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Literature Evaluation Table
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The articles selected in this Literature Evaluation Table have a common thread in that their findings and conclusions directly or indirectly contribute to getting the answer to the pertinent clinical question using the PICOT framework that states; In ICU patients, how effective is it to remove Foley catheters within 24-72 hours in preventing infection versus intermittent catheterization in decreasing the incidence of infection within 90 days? The proposed project is based on a Neuro ICU that is seeking to reduce the duration that the patients stay in line before consulting the clinician, decrease the incidences of infection while simultaneously increasing the patient’s satisfaction. The Foley Catheters and its relationship with the frequency of Catheter-Associated Urinary Tract infections (CAUTI) is the main issue in the institution. The unit has already implemented some strategies to improve its functioning, incorporating a nurse-driven protocol which requires a daily evaluation of the catheter necessity
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| Criteria | Article 1 | Article 2 | Article 3 | Article 4 |
| Author, Journal (Peer-Reviewed), and Permalink or Working Link to Access Article | Andrade, V. L. F., & Fernandes, F. A. V. (2016). Prevención de la infección del tracto urinario asociada al cateterismo: estrategias en la implementación de las directrices internacionales. Revista Latino-Americana de Enfermagem, 24. https://www.scielo.br/pdf/rlae/v24/0104-1169-rlae-0963-2678.pdf A qualitative research Methodology Approach | Atkins, L., Sallis, A., Chadborn, T., Shaw, K., Schneider, A., Hopkins, S., … & Lorencatto, F. (2020). Reducing catheter-associated urinary tract infections: a systematic review of barriers and facilitators and strategic behavioural analysis of interventions. Implementation Science, 15(1), 1-22. https://implementationscience.biomedcentral.com/articles/10.1186/s13012-020-01001-2 A mixed method Research Methodology | Barbara Pashnik, R. N. (2020). Intensive care unit rounding checklists to reduce catheter-associated urinary tract infections. Infection Control & Hospital Epidemiology, 1, 4.https://www.researchgate.net/publication/339694453_Intensive_care_unit_rounding_checklists_to_reduce_catheter-associated_urinary_tract_infections A Quantitative research Methodology Approach | Sandhu, R., Sayal, P., Jakkhar, R., & Sharma, G. (2018). Catheterization-associated urinary tract infections: Epidemiology and incidence from tertiary care hospital in Haryana. Journal of Health Research and Reviews, 5(3), 135. https://www.jhrr.org/article.asp?issn=2394-2010;year=2018;volume=5;issue=3;spage=135;epage=141;aulast=Sandhu;type=3 A quantitative research methodology approach |
| Article Title and Year Published | Prevention of catheter-associated urinary tract infection: implementation strategies of international guidelines, 2016 | Reducing catheter-associated urinary tract infections: a systematic review of barriers and facilitators and strategic behavioral analysis of interventions(2020) | Intensive care unit rounding checklists to reduce catheter-associated urinary tract infections , 2020. | Catheterization-associated urinary tract infections: Epidemiology and incidence from tertiary care hospital in Haryana. 2018. |
| Research Questions (Qualitative)/Hypothesis (Quantitative) | Research Question What strategies do health professionals use to implement the Centers for Disease Control and Prevention (CDC) guidelines to prevent urinary infection connected to catheterism? | Research Question-Qualitative section What are the barriers and facilitators of behavior do current CAUTI reduction interventions face? Research Hypothesis Quantitative section CAUTI prevention intervention used in HCPs are related to barriers to and facilitators of CAUTI- related behavior s | Research Hypothesis Implementation of an intensive care unit (ICU) rounding checklist lowers the number of CAUTIs. | Research hypothesis Identifying microbial , and determining their pattern of susceptibility to prophylactics that are commonly used would offer baseline inform action on incidence of CAUTI leading to decreased hospitalization, medication and morbidity. |
