Benchmark -Evidence-Based Practice Project: Literature Review

NUR 550 Benchmark -Evidence-Based Practice Project: Literature Review

Nurses and other healthcare providers leverage the evidence-based practice process to appraise research studies and their outcomes to develop interventions to address care issues in their practice settings. Quality improvement initiatives focus on enhancing patient safety by reducing associated risks and sentinel events like catheter-associated urinary tract infections (CAUTIs) (AHRQ, 2019). The Centers for Medicare and Medicaid Services (CMS) considers CAUTIs as never events and does not reimburse healthcare facilities and providers for their occurrence. This means that providers and facilities should seek ways, like bundle care interventions, to reduce and prevent their occurrence. The purpose of this review of literature on the EBP project is to compare articles on the use of bundled care intervention to reduce CAUTIs.

PICOT Statement and Question

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Catheter-associated urinary tract infections (CAUTIs) are considered one of the most prevalent hospital acquired infections, especially among hospitalized patients in medical-surgical units. CAUTIs account for about 40% of the hospital acquired infections in the world and consider a public health issue in the U.S. health system. Over 30 million catheters are uses in hospitals and other healthcare settings each year (Podkovik et al., 2021). The use of bundled care intervention is considered one of the most effective ways for nurses and other providers to reduce and prevent the occurrence of CAUTIs among hospitalized patients in medical-surgical settings (Connor, 2018). Through an extensive review of literature, this paper demonstrates the efficacy of using bundle care interventions to reduce CAUTIs in healthcare settings, especially medical-surgical units.

PICOT Question for the Proposed EBP Project

Among patients requiring urinary catheterization in the medical and surgical ward (P), does the use of bundle care (I) as compared to usual care (C) result in at least 50% reduction in CAUTIs (O) within eight months? (T).

Search Methods

The evidence-based practice implores one to utilize effective search methods or approaches to get evidence that supports their proposed projects. These include use of terms, phrases, and words related to the topic under investigations. Again, the search methods include using databases to generate scholarly articles on the topic of interest for effective review of the literature. In this case, the study used all these strategies, starting with key words and terms as well as phrases in databases like PubMed, Google Scholar, CINAHL and Cochrane. The key terms like “CAUTIs in medical-surgical settings,” peer reviewed articles on bundle care to reduce CAUTIs were effective strategies to get relevant articles published within the last five years. Imperatively, the study employed the CRAAP model that entails searching for articles that are current, relevant, accurate, authoritative, and purposeful to the topic of interest. Through this approach or criteria, the study identified the reviewed article and documents how they support the proposed EBP project to reduce CAUTIs in medical-surgical units.

Synthesis of Research

Article 1

The first article by Soundaram et al. (2020) is a comparative study in intensive care units to determine the effects of implementing care bundle to reduce CAUTIs. The researchers conducted the study for 9 months and their findings show a positive correlation between the implementation of the care bundle and a reduction in the number of CAUTIs. The findings show that CAUTIs reduced due to adherence to the care bundle. The authors recommend the implementation of this intervention as a component of routine practice to reduce and prevent CAUTIs. Consequently, the findings support the effectiveness and efficacy of care bundle in reducing and preventing the occurrence of CAUTIs in critical care units like the medical-surgical settings.

Article 2

In their study on the use of a bundled care model to prevent and reduce CAUTIs in critical care units, Van Decker et al. (2021) carried a research at Boston Medical Center’s intensive care unit (ICU). Using the plan-do-study-act (PDSA) model, the researchers implemented five care bundles over a period of five years. These included processes for insertion and maintenance of foley catheter, indications for indwelling catheters, use of effective testing, findings alternatives to the indwelling ones, and sterilization methods. In their findings, the authors assert that the interventions led to a reduction of CAUTIs by over 83% and a decline in the use of indwelling foley catheter use by close to 40%. The implication is that the use of care bundle helps facilities to reduce CAUTIs by a considerable level. The article supports the EBP as it shows the efficacy of the care bundle approach.

Article 3

In their study, Shadle et al. (2021) focus on the utilization of a bundle-based approach in preventing CAUTIs among patients in ICU. Using a pre-post design in two consecutive 4-month periods, the assert that there was a reduction in the number of CAUTIs. The bundle-based approach entailed using staff education, having a daily electronic checklist and a nurse-driven removal protocol for patients that had indwelling urinary catheters. The bundled approach demonstrates effective outcomes in reducing the CAUTIs. As such, the findings show that the intervention as proposed by the EBP project is effective and can help mitigate these events.

