Scholarship & Research
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Item Development and implementation of a policy to reduce urinary catheter days(Montana State University - Bozeman, College of Nursing, 2022) Trystianson, Bowen Austin Stephen; Chairperson, Graduate Committee: Yoshiko Yamashita ColcloughUrinary catheters are useful medical tools for draining urine. These devices are often used for patients whose medical conditions make urination difficult or may limit their mobility, making toileting challenging. The use of urinary catheters is associated with risks such as trauma or infection. Therefore, medical research aims to limit the usage of urinary catheters only for patients who need intervention and also to reduce the duration of catheter usage. A hospital in central Montana had noted an increase in their overall urinary catheter use. To address this increase a project was started with the goal of revising an existing catheter policy and adding in the authorization for registered nurses to remove catheters when appropriate. To help guide the project, a literature review was undertaken. Research was sought out in the areas of urinary catheter guidelines, utilization of policies, implementation of policies, and sustaining change. Once the literature review was completed, an existing policy was checked against existing guidelines and a point was added to this policy to permit registered nurses to remove urinary catheters when deemed appropriate. Further, this policy was adopted by the facility. Training presentations were then developed and recorded to familiarize nurses with the new policy and the new nurse-driven urinary catheter removal process. An algorithm was developed to aid nurses' decision-making process for the removal of catheters. As there was considerable delay in the project implementation due to various factors, the end goal of achieving a reduction in urinary catheter days was not determined. Despite not achieving the ultimate goal within the specified time, this project is still of value to future quality improvement initiatives. The project identifies a number of potential pitfalls and recommends ways to overcome these obstacles. It also highlights the value of persevering the implementation process despite the associated difficulties and delays.Item Nurse-driven catheter-associated urinary tract infection (CAUTI) prevention project(Montana State University - Bozeman, College of Nursing, 2021) Gaskin, Katelyn Dawn; Chairperson, Graduate Committee: Susan LuparellAn indwelling urinary catheter (IUC) is a tube that is placed into the bladder through the urinary tract, left in place and connected to a closed system drainage bag. Catheter placement in the urinary tract increases the risk of bacteria ascending the catheter and causing an infection, known as a catheter-associated urinary tract infection (CAUTI) (Center of Disease Control [CDC], 2019; Fekete, 2020). Healthcare-associated infections (HAI) are the most common complication of healthcare treatment and are a major cause of mortality and morbidity. CAUTIs are the most common and preventable HAI, making up over 30% of the HAI in the United States (Agency of Healthcare Quality and Research [AHRQ], 2015; CDC, 2019; Centers for Medicare & Medicaid Services [CMS], 2008). CAUTIs cause increase pain and discomfort, and increase patients' hospital length of stay (AHRQ, 2017; CDC, 2019). IUCs are frequently placed without appropriate indication and remain in longer than medically necessary (CDC, 2019). Problem statement: Critical care patients are most vulnerable to acquiring a CAUTI from an IUC due to their weakened immune systems and underlying co-morbidities (CDC, 2019). The intensive care unit (ICU) setting has the highest reported rates of CAUTIs (CDC, 2019). Purpose statement: The purpose of this project was to reduce CAUTIs by implementing a nurse-driven algorithm to avoid IUC insertion, decrease IUC duration, and strengthen existing CAUTI prevention measures. Methods: Kotter's change management theory combined with the Plan-Do-Study-Act (PDSA) model served as the project's framework. The project was designed to foster a collaborative approach to reduce CAUTI incidences by empowering nurses to work at the highest level of their scope of practice, standardizing care, and strengthen existing CAUTI prevention. Results: CAUTIs were measured pre/post-implementation, and an absolute reduction from 2 to 0 was observed. The standard infection ratio (SIR) decreased to 0 post-implementation and the standard utilization ratio (SUR) decreased by 2.17%. ICU nurses were very likely (92%) to implement the algorithm into practice, and 81% indicated they implemented the algorithm on 75% of their patients. Conclusion: Although many studies have looked at reducing CAUTIs and have shown the benefit of avoiding insertion and using alternatives, there are few that have examined the standardization and combination of alternative measures, appropriate indications, and acute urinary retention measures into one nurse-driven algorithm. This quality improvement project implemented evidence-based practice in a nurse-driven algorithm and observed a decrease in CAUTI incidence.Item The development and validation of a standard in vitro method to evaluate the efficacy of surface modified urinary catheters(Montana State University - Bozeman, College of Engineering, 2019) Summers, Jennifer Grace; Chairperson, Graduate Committee: Philip S. Stewart; Darla Goeres (co-chair)Urinary catheters are a critical medical device in modern medicine, used in almost every healthcare setting worldwide. Catheter associated urinary tract infections (CAUTI) account for 37% of all healthcare associated infections. Many surface modifications, such as antimicrobial coatings, have been proposed but none have resulted in a significant decrease in CAUTI. A variety of test methods exist to evaluate the efficacy of surface modified urinary catheters, but there is no validated in vitro standard method. This thesis reports on a standard test method which aims to replicate the two routes by which infection may occur, intraluminally and extraluminally, through two quantitative, in vitro models. The first, the Intraluminal Catheter Model (ICM), was devised to evaluate the efficacy of surface modifications to inhibit biofilm growth on the catheter lumen. The ICM was subjected to a rigorous statistical evaluation of its ruggedness. Specifically, the amount the log density and log reduction changed with small adjustments to key operational factors. Five operational factors were varied - inoculum concertation, flow of media through the catheter, pH of the artificial urine media, temperature of the incubator, and biofilm removal technique. The results of the analysis highlighted that biofilm growth is sensitive to changes in pH, which indicates that the growth media must to optimized to increase the method's ruggedness. The analysis also demonstrated that sonication was more efficient than scraping as a means to harvest biofilm from the catheter surface. With further optimization of the procedure, the ICM has potential to become a useful tool to evaluate the efficacy of surface modified urinary catheters. Three extraluminal models were tested but did not meet the statistical requirements necessary for standardization. Extraluminal infections account for 66% of all CAUTIs, therefore, the in vitro evaluation of a surface modification's ability to inhibit migration of bacteria along the extraluminal surface of a catheter is critical to fully understand how a modification will perform in the clinical setting. The development of a standardized in vitro method which reflects the physiological conditions of CAUTI will help FDA regulators to compare efficacies across products enabling them to recognize effective treatments for patients.