| Purposes/Aim of Study | To describe measures and strategies that health professionals use to implement CDC guidelines to prevent CAUTIs. | To identify both barriers to and facilitators of CAUTI- related behaviors in HCPs, describe then content of Interventions adopted to decrease CAUTI at the national level within England. | To assess the efficacy of an ICU rounding checklist to decrease the number of CAUTIs. As you continue, thestudycorp.com has the top and most qualified writers to help with any of your assignments. All you need to do is place an order with us. (Literature Evaluation Table) | To offer a baseline information within the context of CAUTI incidences, identify the related microbial and determine pattern of susceptibility to commonly used antimicrobial agents for prophylactic and empiric therapy to patients who suffer from CAUTI. |
| Design (Type of Quantitative, or Type of Qualitative) | Qualitative methodology | Mixed –Method . | Quantitative methodology. | Quantitative Methodology. |
| Setting/Sample | USA Systematic review 13 quantitative studies | England Sample – systematic review of articles published between 1995 and Nov 2017. 25 articles were identified | Academic community hospital 16- bed with mixed surgical, cardiac and medical ICU. Sample Patients admitted in the ICU and diagnosed with CAUTI 15, 886 patients | Department of Microbiology, BPS Govt. Medical College for Women, Khanpur Kalan, Sonepat Sample- Both males and females above 15years 97 males, 64 females |
| Methods: Intervention/Instruments | . Systematic review of quantitative articles on prevention of CAUTIs. | Approach in a 3- phase study Phase 1- systematic review on barriers to facilitator of CAUTI- related behavior. Phase2- Content analysis of Kingdom wide intervention meant to decrease CAUTIs in England Phase 3- Comparison of findings from Phase 1 &2 to establish the magnitude to which intervention content was theoretically congruent to the barriers and facilitate identified | Retrospective pre- and post-study that took place between for a period of 4 years beginning in March 2013 and ending in February, 2017 | prospective study conducted on non- repetitive samples of urine taken from catheterized patients As you continue, thestudycorp.com has the top and most qualified writers to help with any of your assignments. All you need to do is place an order with us. (Literature Evaluation Table) |
| Analysis | Articles reviewed presented a high level of evidence on the matter under investigation between levels I and II- of evidence | Data collected in a three –step framework as well as thematic analysis to synthesize and account for the barriers to and facilitators to CAUTI –related behaviors related in the systematic review. Framework analysis was used to deductively code extracted data to barriers and facilitators. Thematic analysis within each TDF domain, grouping similar data points and inductively generating summary theme labels. Ranking TDF domains in terms of importance according to frequency (number of studies), elaboration (number of themes) and evidence of conflicting beliefs within domains (e.g. if some participants report lack of knowledge of guidelines whereas others report familiarity with guidelines) Rank order was determined first by frequency, then elaboration, then evidence of conflicting belief. | The collected data was analyzed using SAS software. In the four years the intervention was in progress only 19 incidences of CAUTIs were recorded in 9, 288 catheter days with a total number of patients standing at 15, 886. Of the 19, 23.8% of them had occurred prior the intervention. It is important to note that the rate of CAUTI measured as a number of CAUTIs per 1000 catheter days decreased after the implementation of the rounding intervention. | Descriptive statistics that were expressed as percentages were employed for the evaluation of the CAUTI incidence in tertiary care hospital wards as well as the ICUs with individuals above 18 years. Similarly, descriptive statistics were also used to define the isolated pathogens resistance patterns. |
| Key Findings | Healthcare professionals (HCPs) as per the prevention guidelines for CAUTI- implement them in different ways. Attention during the CAUTI prevention procedure, how the vesical catheter, length of catheterization and staff training remain paramount. | The aims of this study were to identify barriers to and facilitators of CAUTI prevention behaviors, describe the content of nationally adopted interventions and assess the extent to which intervention content is theoretically congruent with facilitators and barriers. Interventions incorporated half the potentially relevant content to target identified barriers to and facilitators of CAUTI-related behaviors. There were missed opportunities for intervention as most focus on shaping knowledge rather than addressing motivational, social and environmental influences. | The timing of different interventions in the ICU that may have impacted CAUTI rates in relation to when the ICU rounding checklist was implemented First, weekly maintenance bundle audits, with