Article 4

The fourth article by Wanat et al. (2020) focuses on how providers can optimize interventions to reduce CAUTIs in primary, secondary and care home areas. Through a comprehensive review of existing literature, the authors identified an array of interventions that providers and organizations can optimize to reduce and prevent the occurrence of CAUTIs. For instance, the authors identify checklists, providing information and having guidelines as critical to reducing CAUTIs. Imperatively, this article supports the use of care bundle as effective in reducing CAUTIs among patients in critical care settings.

Article 5

In this article, Alex et al. (2022) carry a study protocol to determine the impact of using bundle-of-care interventions in enhancing self-management of patients who have urinary catheters. The study asserts that the interventions that are patient-centered led to an increase in knowledge retention and improved catheter self-management among the targeted individuals. Therefore, the study is essential to the proposed EBP project since it shows that using multiple interventions increases the chance of reducing these adverse events and improving quality of care and safety.

Article 6

In their study, Yu et al. (2020) carry out an integrative review on the interventions and strategies to prevent CAUTIs for patients using short-term indwelling catheters. Using various interventions like audit and feedback, involvement of a multidisciplinary team and reminder as well as stop orders and education for nurse leads to a reduction in CAUTIs. The authors’ findings support the EBP project as they show that care bundled intervention is effective and should be used to mitigate these events.

Article 7

The seventh article by Fauziah et al. (2018) is a systematic review on care bundles in reducing and preventing the occurrence of CAUTIs. Based on their evaluation using their criteria, the authors assert that bundle of care has significant impact on the reduction and prevention of CAUTIs. The researchers offer various interventions as part of the care bundle to demonstrate their efficacy. Imperatively, this article supports the EBP intervention as it shows that while providers may not have a uniform approach to using the bundled care, these strategies reduce and mitigate the occurrence of CAUTIs.

Article 8

The eighth article by Dehghanrad et al. (2109) explores the impact of instruction and implementation of a preventive urinary tract infection bundle on prevalence of CAUTIs. Using a quasi-experimental design, the authors conclude that these interventions lead to a reduction of CAUTI even though not significant. The article is critical as it shows that despite their effectiveness, some components of the care bundle may not be effective in reducing CAUTIs. However, the article supports the EBP project as it shows that these interventions work.

Comparison of the Articles

The eight reviewed articles share similarities that include the focusing on different care bundle strategies that providers and nurses can use to reduce and prevent the occurrence of CAUTIs. None of the articles has any controversies but they all agree in their conclusions that there is need for further studies to show the efficacy of combining some of the interventions or those that work together to offer the greatest or significant outcomes. The limitations among the articles include time taken to conduct the research, need for funding to explore diverse areas, and the need for increased support from the organizations’ management.

The eight articles have no significant differences as they all explore the role of care bundles in critical care settings that include the intensive care units and the medical-surgical areas. The implication is that a core theme that emerges from these articles is that bundled care can have significant effects on catheter-associated urinary tract infections. As such, it is essential for healthcare organizations to implement such interventions to reduce the negative effects of these infections.

Suggestions for Future Research

The analysis of these articles presents significant gaps that require further research. Firstly, none of the articles suggests the most effective combination of the interventions to reduce CAUTIs. Imperatively, it is critical to conduct more studies on this aspect. Secondly, the research articles are categorical that care bundle approach leads to a reduction of CAUTIs. However, there is need to establish the level of effects and if the implementation provides a cost-benefit incentive for providers and organizations to implement these aspects.

Conclusion

The use of bundle care interventions to reduce and prevent the occurrence of CAUTIs in critical care settings implores providers to develop customized approaches for their facilities to attain best outcomes. The bundle of care approach is essential as it means that the organizations can use various strategies based on their capacities and resources to reduce and prevent the occurrence of infections, including CAUTIs. Therefore, these review shows that there is sufficient evidence from research to support the proposed interventions to reduce these infections among patients in medical-surgical settings.

References

Agency for Healthcare Research and Quality (AHRQ) (2019). Educational Bundles.

Alex, J., Ferguson, C., Ramjan, L. M., Montayre, J., Lombardo, L., & Salamonson, Y. (2022).

Bundle-of-care interventions to improve self-management of patients with urinary catheters: Study protocol. Collegian, 29(3), 405-413. https://doi.org/10.1016/j.colegn.2021.08.007

Connor, B. T. (2018). Best Practices: CAUTI Prevention. American Nurses Association (ANA).

