15/2017. Due

to the increase in the number of Hospital Acquired Infections (HAI) related to indwelling urinary

catheters (UC), we must update the policy with new Evidence-Based Practice research to ensure

patient safety and help decrease our Catheter-Associated Urinary Tract Infections. The policy

states for maintenance of an indwelling urinary catheter perform peri-care with soap or non-

antimicrobial wipes at least every twelve hours and with each fecal incontinence episode. Refer

to Mosby's clinical practice guidelines for peri-care technique.

One question this policy pose is, will just be cleaning the catheter line with soap or a non-

antimicrobial wipe with each fecal incontinence every 12-hours be enough to help prevent

infections with a patient with an indwelling urinary catheter/foley? Patients with urinary tract

infections (UTI) can have complications such as extreme pain, cystitis, pyelonephritis, and

prostatitis. In older populations UTI’s can lead to patients becoming confused, increasing the risk

for falling, and in severe cases, the infection can spread to other organs and even cause sepsis

can occur.

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Research the changes needed to update and align the policy with current standards and

guidelines.

Chlorhexidine (CHG) is an abroad-spectrum antimicrobial. It is effective against Gram-

positive bacteria, Gram-negative bacteria, and fungi. These organisms are often associated with

Healthcare-Associated Infections (HAIs) (Chlorhexidine Facts). Chlorhexidine has many

benefits and has been used with many healthcare products. Due to the bactericidal properties of

Chlorhexidine (CHG), it has become the standard of care in health care organizations for

infection prevention and reduction. Giving a patient a daily Chlorhexidine bath has shown to

reduce and prevent hospital-acquired infections. Chlorhexidine’s antimicrobial properties, and

incorporating a daily Chlorhexidine bath into the maintenance of a patient with an indwelling

urinary catheter hopefully will help reduce and prevent patients from getting a Catheter-

Associated Urinary Tract Infections (CAUTI).

Propose revisions that are based on current identified standards and/or new guidelines.

Policy C-193, CAUTI Prevention, will update section D. Maintenance of Indwelling

Urinary Catheters. Section D, Maintenance of Indwelling states: “1. Review and document the

need for the indwelling UC at least daily; remove if no longer indicated per the Nurse-Driven

Indwelling Catheter Discontinuation Protocol 2. To prevent catheter movement, ensure that the

catheter is secure using a hospital-approved securement device. 3. To prevent contamination and

the backflow of urine, keep the urinary bag off of the floor and below the level of the patient’s

bladder. 4. Position the urinary system to always drain away from the patient with no dependent

loops or kinks in the tubing. 5. Utilize the attached clip to direct urine flow. 6. Maintain the

urinary catheter system as a closed system and avoid opening the system/changing the urine

collection bag when possible. 7. If the closed system is compromised, remove the catheter, and

POLICY ANALYSIS

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replace it if indicated. 8. Perform peri-care with soap or non-antimicrobial wipes at least every

twelve hours and with each fecal incontinence episode. Refer to Mosby's clinical practice

guidelines for peir-care technique. 9. Ensure that the catheter drainage bag is no greater than 2/3

full and empty before patient transport. 10. Use a single, dedicated measuring container (e.g.

graduated cylinder, urinal) to empty” (MUSC Policy C-193).

Along with these 10 other guidelines to maintain a proper indwelling urinary catheter,

there were be a few more additions. Guideline 11. Perform a daily linen change and

Chlorhexidine (CHG) bath with the liquid solution or Chlorhexidine wipes every 24 hours.

Document the time of bath appropriately in the daily care section of the patient’s flow sheet

under the Hygiene Care tab.

Analyze the significance of the selected policy updates as it relates to potential litigation.

The Medical University of South Carolina Policy C-193 clearly identifies the indications

necessary for a patient to have an indwelling urinary catheter. It states the proper way to insert an

indwelling catheter on either a male or female and the maintenance care of a catheter after it's

been inserted on a patient. All these steps must be followed correctly and charted to deliver the

best quality and safe handling of care for the patient with an indwelling urinary catheter. If a

nurse fails to insert an indwelling catheter precisely or does not keep up with the proper care and

maintenance this can cause harm to the patient and leave the health care facility liable due to

negligent care of the nurse. Corporate negligence occurs when a health care facility fails to

perform the standard of duties owed to the patient to make sure the patient is safe during their

stay at the hospital. If a patient is harmed or injured as a result of the broken standard of care, the

health care facility is held responsible under the concept of corporate negligence (Pozgar p.184).

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Summarize a personal perspective on the revisions as well as any additional changes that

should be considered.

With the hospital-acquired infection rates going up recently, updating the policy C-193

for CAUTI prevention is a must. Every day that a catheter is in place increases the risk of up to

5%. If a hospital-acquired infection occurs, this can lead to a longer length of stay, a higher

medical cost for the healthcare facility as well the facility can be penalized with Medicare

reductions. Chlorhexidine has many health benefits due to the bactericidal properties making

Chlorhexidine a logical choice to add to the CAUTI prevention maintenance bundle. Not only

does Chlorhexidine promote a daily bath for patients, but it will also help reduce infection rates

and prevent further hospital-acquired infections that could be caused by indwelling urinary

catheters or other invasive lines.

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References:

Medical University Policy C-193 (2013).

George D. Pozgar. 2019. Legal Aspects of Health Care Administration (13th ed.). Jones &

Bartlett Learning

Strouse, Abigail, MS, RN & ACNS-BC, NEA-BC. (2015). CNE: Appraising the Literature On

Bathing Practices And Catheter-Associated Urinary Tract Infection Prevention. Urologic

Nursing, 35, 11-17. https://doi.org/10.7257/1053-816X.2015.35.1.11

Frost, S. A., Hou, Y. C., Lombardo, L., Metcalfe, L., Lynch, J. M., Hunt, L., Alexandrou, E.,

Brennan, K., Sanchez, D., Aneman, A., & Christensen, M. (2018). Evidence for the

effectiveness of chlorhexidine bathing and health care-associated infections among adult

intensive care patients: a trial sequential meta-analysis. BMC infectious diseases, 18(1),

679. https://doi.org/10.1186/s12879-018-3521-y

Huang, H. P., Chen, B., Wang, H. Y., & He, M. (2016). The efficacy of daily chlorhexidine

bathing for preventing healthcare-associated infections in adult intensive care units. The

Korean Journal of internal medicine, 31(6), 1159–1170.

https://doi.org/10.3904/kjim.2015.240

Chlorhexidine Facts. (n.d.). Retrieved from https://chlorhexidinefacts.com/