Reducing UTI in Nursing Homes

  This paper is a reflection journal of research I conducted on reducing urinary tract infections (UTIs) in nursing homes. Before the research, I knew that UTIs had been associated with indwelling catheters, which are commonly used in nursing homes. As I found out, it is important to adopt new practice approaches in situations where the use of indwelling catheters is avoidable. For instance, nurses can use intermittent catheterization for most of the patients or external condom catheters (Ribeiro, 2015). However, quickly, I have decided not to focus on catheter induced UTI but any kind of UTI.

       Research on UTI prevention confirmed there was a need for intraprofessional collaboration in preventing UTIs. It made me realize that all nurses in nursing homes should take a proactive approach to prevent UTI (Ribeiro, 2015). They should do so in a way that promotes intraprofessional collaboration. During the research, I spent some time reflecting on what it means to be a good team player as a nurse. It made me realize that this was one of my strengths. My research have involved nurses, CNAs, people from the administration and communication was key

       Before undertaking the research, I knew nurses have a duty to ensure patients who use indwelling catheters do not stay with them for long unless it is avoidable. According to Wald et al. (2014), indwelling catheters are associated with 80 percent of healthcare-acquired UTIs. However, doing research on the prevention of UTIs has made me discover that most of the UTI in nursing homes are avoidable because they are the consequence of improper care provided to incontinent patients. They are avoidable and cause unnecessary expenses.  They are avoidable because they have the highest rate of weekly quality assurance report. That is the reason why I focus my EBP on providing perineal care by a special team. Besides that, the research has made me appreciate the need for a surveillance system in nursing homes to achieve proper catheter use. For instance, I learned that the use of electronic health records could promote the standardization and efficiency of the surveillance (Wald et al., 2014). I also learned that an electronic CAUTI surveillance algorithm can be used to conduct surveillance of catheter-associated UTI (CAUTI) and IUC utilization to influence optimal outcomes in preventing CAUTI in nursing homes. All these are something new for me. Despite focusing on nursing action that can reduce UTI just by providing timely toileting, good hydration and good perineal care, I have discover a lot about how to reduce catheter induce UTI.

       Additionally, my professional practice informs me that nurses should act in ethical ways. Ensuring I adhere to ethical guidelines is one of my strengths. As such, I cannot perform any procedure without involving the patient and ensuring they know why I am doing a particular procedure. I remember when we started the Peri-Team, patient were very excited any time the team introduced itself and explained the reason why they were doing this.  

       In addition, nurses should consider population health concerns in preventing UTI in nursing homes. Before conducting the research, I knew that everyone in a nursing home including the patients, nurses, and other health care workers are supposed to be vigilant in avoiding things that put themselves and the other people at risk of UTI. However, this research made me realize that one way of preventing UTI infection in a nursing home is to encourage everyone who comes to a nursing home to take plenty of water and other fluids every day to achieve proper hydration (Ribeiro, 2015). It also made me note I had a weakness in that I only used to focus on educating the patients about the need for proper hydration while ignoring their family members and other visitors. The reason is because contamination can come from outside while the patient is under our care.

        The research made me learn how new engineering strategies and novel coatings are being used to overcome the bacterial challenge on indwelling catheters (Mandakhalikar et al., 2016). For example, I learned that the use of silver alloy with hydrogel as a coating of indwelling catheters is one of the newest and most effective technologies of preventing UTIs.

During my research, I have come across several catheter utilization policies. Conducting this research made me realize that not all nursing homes have catheter utilization policies (Mody et al., 2016).  However, I noted that those which had catheter utilization policies covered similar things such as requiring documentation of why a catheter use is necessary, requiring a physician’s approval before placing a urinary catheter, as well as best catheter insertion and maintenance practices. I noted that in nursing homes where these policies were adhered to, catheter utilization was highly reduced and this decreased the risks of UTIs (Mody et al., 2016).

       Conducting research on UTI prevention further reminded me of the health disparities that exist in nursing homes. Before doing the research, I knew that UTI was common among old women. I learned that it might be difficult to prevent UTI in older women. I also noted that some of the recommended strategies to reduce UTIs in older women provided conflicting results. Nevertheless, I learned that giving cranberry juice cocktail to older women is one of the ways of preventing UTIs (Rowe & Juthani-Mehta, 2013).

       Lastly, carrying out the research enabled me to realize the role of leadership in preventing UTIs in nursing homes. Nurse leaders should take charge in ensuring proper care is provided , and all nurses in nursing homes are adhering to maximum hygiene. They should also ensure their respective nursing homes adopt the right economic models that can enable them to utilize their resources more efficiently in preventing UTIs (Mody et al., 2016)

            In summary, nurses should provide leadership in preventing UTI by ensuring the necessary interventions are undertaken according to the relevant healthcare policy. They should also ensure patients, family members, and other healthcare workers are educated regarding upholding hygiene, catheter avoidance, and the importance being well-hydrated throughout the day, and provide good perineal care for all incontinent patients as well as timely toileting.  

References

Mandakhalikar, K., Chua, R., & Tambyah, A. (2016). New technologies for prevention of    catheter associated urinary tract infection. Current Treatment Options in Infectious    Diseases, 8 (2016), 24-41.

Mody, L., Greene, T., Saint, S., Meddings, J., Trautner, B., Wald, H.,…..Krein, S. (2016).      Comparing catheter-associated urinary tract infection prevention programs between        veterans affairs nursing homes and non–veterans affairs nursing homes. Retrieved       from http://www.medicine.wisc.edu/sites/default/files/comparing_catheter_associated_utis       _prevention_programs_crnich_12_5_16.pdf

Ribeiro, S. (2015). Nursing management of urinary tract infections. Nursing Older People, 27  (7), 24-29.

Rowe, T., & Juthani-Mehta, M. (2013). Urinary tract infection in older adults. Aging Health,         9 (5), 519-528.

Wald, H., Bandle, B., Richard, A., Min, S., & Capezuti, E. (2014). Implementation of electronic surveillance of catheter use and catheter-associated urinary tract infection at Nurses Improving Care for Healthsystem Elders (NICHE). American Journal of Infection Control, 42 (10), S242-S249.