Dehghanrad, F., Nobakht-e-Ghalati, Z., Zand, F., Gholamzadeh, S., Ghorbani, M., & Rosenthal,

V. (2019). Effect of instruction and implementation of a preventive urinary tract infection bundle on the incidence of catheter associated urinary tract infection in intensive care unit patients. Electronic Journal of General Medicine, 16(2). https://doi.org/10.29333/ejgm/94099

Fauziah, W., Rochana, N. & Juniarto, A. Z. (2019). The Effect of Catheter Associated Urinary

Tract Infection (CAUTI) Bundle of Care: A Systematic Review. Proceedings of the 1st International Conference of Indonesian National Nurses Association (ICINNA 2018), pages 123-131. DOI: 10.5220/0008205901230131

Podkovik, S., Toor, H., Gattupalli, M., Kashyap, S., Brazdzionis, J., Patchana, T., Bonda, S.,         Wong, S., Kang, C., Mo, K., Wacker, M. R., Miulli, D. E., & Wang, S. (2019). Prevalence of Catheter-Associated Urinary Tract Infections in Neurosurgical Intensive Care Patients—The Overdiagnosis of Urinary Tract Infections. Cureus, 11(8), e5494.

Shadle, H. N., Sabol, V., Smith, A., Stafford, H., Thompson, J. A., & Bowers, M. (2021). A

bundle-based approach to prevent catheter-associated urinary tract infections in the intensive care unit. Critical Care Nurse, 41(2), 62-71. https://doi.org/10.4037/ccn2021934

Soundaram, G. V., Sundaramurthy, R., Jeyashree, K., Ganesan, V., Arunagiri, R., & Charles, J.

(2020). Impact of care bundle implementation on incidence of catheter-associated urinary tract infection: a comparative study in the intensive care units of a tertiary care teaching hospital in South India. Indian Journal of Critical Care Medicine: Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine, 24(7), 544. DOI: 10.5005/jp-journals-10071-23473

Van Decker, S. G., Bosch, N., & Murphy, J. (2021). Catheter-associated urinary tract infection

reduction in critical care units: a bundled care model. BMJ Open Quality, 10(4), e001534. http://dx.doi.org/10.1136/bmjoq-2021-001534

Yu, S., Marshall, A. P., Li, J., & Lin, F. (2020). Interventions and strategies to prevent

catheter‐associated urinary tract infections with short‐term indwelling urinary catheters in hospitalized patients: An integrative review. International Journal of Nursing Practice, 26(3), e12834. https://doi.org/10.1111/ijn.12834

Wanat, M., Borek, A. J., Atkins, L., Sallis, A., Ashiru-Oredope, D., Beech, E., … & Tonkin-

Crine, S. (2020). Optimising interventions for catheter-associated urinary tract infections (CAUTI) in primary, secondary and care home settings. Antibiotics, 9(7), 419. DOI: 10.3390/antibiotics9070419

Appendix: APA Checklist

APA Writing Checklist

Use this document as a checklist for each paper you will write throughout your GCU graduate program. Follow specific instructions indicated in the assignment and use this checklist to help ensure correct grammar and APA formatting. Refer to the APA resources available in the GCU Library and Student Success Center.

☒ APA paper template (located in the Student Success Center/Writing Center) is utilized for the correct format of the paper. APA style is applied, and format is correct throughout.

☒ The title page is present. APA format is applied correctly. There are no errors.

☒ The introduction is present. APA format is applied correctly. There are no errors.

☒ Topic is well defined.

☒ Strong thesis statement is included in the introduction of the paper.

☒ The thesis statement is consistently threaded throughout the paper and included in the conclusion.

☒ Paragraph development: Each paragraph has an introductory statement, two or three sentences as the body of the paragraph, and a transition sentence to facilitate the flow of information. The sections of the main body are organized to reflect the main points of the author. APA format is applied correctly. There are no errors.

☒ All sources are cited. APA style and format are correctly applied and are free from error.

☒ Sources are completely and correctly documented on a References page, as appropriate to assignment and APA style, and format is free of error.

Scholarly Resources: Scholarly resources are written with a focus on a specific subject discipline and usually written by an expert in the same subject field. Scholarly resources are written for an academic audience.

Examples of Scholarly Resources include: Academic journals, books written by experts in a field, and formally published encyclopedias and dictionaries.

Peer-Reviewed Journals: Peer-reviewed journals are evaluated prior to publication by experts in the journal’s subject discipline. This process ensures that the articles published within the journal are academically rigorous and meet the required expectations of an article in that subject discipline.

Empirical Journal Article: This type of scholarly resource is a subset of scholarly articles that reports the original finding of an observational or experimental research study. Common aspects found within an empirical article include: literature review, methodology, results, and discussion.

Adapted from “Evaluating Resources: Defining Scholarly Resources,” located in Research Guides in the GCU Library.

☒ The writer is clearly in command of standard, written, academic English. Utilize writing resources such as Grammarly, LopesWrite report, and ThinkingStorm to check your writing.