nursing

Literature Review

Yesenia Ruiz

Nightingale College

BSN 355-08, Capstone Proposal

Dr. Marnell

June 14,2026

Literature Review

Catheter-associated urinary tract infection (CAUTI) is still one of the most frequently reported healthcare-associated infections, and is still associated with increased patient morbidity, longer hospital stays and increased healthcare costs. Although there is evidence for preventative measures, there is some lack of standardization on the insertion, maintenance and removal of CAUTIs in acute care settings. Nurses are key to preventing CAUTIs as they are responsible for a significant portion of the ongoing care and assessment of patients with indwelling urinary catheter. Evidence-based catheter care bundles have been shown to yield positive results in decreasing infection rates and enhancing patient safety as part of quality improvement programs. The Centers for Disease Control and Prevention (CDC, 2024) emphasize that the adoption of evidence-based prevention practices is still crucial to help lower the rate of CAUTI in healthcare facilities. The PICOT question guiding this literature review is: In adult patients with indwelling urinary catheters admitted to the medical-surgical unit at Valley View Community Hospital (P), how does implementation of a nurse-led CAUTI prevention bundle (I), compared to current practice (C), decrease the incidence of catheter-associated urinary tract infections (O) over a 16-week period (T)? This paper aims to summarize the current evidence around the prevention bundles of CAUTI and the implications for a nurse-led quality improvement project to decrease CAUTI rates.

Project Proposal Topic

CUTIs are largely preventable complications affecting hospitalized patients in the United States and all over the world. Antibiotic use, length of stay and higher rates of morbidity and healthcare costs have been associated with CAUTIs. Three major factors that contribute to development of infections are inappropriate use of the catheter, catheterization for long periods of time, and inconsistent maintenance practices (CDC, 2024). Despite the availability of evidence-based guidelines, many organizations still report a disconnect between what is recommended in the guidelines and what is delivered at the bedside. This is often associated with varying staff education, poor standardization and poor monitoring of the need for the catheter. The proposed quality improvement project will aim to fill this gap by introducing a nurse-led CAUTI prevention bundle to enhance compliance with evidence-based CAUTI prevention practices and reduce the incidence of CAUTI in hospitalized adult patients.

Methods of Searching

A literature review was completed in the electronic databases to find existing peer reviewed research on quality improvement interventions and CAUTI prevention. The databases used were PubMed, CINAHL, Google Scholar, and the American Journal of Infection Control database. Some of the keywords used in the search were “catheter-associated urinary tract infection,” “CAUTI prevention bundle,” “nurse-led intervention,” “quality improvement,” “catheter removal protocol” and “hospital-acquired infection prevention.” The search was restricted to the period of 2022–2026 to ensure that the latest evidence is used. Pediatric focused articles, non-peer-reviewed articles, opinion articles, blogs and commercial websites were excluded. For this review, five peer-reviewed sources that were closely related to the PICOT question and quality improvement focus were selected.

Review of the Literature

The CDI (2024) CAUTI Prevention Guideline underpins evidence-based CAUTI management practices. The guideline focuses on reducing unnecessary catheter use, good aseptic insertion, common catheter assessment and catheter removal when clinically appropriate. The guideline also proposes to implement standardized bundles for insertion and maintenance, and to carry out continuous monitoring of outcomes. One of the major strengths of this guideline is the fact that it is evidence-based, and offers practical guidelines for implementing and measuring performance. The recommendations are directly relevant to the proposed capstone project as many of the CDC recommended prevention strategies are included in the nurse led CAUTI prevention bundle. The guideline emphasizes a systematic approach to interventions rather than relying solely on clinician judgment.

In a study by Chambers and Lee (2023) the effectiveness of a CAUTI prevention bundle was evaluated in a medical-neurological intensive care unit. They created insertion checklists, daily assessment of the need for the catheter, nurse-initiated removal of the catheter, urinary retention protocols, external collection devices for urine and interdisciplinary rounding as part of their quality improvement project. After implementation, there was a 31.8% reduction in the use of catheters and an almost 50% reduction in the incidence of CAUTIs. The unit did not have a statistically significant reduction in the rate of CAUTI, but the unit was CAUTI free for 21 consecutive months. The results indicate that prevention bundles can yield clinically significant results while failing to meet statistical significance. The study provides strong support for the proposed capstone project since it showed that a nurse led intervention can lead to positive patient outcomes by standardizing the care of patients' catheters.

APSIC Guide for Prevention of Catheter-Associated Urinary Tract Infections was developed by Ling et al. (2023) to give practical guidance for healthcare facilities. The authors suggest developing all-encompassing CAUTI prevention programs, which include surveillance, insertion bundles, maintenance bundles, multidisciplinary collaboration, and quality improvement methodologies. The guide highlights the importance of organizational commitment and ongoing measurement of results for sustainable IP efforts. An important insight from this article is that it focused on frameworks of quality improvement, rather than on individual interventions. The findings reinforce the capstone project, which included the need for prevention bundles to be part of a larger infection prevention program in organizations. The article also emphasizes the importance of multi-disciplinary involvement and continual evaluation to maintain the improvements.