peer feedback of noncompliant elements; Secondly, mandatory CAUTI competency session to review urinary catheter technique with nurses; Thirdly, the addition of competency to new nursing orientation on a monthly basis; and lastly, the requirement that all insertions be done by 2 registered nurses. The timing of different interventions within the ICU may has significantly affected the rates of CAUTIs in connection to when the ICU rounding checklist was implemented beginning with weekly maintained of bundle audits, followed by mandatory CAUTI competency sessions to review urinary catheter with the nurses and an additional competency orientation for new nurses every month. Additionally there was a requirement that all catheter insertions be done by two registered nurses. | The study indicated that the presence of an indwelling catheter predisposes t o a symptomatic infection because it provides a surface for the attachment of microbial adhesion. Symptomatic infection can lead to ascending infection of bladder, ureters, and kidney, with subsequent need for antimicrobial agents. CAUTIs is a huge reservoir of resistant pathogens with the risk of cross-infection of other patients. Along the same vein, it can be argued that UTIs are most often caused by ascending colonization, hematogenous dissemination secondary to organisms in the bloodstream is another possible route to the development of UTI. |
| Recommendations | There is need to implement policies that promote the removal of catheters at the earliest opportunity and those that are not necessary. | It is necessary to include strategies like effective communication as one reaches out to the target audience once the CAUT prevention guidelines are published across all settings. | ICUs should use a daily rounding checklist of the Foley catheterization since doing so has demonstrated a capacity to reduce the average number of CVAUTIs in ICU patients. | It is recommended that old catheters replacement before initiating antibiotic treatment remains the most viable option while treatment should be premised on the susceptibility of the pathogens that are separated from urine aspirated from the new catheter. This is because samples collected from the old\ catheter may contain different species and more numbers of pathogens. |
| Explanation of How the Article Supports EBP/Capstone Project | The article contributes to answering my PICOT question in that before one can make the choice of whether to use Foley Cather or intermittent catheterization one should know and be conversant with CAUTI prevention guidelines. | The article is relevant to getting the answers to my PICOT question because it underlines the role that educational strategies play in the successful implementation of a chosen intervention. As such once the proposed intervention proves that Foley Catheterization is more efficient that intermittent catheterization, nursing staff stationed at the ICU education will still be an important component of the recommended measures,The article is spot on in that it specifically focusses on the same unit ICU, as the selected PICOT question hence its findings are relevant and generalizable to my patient population as well. | The study findings are important in that they emphasize on the use of Foley catheters between 24 and 72 hours of insertion. |
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References
Andrade, V. L. F., & Fernandes, F. A. V. (2016). Prevención de la infección del tracto urinario asociada al cateterismo: estrategias en la implementación de las directrices internacionales. Revista Latino-Americana de Enfermagem, 24. https://www.scielo.br/pdf/rlae/v24/0104-1169-rlae-0963-2678.pdf
Atkins, L., Sallis, A., Chadborn, T., Shaw, K., Schneider, A., Hopkins, S., … & Lorencatto, F. (2020). Reducing catheter-associated urinary tract infections: a systematic review of barriers and facilitators and strategic behavioural analysis of interventions. Implementation Science, 15(1), 1-22. https://implementationscience.biomedcentral.com/articles/10.1186/s13012-020-01001-2
Barbara Pashnik, R. N. (2020). Intensive care unit rounding checklists to reduce catheter-associated urinary tract infections. Infection Control & Hospital Epidemiology, 1, 4.https://www.researchgate.net/publication/339694453_Intensive_care_unit_rounding_checklists_to_reduce_catheter-associated_urinary_tract_infections
Sandhu, R., Sayal, P., Jakkhar, R., & Sharma, G. (2018). Catheterization-associated urinary tract infections: Epidemiology and incidence from tertiary care hospital in Haryana. Journal of Health Research and Reviews, 5(3), 135. https://www.jhrr.org/article.asp?issn=2394-2010;year=2018;volume=5;issue=3;spage=135;epage=141;aulast=Sandhu;type=3