BHA4010_u901_Mszymanski

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1 Catheter-Associated Urinary Tract Infections: Finding Best Practices for Prevention in Patients During ICU Stay Michelle Szymanski BHA4010: Intro to Health Care Research Instructor: Jason Roberts September 10, 2023

2 Table of Contents Background and Evidence ................................................................................................ 3 Problem Statement ............................................................................................................ 4 Purpose Statement ............................................................................................................. 4 Qualitative Research Question ......................................................................................... 4 Qualitative Methodologies ................................................................................................ 5 Qualitative Data Collection Strategies ............................................................................. 6 Invaluable Targeted Data Collection ............................................................................... 6 Summary ............................................................................................................................ 7

3 Background and Evidence According to the Centers for Medicare & Medicaid Services (CMS), hospital-acquired conditions (HACs) identified as high cost or high volume or a combination of both “result in the assignment of a case to a DRG that has a higher payment when present as a secondary diagnosis” and within reason, are preventable through “application of evidence-based guidelines” (Centers for Medicare and Medicaid Services, 2020). In the United States, CAUTIs not only prolong the length of stay for a patient but also cost the healthcare system upwards of $400 million annually (Rinke et al., 2020). This research paper will focus on the prolonged use of catheters and the correlation to catheter-associated UTIs (CAUTIs). A catheter-associated UTI (CAUTI) is a urinary tract infection. It is the most common type of HAC, accounting for one million cases per year in the United States, according to research from Werneburg (2022). Their study also found that the associated costs range from an estimated $115 million to $1.82 billion per year and that for patients in the intensive care unit (ICU), the “incidence of CAUTI is 7.78 per 1000 catheter days” and that these infections attribute to increased lengths of stay, increased expenditure within health care and overuse of antibiotics (Werneburg, 2022). Besides the costs, CAUTIs can lead to further medical complications and sometimes death as the research found by Dias et al. (2022), “its [CAUTI] use is a precursor to over 75% of cases of hospital urinary infections, and responsible for up to 40% of nosocomial infections showing a mortality rate of 2.3%”. As part of one particular study tracked CAUTI rates across 47,926 patients hospitalized between 2012 and 2016 in an urban academic health system comprising two medical centers, two community hospitals, and a pediatric hospital, the root cause analysis found that CAUTI primary contributing factor was the time the catheter remained in the patient and that both clinical and infection control persons agreed that the catheter could have been removed sooner (Letica-

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4 Kriegel et al., 2019). In another study conducted in Minneapolis, researchers could link a reduction of percent of the time with catheter insertion and an overall decrease in reported CAUTI because of training or re-training of clinical staff and daily evaluation of the need to continue the use of the urinary catheter specifically those patients in the ICU (Menegueti et al., 2019). Problem Statement We can avoid CAUTI by reducing the time the urinary catheter remains in a patient during their ICU stay, as cited in the research conducted by researchers including Letica-Kriegel et al., Werneburg, G. and Menegueti, M.G. et al. Purpose Statement The research into CAUTI and the efforts to reduce the occurrence of this type of HAC, specifically for patients in the ICU, will provide evidence proving that the shorter period the urinary catheter is in place, the greater the likelihood that a CAUTI will develop. For example, Letica-Kriegel et al. (2019) aimed to examine how the risk for CAUTI changes over time, in their case, using a large data set of patients hospitalized between the years 2012 and 2016. They aimed to evaluate the time from catheter insertion to the CAUTI event and whether risk factors, such as age, sex, etc., varied the results (Letica-Kriegel et al., 2019). Qualitative Research Question The problem: The time a catheter remains in a patient during their ICU confinement is a significant risk factor for developing a urinary tract infection (Letica-Kriegel et al., 2019). The study conducted by Letica-Kriegel et al. (2019) found that 1.41% of the patients in their population who had received catheterization developed a CAUTI and that the rates increased for each additional day the catheter remained in use. Specifically, for those patients in an ICU, Menegueti et al. (2019) analyzed several studies of this population and found more than a

5 50% likelihood of developing a CAUTI. This review seeks to answer the question: What best practices can hospitals implement to reduce CAUTIs, specifically in patients during their ICU stay? Qualitative Methodologies There are various qualitative methods when collecting data to support research: surveys, interviews, experimental, observational, archival, and combined research (Vogt et al., 2012). The interview design in research is often systematic in that several people are asked the same questions to answer the research question. Comparably, the survey design aims to do the same but can be a more cost and time-efficient way of collecting answers (Vogt et al., 2012). The experimental design is a good option when the research is focused on causality vs. the outcomes or when variables can be manipulated and observational can recognize trends among variables within the data collection (Vogt et al., 2012). Archival research uses published materials to answer a research question, such as books, journals, governmental records, internet resources, and newspapers. This type of methodology is used in just about every type of research unless the researcher is the subject expert (Vogt et al., 2012). Combined research methodology is an excellent choice for developing a theory about a marvel of interest or possibly elaborating or building upon various qualitative methods when collecting data to support research: surveys, interviews, experimental, observational, archival, and combined research (Vogt et al., 2012). The interview design in research is often systematic in that several people are asked the same questions to answer the research question. Comparably, the survey design aims to do the same but can be a more cost and time-efficient way of collecting answers (Vogt et al., 2012). The experimental design is a good option when the research is focused on causality vs. the outcomes or when variables can be manipulated and observational can recognize trends among variables within the data collection (Vogt et al., 2012). Archival research uses published materials to

