Capstone Paper, Part I

Capstone Paper, Part I

Introduction (Completed in Week 1) 

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o State the practice problem in measurable terms and that reflect quality indicators.

This is the same problem described in the Week 1 Practice Experience discussion.

Provide the rationale for selecting the practice problem

o Include a purpose statement.

· Analysis of Evidence (Completed in Week 2) 

o Synthesize a minimum of 5 evidence-based practice resources that support your practice problem. Include a minimum of two to three research studies obtained from the Walden Library.

· Quality Improvement Process (Completed in Week 3)

o Describe the quality improvement process and a brief overview the quality model that will be used to improve your practice problem. Include a description of a quality tool that will be used in the quality improvement plan.

o This process will be used to support the detailed proposed quality improvement plan in Week 4

o Explain why the specific quality model was selected and document your explanation with references.


§ Summarize the key points discussed in the paper.

Catheter-Associated Urinary Tract Infections


Hospital-acquired infections cost healthcare organizations billions of dollars every year. They are the leading courses of the extended length of stay in a hospital, increased use of resources and a decreased patient outcome. After speaking with nursing management and infectious control department, it is clear that Catheter-Associated Urinary Tract Infections has become a menace in our healthcare facility with a higher acute rehabilitation unit incidence (Saini et al., 2017). I also noted that low hygiene and poor catheter insertion and removal techniques are the leading causes of organism inoculation inside the bladder promoting bacterial colonization through providing adhesion surfaces and resulting in irritation of the mucosal membrane in the perineal area. Capstone Paper, Part I

Unnecessary and prolonged use of the indwelling urinary catheters is the major predisposing factor leading to (CAUTI) Catheter-Associated Urinary Tract Infections ((Felix, et al., 2016), and more so failure to adequately clean the perineal area and on daily basis. Alone, CAUTI causes approximately 13000 deaths annually, causing increased mortality and morbidity arête and increased healthcare costs. Yet hospital-acquired infections such as CAUTI can be easily prevented (Healthcare-associated infection, 2018). Indwelling urinary catheters are external catheters used by in cooperative urinary tract male patients with a dysfunction of bladder emptying or such conditions as a spinal injury. Therefore the urinary tract catheter device is inserted by a physician to help in managing the flow of urine in cases where there is no bladder obstruction or urinary retention.


Indwelling urinary catheter insertions (IDC) is done mostly in the admission room which is where I work in a community hospital. CAUTI has become a serious infection concern which occurs when urinary catheter insertion or removal is inappropriate or unjustified and lack of frequent cleaning of the perineal area (CDC, 2016). Working in an environment where most patients get urinary tract catheter insertions makes those patients more prone to acquiring infections while in the hospital.  CAUTI can be devastating complications for patients that are already critically ill in the intensive care unit. According to (Curiej, 2019), hospital-acquired infections affect 1.7 million patients annually and result in 9,000 deaths each year. Research has shown the risk of developing bacteriuria on catheterized patients as high as 3% to 10% per day and close to 100% after the catheter has been in place for 30 days (McNeill, 2017). In the United States, the statistics are alarming, approximately five million catheters are placed annually, and 50% of the patients do not meet appropriate criteria, and 40% of physicians are unaware of their patients have a urinary catheter in place (Mori, 2014).


After discussing with the critical care manager and infectious control team, it was agreed that perineal area damage during insertion and removal of the urinary catheter in the urethra and lack of frequent cleaning is detrimental to patient outcomes which include the entry of gram-negative bacteremia, sepsis, and high mortality (Skanlon, 2017). We discussed many ways to prevent CAUTI which include use of the long-term acute care hospital (LTACH), that involve frequent and regular cleaning of the perineal area. extra catheter care supplies, such as Foley catheter bags, tubing, stat locks, perineal soap, etc. and providing educational resources for staff and patients on recognizing CAUTI, ways of preventing CAUTI and general care for an indwelling catheter. It is very important to prevent any complications when it comes and the quality of care that is provided is the main contribution to whether an infection is either obtained or prevented.



European Society of Radiology (ESR. (2019). Patient safety in medical imaging: A joint paper of the European Society of Radiology (ESR) and the European Federation of Radiographer Societies (EFRS). Insights into imaging10(1), 45.


Gould, C. V., Umscheid, C. A., Agarwal, R. K., Kuntz, G., Pegues, D. A., & Healthcare Infection Control Practices Advisory Committee. (2010). Guideline for prevention of catheter-associated urinary tract infections 2009. Infection Control & Hospital Epidemiology31(4), 319-326.


McNeill, L. (2017). Back to basics: How evidence-based nursing practice can prevent catheter-associated urinary tract infections. Urologic Nursing37(4), 204-207.


Oliveira, P. R., Carvalho, V. C., Felix, C. D. S., Paula, A. P. D., Santos-Silva, J., & Lima, A. L. L. M. (2016). The incidence and microbiological profile of surgical site infections following internal fixation of closed and open fractures. Revista brasileira de ortopedia51(4), 396-399.


Saini, H., Vadekeetil, A., Chhibber, S., & Harjai, K. (2017). Azithromycin-ciprofloxacin-impregnated urinary catheters avert bacterial colonization, biofilm formation, and inflammation in a murine model of foreign-body-associated urinary tract infections caused by Pseudomonas aeruginosa. Antimicrobial agents and chemotherapy61(3), e01906-16.

Scanlon, K. A., Wells, C. M., Woolforde, L., Khameraj, A., & Baumgarten, J. (2017). Saving lives and reducing harm: A CAUTI reduction program. Nursing Economics35(3), 134-141. Capstone Paper, Part I

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