NURS 8002 – Researching and Analyzing Primary Research Articles
Research is a crucial aspect of a DNP nurse’s role, often involving evidence-based practices. My specific interest centers around reducing catheter-associated urinary tract infections (CAUTI), a significant clinical concern that demands attention to improve patient well-being. In this write-up, we will summarize and synthesize information from two peer-reviewed articles retrieved through a Walden Library search, focusing on strategies to decrease CAUTI.
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Summary of the Articles
The first article, titled “Chlorhexidine for Meatal Cleaning in Reducing Catheter-Associated Urinary Tract Infections: A Multicentre Stepped-Wedge Randomized Controlled Trial,” by Fasugba et al. (2019), examines the reduction of CAUTI. This study compares the effectiveness of using normal saline versus a 0.1% chlorhexidine solution for cleaning the meatal area before catheter insertion to lower CAUTI rates. The research involved a cross-sectional randomized control trial conducted in three hospitals over three weeks, with a total of 1642 participants. Of these, 58% were in the intervention group, and 42% were in the control group. The results showed that the control group had 13 CAUTI cases compared to only 4 cases in the intervention group, indicating a significant 94% reduction in CAUTI rates due to the intervention.
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A more recent study by Nassikas et al. (2020), titled “Intensive Care Unit Rounding Checklists to Reduce Catheter-Associated Urinary Tract Infections,” aimed to determine whether the use of a rounding checklist in an ICU setting could decrease the incidence of CAUTI. The researchers employed a retrospective before-and-after study design in a 16-bed ICU unit within an academic community hospital. The intervention involved an ICU rounding checklist that ensured healthcare providers addressed the use of indwelling catheters. Analysis compared CAUTI rates before and after checklist implementation, a method commonly used to assess intervention efficacy in managing conditions. Findings revealed that before the intervention, the unit recorded nineteen CAUTI cases per one thousand catheter days. After the intervention, this rate reduced to 2.12 from the previous 4.62, demonstrating the checklist’s effectiveness.
Synthesis of the Sources
Fasugba et al.’s (2019) findings suggest that thorough cleaning of the meatal area can significantly reduce CAUTI rates. By opting for the standard approach of using a 0.9% saline solution, whose efficacy has been established in previous studies (Khahakaew et al., 2019), this research demonstrates that a 0.1% chlorhexidine solution is more effective, adding valuable evidence for practice. These findings align with those of other studies (Mitchell et al., 2019), though they differ from some reports where the use of chlorhexidine did not lead to lower CAUTI rates, albeit in a single-site randomized control trial.
In the case of Nassikas et al.’s (2020) study, their results are significant for ICU settings. The use of a checklist to manage indwelling catheters can have broader applications in various ICU locations. Notably, this intervention proves to be cost-effective, despite initial increased catheter usage, ultimately resulting in lower overall usage rates. Other studies also support these findings, with research showing that combining checklists and education can effectively reduce CAUTI rates (Menegueti et al., 2019).
References
Fasugba, O., Cheng, A. C., Gregory, V., Graves, N., Koerner, J., Collignon, P., … & Mitchell, B. G. (2019). Chlorhexidine for meatal cleaning in reducing catheter-associated urinary tract infections: a multicentre stepped-wedge randomised controlled trial. The Lancet Infectious Diseases, 19(6), 611-619. Doi: 10.1016/S1473-3099(18)30736-9.
Khahakaew, S., Suwanpimolkul, G., Wongkeskij, T., Punakabutra, N., & Suankratay, C. (2019, October). 1151. A Comparison of Periurethral Cleaning Between Normal Saline and Savlon Solutions Before Indwelling Urinary Catheterization in Reducing Catheter-Associated Bacteriuria: A Randomized Controlled Study. In Open Forum Infectious Diseases (Vol. 6, No. Supplement_2, pp. S411-S411). US: Oxford University Press. https://doi.org/10.1093/ofid/ofz360.1015
Menegueti, M. G., Ciol, M. A., Bellissimo-Rodrigues, F., Auxiliadora-Martins, M., Gaspar, G. G., da Silva Canini, S. R. M., … & Laus, A. M. (2019). Long-term prevention of catheter-associated urinary tract infections among critically ill patients through the implementation of an educational program and a daily checklist for maintenance of indwelling urinary catheters: a quasi-experimental study. Medicine, 98(8). Doi 10.1097/MD.0000000000014417.
Mitchell, B. G., Fasugba, O., Cheng, A. C., Gregory, V., Koerner, J., Collignon, P., … & Graves, N. (2019). Chlorhexidine versus saline in reducing the risk of catheter associated urinary tract infection: a cost-effectiveness analysis. International journal of nursing studies, 97, 1-6. https://doi.org/10.1016/j.ijnurstu.2019.04.003.
Nassikas, N. J., Monteiro, J. F. G., Pashnik, B., Lynch, J., Carino, G., & Levinson, A. T. (2020). Intensive Care Unit Rounding Checklists to Reduce Catheter-Associated Urinary Tract Infections. Infection control and hospital epidemiology, 41(6), 680-683. Doi: 10.1017/ice.2020.43
Spurlock Jr, D. R. (2018). The single-group, pre-and posttest design in nursing education research: It’s time to move on. Journal of Nursing Education, 57(2), 69-71. Doi: https://doi.org/10.3928/01484834-20180123-02.
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