The Development of Nursing Practice Guidelines by Using Evidence-based Practices to Reduce Catheter-associated Urinary Tract Infection in Prapokklao Hospital
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Abstract
BACKGROUND: Catheter-associated urinary tract Infection (CAUTI) is one of the top three infections in Prapokklao Hospital, Chanthaburi, Thailand. The trend of the incidence density of CAUTI rose from 2.59, 2.78, and 3.25/1000 device days in the fiscal years 2016-2018, respectively. This was higher than the hospital target (<2/1000 device days).
OBJECTIVES: To develop and evaluate the nursing practice guidelines for the prevention of CAUTI based on the NOCAUTI bundle concept.
METHODS: The population and sample were all indwelling urinary catheter patients in Prapokklao Hospital from October 2017 to August 2021. The evidence-based nursing practice guidelines for the prevention of CAUTI was developed by using an evidence-based practice process integrated with the PDSA cycle of quality improvement and multidisciplinary approach. The steps comprised 1) Identifying the clinical problem, 2) using the PICO format for searching for the evidence, 3) appraising the evidence, and 4) applying the evidence and developing nursing practice guidelines that emphasized the catheter removal criteria integrated with the establishment of a nursing supervision system and multidisciplinary team approach, as well as reminding of the CAUTI prevention by using a NOCAUTI bundle concept. This concept consisted of N-Need, O-Obtain patient consent, C-Competency, A-Aseptic technique, U-Unobstructed flow, T–Timely, and I-Infection risk and was implemented into the clinical practice. 5) The outcome of the evaluated processes used a control U-chart of the CAUTI rate and evaluated the efficacy of the guidelines during the study period from December 2019 to August 2021.
RESULTS: The control U-chart analysis showed a statistically significant reduction of the CAUTI. This also decreased at 1.70/1000 device days in 2021.
CONCLUSIONS: The NOCAUTI bundle could effectively reduce CAUTI in accordance with the hospital target (<2/1000 device days). The key measures were the catheter removal criteria together with the establishment of a nursing supervision system, as well as the strategies of the multidisciplinary team approach and dialogue.
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