The study by Riley et al. (2025) was a quasi-experimental four-year study to assess nurse-led implementation of evidence-based catheter bundles in a large academic hospital. The intervention consisted of insertion bundles, maintenance bundles, comprehensive staff education, and nurse-driven removal protocols with a focus on the Plan-Do-Check-Act (PDCA) quality improvement model. There was a reduction of 38% in the risk of CAUTI and 11% in the use of catheters. Rates of reinsertion of the catheter were reduced, indicating that there was no adverse impact on the outcomes of patients due to early removal of the catheter. The findings of this study are compelling evidence for nurse-led quality improvement efforts as there was substantial reduction in infection rates and in the use of a catheter. The study related very well to the PICOT question presented and emphasized the importance of the nurse's role in the implementation of change to evidence-based practice which affects patient safety.

Walker and Jacob (2023) shared a quality improvement project in an inpatient rehabilitation center during the COVID-19 pandemic. After a rise in the number of CAUTIs, the facility began conducting earlier voiding trials and emphasized the need to minimize unnecessary catheterization. CRA indicated that at times, patients were having catheters inserted for longer than they needed to be and were leaving hospital without being catheterized. The intervention focused on addressing this deficit, which was related to the timely removal of the catheter. The project successfully addressed the issue of catheter necessity by the systematic evaluation and thereby reduced CAUTIs, thus proving the value of the intervention. This study will help to back up the proposed capstone project as an example of the nurse's role in reducing the time of the catheter and lowering the risk of infection and better patient outcomes. It also emphasizes the significance of understanding organizational factors that contribute to preventable infections.

Findings

The literature has demonstrated that nurse-led CAUTI prevention bundles are proven strategies for preventing catheter use and decreasing the rate of CAUTI in hospitalized patients. In the studies reviewed, certain components of interventions were found to be common, such as insertion checklists, maintenance bundles, daily assessment of catheter necessity, nurse-driven removal protocols, staff education, surveillance systems, and multidisciplinary collaboration (Chambers & Lee, 2023; Riley et al., 2025). The interventions were all in line with the CDC (2024) and APSIC recommendations (Ling et al., 2023). There is literature that standardized protocols result in a more consistent approach to care and decreased variability in clinical practices that would increase infection risk. In addition, the effectiveness of nurse-led interventions seems to be especially good since the nurses are directly involved with the catheter's ongoing management and the patient's assessment.

The following strengths and weaknesses became apparent in the literature reviewed. A key strength is that findings are consistent across various types of healthcare settings, such as acute care hospitals, intensive care and rehabilitation units. The majority of studies have found CAUTI incidence rates and catheter use to decrease after bundles were implemented. But there were some constraints identified. Quality improvement or quasi-experimental designs, without randomization were used in several studies making causal conclusions less possible. Sample sizes and context also varied, which could have an impact on generalizability. Another research gap is the lack of post intervention research on long term sustainability. Overall, the evidence is clear that nurse-led CAUTI prevention bundles are effective quality improvement interventions for preventing HAIs and ensuring patient safety, despite these limitations.

Conclusion

Several studies have been published that recommend nurse-led CAUTI prevention bundles to decrease catheter-associated urinary tract infection (UTI) rates in hospitalized patients. The key findings are that standardized insertion and maintenance protocols are effective, nurse-led strategies for the removal of catheters are effective, and there is value in continuing education and surveillance programs (Riley et al., 2025). The studies reviewed also show that implementing quality improvement strategies can substantially decrease the use of catheter devices and improve outcomes for patients. Evidence provided for the proposed PICOT question is supportive of the implementation of a nurse-led CAUTI prevention bundle versus current practice. The literature is generally adequate for the implementation of the proposed quality improvement project, and the evidence-based nursing interventions seem to have significant potential for reducing the incidence of CAUTI and improving patient safety.

References

Centers for Disease Control and Prevention. (2024, May 10). Catheter-Associated Urinary Tract Infections (CAUTI) Prevention Guideline. Infection Control. https://www.cdc.gov/infection-control/hcp/cauti/index.html

Chambers, N. E., & Lee, J. (2023). Implementation of a catheter-associated urinary tract prevention bundle in a medical-neurological intensive care unit. American Journal of Infection Control, 51(7, Supplement), S52–S53. https://doi.org/10.1016/j.ajic.2023.04.108

Ling, M. L., Ching, P., Apisarnthanarak, A., Jaggi, N., Harrington, G., & Fong, S. M. (2023). APSIC guide for prevention of catheter associated urinary tract infections (CAUTIs). APSIC Guide for Prevention of Catheter Associated Urinary Tract Infections (CAUTIs), 12(1), 52–52. https://doi.org/10.1186/s13756-023-01254-8

Riley, M. M.-S., Tung, W.-C., & Tofanelli, C. (2025). Nurse-led implementation of evidence-based bundles to reduce CAUTIs in an academic acute care hospital: A four-year longitudinal quasi-experimental study. Applied Nursing Research, 85, 152004. https://doi.org/10.1016/j.apnr.2025.152004

Walker, C., & Jacob, J. (2023). Reducing the number of catheter-associated urinary tract infections at an inpatient rehabilitation facility: A quality improvement project. Infection Control and Hospital Epidemiology, 44(11), 1–3. https://doi.org/10.1017/ice.2023.97