Catheter Associated Urinary Tract Infections Caused in the Emergency Department?

2.50
Hdl Handle:
http://hdl.handle.net/10755/198299
Title:
Catheter Associated Urinary Tract Infections Caused in the Emergency Department?
Abstract:
[ENA Annual Conference 2011 - Evidence-based Practice Presentation] Catheter Associated Urinary Tract Infections caused in the Emergency Department?

Purpose: To determine if recently reported CAUTI’s originating in the emergency department were caused by ineffective sterile insertion technique during foley catheter placement thus requiring additional staff education or did the patient present to the emergency department with signs/symptoms of a urinary tract infection. Also, to ensure appropriateness of foley catheter placement based on approved evidence-based criteria and physician order present.

Design: A retrospective chart review was performed on 35 correctly completed Foley Audit Tools. Lab data was reviewed including the results of urinalysis and urine culture.

Setting: A private, not-for-profit, hospital located in a southeastern metropolitan region. This hospital is a Level II trauma center with a 66 bed emergency department. The hospital system was awarded the Magnet Recognition for Nursing Excellence in 2005 and has since been redesignated.

Participants/Subjects: The participants of this study included any patient entering the emergency department requiring the placement of a foley catheter as determined by patient medical status, physician order, and evidence-based criteria.

Method: A foley audit tool was developed and placed on every foley catheter insertion tray. The audit tool was completed upon insertion of a foley catheter in the emergency department. The foley catheter was only placed in the emergency department if required by the patient’s medical status, a physician order was present, and if evidence-based criteria had been met. The Medical Director of this emergency department mandated that a urine specimen should be collected at the time of the foley catheter insertion and sent to the lab for urinalysis and urine culture. The audit tools and patient lab data were reviewed to determine if the patient presented to the emergency department with any signs/symptoms of a urinary tract infection. Criteria reviewed, included positive for: pyuria, nitrites, leukocyte esterase and a culture of greater than or equal to 100,000 CFU/ml with no more than 2 species of microorganisms.

Results: Fifty audit tools were collected over a 2-month period. Ten of these audit tools did not have patient identifiers therefore no retrospective data was collected. Five of these audits did not have associated lab data. Twenty-two audit tools met criteria and had no growth or no signs or symptoms of a UTI based on urinalysis results. Thirteen charts met criteria and had a positive indicator of UTI based on culture or urinalysis results. Approximately 1/3 of the patients presented to the emergency department with signs/symptoms of UTI based on lab results.

Implications: This study implies that there is a need for a present on admission (POA) indicator related to UTI and CAUTI in the emergency department. With the implementation of evidence-based criteria related to urethral catheter use and the collection of a urine specimen at the time of foley catheter insertion we were able to determine that sterile technique was implemented appropriately and that many patients present to the emergency department with occult UTI.


Repository Posting Date:
21-Dec-2011
Date of Publication:
21-Dec-2011

Full metadata record

DC FieldValue Language
dc.titleCatheter Associated Urinary Tract Infections Caused in the Emergency Department?en_GB
dc.identifier.urihttp://hdl.handle.net/10755/198299-
dc.description.abstract[ENA Annual Conference 2011 - Evidence-based Practice Presentation] Catheter Associated Urinary Tract Infections caused in the Emergency Department?<br/><br/>Purpose: To determine if recently reported CAUTI’s originating in the emergency department were caused by ineffective sterile insertion technique during foley catheter placement thus requiring additional staff education or did the patient present to the emergency department with signs/symptoms of a urinary tract infection. Also, to ensure appropriateness of foley catheter placement based on approved evidence-based criteria and physician order present.<br/><br/>Design: A retrospective chart review was performed on 35 correctly completed Foley Audit Tools. Lab data was reviewed including the results of urinalysis and urine culture.<br/><br/>Setting: A private, not-for-profit, hospital located in a southeastern metropolitan region. This hospital is a Level II trauma center with a 66 bed emergency department. The hospital system was awarded the Magnet Recognition for Nursing Excellence in 2005 and has since been redesignated.<br/><br/>Participants/Subjects: The participants of this study included any patient entering the emergency department requiring the placement of a foley catheter as determined by patient medical status, physician order, and evidence-based criteria.<br/><br/>Method: A foley audit tool was developed and placed on every foley catheter insertion tray. The audit tool was completed upon insertion of a foley catheter in the emergency department. The foley catheter was only placed in the emergency department if required by the patient’s medical status, a physician order was present, and if evidence-based criteria had been met. The Medical Director of this emergency department mandated that a urine specimen should be collected at the time of the foley catheter insertion and sent to the lab for urinalysis and urine culture. The audit tools and patient lab data were reviewed to determine if the patient presented to the emergency department with any signs/symptoms of a urinary tract infection. Criteria reviewed, included positive for: pyuria, nitrites, leukocyte esterase and a culture of greater than or equal to 100,000 CFU/ml with no more than 2 species of microorganisms. <br/> <br/>Results: Fifty audit tools were collected over a 2-month period. Ten of these audit tools did not have patient identifiers therefore no retrospective data was collected. Five of these audits did not have associated lab data. Twenty-two audit tools met criteria and had no growth or no signs or symptoms of a UTI based on urinalysis results. Thirteen charts met criteria and had a positive indicator of UTI based on culture or urinalysis results. Approximately 1/3 of the patients presented to the emergency department with signs/symptoms of UTI based on lab results.<br/><br/>Implications: This study implies that there is a need for a present on admission (POA) indicator related to UTI and CAUTI in the emergency department. With the implementation of evidence-based criteria related to urethral catheter use and the collection of a urine specimen at the time of foley catheter insertion we were able to determine that sterile technique was implemented appropriately and that many patients present to the emergency department with occult UTI. <br/> <br/> <br/>en_GB
dc.date.available2011-12-21T12:45:18Z-
dc.date.issued2011-12-21T12:45:18Z-
dc.date.accessioned2011-12-21T12:45:18Z-
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.