6 answer a research question, such as books, journals, governmental records, internet resources, and newspapers. This type of methodology is used in just about every type of research unless the researcher is the subject expert (Vogt et al., 2012). Combined research methodology is an excellent choice to develop a theory about a marvel of interest or possibly elaborate or build on findings from other methods (Vogt et al., 2012). Since this review aims to identify best practices to help reduce CAUTIs in ICUs, a national survey is discussed on what hospitals in the United States are doing to prevent common device-associated infections. Qualitative Data Collection Strategies The survey mentioned above was mailed to infection preventionists among close to 900 acute care hospitals with an ICU within the United States in 2017. The survey asked about the practices the hospitals used to prevent three common device-associated infections, one of which was CAUTI. The authors conducting the survey used “sample weights” to estimate the percentage of hospitals reporting “regular use” of each practice, along with “multivariable regression” to find commonalities among the hospitals’ characteristics and prevention practices (Saint et al., 2019, p. 741). “The survey process followed a modified Dillman approach which included an initial mailed invitational letter and survey, a reminder postcard after approximately 2 weeks and additional survey mailings at 1 month, 2 months and 5 months to those who had not yet responded”. (Saint et al., 2019, p. 742) Invaluable Targeted Data Collection When using the survey methodology, informed consent to the participant must be clear by explaining the purpose of the research and being open about any conflicts of interest that those conducting the survey may have. For the data collection to be successful, it would also be essential to inform the respondents that it is acceptable to bypass questions and that if they do not

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7 follow the preferred format of the survey when responding, it will not negate their response from the data collection (Vogt et al., 2012). Another critical factor in this targeted data collection methodology is that the researcher will conduct their analysis and report survey responses fairly and accurately (Vogt et al., 2012). Summary When the data collection and analysis are done so consistently, it reflects the reliability in that “the essence of reliability for qualitative research lies with consistency” (Leung, 2015, p. 326). Saint et al. (2019) use of the survey methodology showed consistency with how the respondents were chosen and the method of collecting the responses. In qualitative research, the validity encompasses all the research variables, including the problem question and statement, whether the qualitative methodology chosen answers that problem question or statement, and the data analyzed (Leung, 2015). Here, Saint, et al. (2019) chose the survey methodology to poll a large data set of specialized providers to answer the questions about prevention practices used in their facilities to prevent three common infections, including CAUTI. The data collection and methodology showed favorably for reliability.

8 References Centers for Medicare and Medicaid Services. (2020, February 11). Hospital-acquired conditions . Centers for Medicare and Medicaid Services. http://www.cms.gov/medicare/medicare- fee-for-service-payment/hospitalacqcond/hospital-acquired_conditions.html Dias, L. D., Duarte, L. S., Naves, P. L. F., Napolitano, H. B., & Bagnato, V. S. (2022). Self- disinfecting urethral catheter to overcome urinary infections: from antimicrobial photodynamic action to antibacterial biochemical entities. Microorganisms , 10 (12), 2484. https://doi.org/10.3390/microorganisms10122484 Letica-Kriegel, A. S., Salmasian, H., Youngerman, B. E., Green, R. A., Furuya, E. Y., Calfee, D. P., & Perotte, R. (2019). Identifying the risk factors for catheter-associated urinary tract infections: A large cross-sectional study of six hospitals. BMJ Open , 9 (2). https://doi.org/10.1136/bmjopen-2018-022137 Leung, L. (2015). Validity, reliability, and generalizability in qualitative research. Journal of Family Medicine and Primary Care , 4 (3), 324–327. https://doi.org/10.4103/2249- 4863.161306 Menegueti, M. G., Ciol, M. A., Bellissimo-Rodrigues, F., Auxiliadora-Martins, M., Gaspar, G. G., Canini, S., Basile-Filho, A., & Laus, A. M. (2019). Long-term prevention of catheter- associated urinary tract infections among critically ill patients through implementing an educational program and a daily checklist for maintenance of indwelling urinary catheters: A quasi-experimental study. Medicine , 98 (8). https://doi.org/10.1097/MD.0000000000014417 Rinke, M. L., Oyeku, S. O., Moonseong, H., Saiman, L., Zachariah, P., Rosenberg, R. E., DeLaMora, P., Rabin, B., Mirhaji, P., Klein, E., Ford, W. J. H., Obaro-Best, O., Drasher,

9 M., Peshansky, A., Balem, K. A., & Bundy, D. G. (2020). Pediatric ambulatory catheter- associated urinary tract infections (CAUTIs): Incidence, risk factors, and patient outcomes. Infection Control & Hospital Epidemiology , 41 (8), 891–899. https://doi.org/10.1017/ice.2020.204 Saint, S., Greene, M. T., Fowler, K. E., Ratz, D., Patel, P. K., Meddings, J., & Krein, S. L. (2019). What US hospitals are currently doing to prevent common device-associated infections: Results from a national survey. BMJ Quality & Safety , 28 (9), 741–749. https://doi.org/10.1136/bmjqs-2018-009111 Vogt, W. P., Gardner, D. C., & Haeffele, L. M. (2012). When to use what research design . The Guilford Press. Werneburg, G. T. (2022). Catheter-associated urinary tract infections: current challenges and future prospects. Research and reports in urology , 14 , 109–133. https://doi.org/10.2147/RRU.S273663

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