Posts Tagged ‘Urinary tract infection’


Using Evidence-Based Practice to Reduce CAUTIs

May 31, 2013

By Karen Roush, AJN clinical managing editor

Using evidence-based practice to . . .

Fill in the blank. There’s something on your unit that could be improved—the rate of ventilator-associated pneumonia (VAP), the engagement of family in care, the readmission rate of patients with heart failure, patient satisfaction with pain management. Whatever it may be, you have the ability to improve it. This month we have a CE article (link is below) about an evidence-based practice (EBP) project to reduce catheter-associated urinary tract infections (CAUTIs).

Scanning electron micrograph of S. aureus bacteria on the luminal surface of an indwelling catheter with interwoven complex matrix of extracellular polymeric substances known as a biofilm/ CDC

Scanning electron micrograph of S. aureus bacteria on the luminal surface of an indwelling catheter with interwoven complex matrix of extracellular polymeric substances known as a biofilm/ CDC

The really interesting thing about this article, and what makes it especially helpful for beginner quality improvers out there, is that it doesn’t just describe an effective project to reduce CAUTIs. It also describes how to do an EBP project, step-by-step. The author, Tina Magers, a novice EBP mentor, followed the seven steps outlined in AJN’s Evidence-Based Practice series and describes the actions involved in each step. It’s a great how-to on applying evidence to practice. Here’s the overview/abstract of this useful June CE article, “Using Evidence-Based Practice to Reduce Catheter-Associated Urinary Tract Infections”:

Overview: In November 2009, AJN launched a 12-part series, Evidence-Based Practice, Step by Step, authored by nursing leaders from the Arizona State University College of Nursing and Health Innovation’s Center for the Advancement of Evidence-Based Practice. Through hypothetical scenarios, based on the authors’ collective clinical experience, the series illustrated the seven steps of evidence-based practice (EBP), defined as “a problem-solving approach to the delivery of health care that integrates the best evidence from studies and patient care data with clinician expertise and patient preferences and values.” This article reports on an EBP project in which the seven-step approach to EBP described in the AJN series was used to reduce the incidence of catheter-associated urinary tract infection among adult patients in a long-term acute care hospital by reducing the duration of catheterization.

Keywords: catheter-associated urinary tract infection, evidence-based practice, hospital-acquired infection, nurse protocol, quality improvement, urethral catheterization

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AJN’s June Issue: Fracking, Assessing Sleep in Teens, Preventing CAUTI, More

May 24, 2013

AJN0613.Cover.3rd.inddAJN’s June issue is now available on our Web site. Here’s a selection of what not to miss.

Fracking hazards. Though we’re moving into summer, our cover does not depict a jar of fresh, local honey. It is a photograph of Washington County, Pennsylvania, resident Jenny Smitzer, holding a jar of contaminated tap water that turned that color af­ter natural gas drilling began in 2005 above her farm. Eleven U.S. states currently engage in natural gas hydrofracking (“fracking”), and eight more are either considering or preparing for this method of gas drilling.

For an in-depth look at the potential health hazards caused by fracking, such as air pollution, working hazards, and water pollution, see our Environments and Health article, “Fracking, the Environment, and Health.” If you’re reading AJN on your iPad, you can listen to a podcast interview with the authors by clicking on the podcast icon on the first page of the article. The podcast is also available on our Web site.

Most teens get far less than the nine hours of sleep a night they require, which could affect their mental and physical health. An understanding of sleep physiology is essential to helping nurses better assess and manage sleep deprivation in teens. “Assessing Sleep in Adolescents Through a Better Understanding of Sleep Physiology” provides an overview of sleep physiology, describes sleep changes that occur during adolescence, and discusses the influence of these changes on adolescent health. This article can earn you 2.1 continuing education (CE) credits. A podcast interview with the author is also available on our Web site.

Seven steps to evidence-based practice (EBP) were described in AJN’s popular 12-part series, Evidence-Based Practice, Step by Step. In “Using Evidence-Based Practice to Reduce Catheter-Associated Urinary Tract Infections,” a novice EBP mentor applied these steps in a quality improvement project aimed at reducing the incidence of catheter-associated urinary tract infection among adult patients. This article can earn you 2.4 CE credits.

Still haven’t taken the plunge into the world of social media? This month’s iNurse article, “Microblogging: Tumblr and Pinterest,” gives nurses some ideas about how they can express themselves and share information on two popular social media platforms.

There is plenty more in this issue, including strategies nurses can use to address patients with low health literacy and evidence-based interventions that may reduce risky sexual behavior in adolescents. Stop by and have a look, and tell us what you think on Facebook, or here on our blog.

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Friday Round-Up: When ‘Natural’ Isn’t ‘Safer,’ A Student Nurse Summit, a Walking Crisis, Chronicity

April 13, 2012

Ad for Chinese herbal medicine, Seattle 1908/ via Wikimedia Commons

Please pardon the relative quiet of this blog this week. All our in-house and far-flung occasional correspondents are otherwise engaged, it seems. Blame the nice weather, if it’s nice where you are. Our editor-in-chief, Shawn Kennedy, is in Pittsburgh at the National Student Nurses Association (NSNA) convention. She’s presenting this afternoon (I think) on the new AJN iPad app, among other things (no, we don’t yet have one for the Kindle, but that may be on the way).

Shawn should have an update on her adventures with the next generation in nursing sometime early next week. So for now, almost entirely avoiding nursing news and health care reform, here are a few items of potential interest:

The Respectful Insolence blog, in reminding us that “natural” doesn’t always mean safer, points to an AFP article that highlights research drawing a connection between a widely used herbal remedy and the unusually high incidence of urinary tract cancer in Taiwan. Says the AFP article,

A toxic ingredient in a popular herbal remedy is linked to more than half of all cases of urinary tract cancer in Taiwan where use of traditional medicine is widespread, said a US study Monday.

Aristolochic acid (AA) is a potent human carcinogen that is found naturally in Aristolochia plants, an ingredient common in botanical Asian remedies for aiding weight loss, easing joint pain and improving stomach ailments.

While the FDA issued an alert about products containing this ingredient last fall, it’s important to recall that the multibillion dollar supplements industry in the U.S., whatever its benefits, is not subject to the same regulations applied to the pharmaceutical industry.

And, in honor of the weekend and the blossoming trees, here’s something of proven health benefit: walking. It’s free, there seem to be new studies out all the time telling us why it’s good for our minds and bodies, but many have noted that Americans don’t do it anymore, and that in some places in the U.S. it can be downright dangerous to do so. Slate has a new series, “The Crisis in American Walking,” that explores the many facets of this issue, from how we got to this place to what we can do about it. It’s well worth a look, though maybe you’d be better off just turning off your electronic device and hitting the streets, paths, hills, mallscape, wherever.

OK, one nursing item, from the news department in the April issue of AJN: we look at two studies that highlight ways that nurse-led teams are helping bring about improvements in risk management, adherence, and perceptions of care for patients with chronic disease.

Enjoy the weekend!—JM, senior editor, blog editor


Why Didn’t Physicians Know What Nurses Know?

September 27, 2010

By Shawn Kennedy, AJN interim editor-in-chief

A recent post on our blog highlighted the experience of AJN’s associate editor Amy Collins in trying to get someone to diagnose the underlying reason for acute confusion in her grandmother. Over a two-week period, Amy’s grandmother was seen by various private and ED physicians, none of whom seemed to have an adequate diagnosis or a suggestion for treatment. Finally, nurses suggested that a urinary tract infection (UTI), fecal impaction, or some other infection might be a factor. It was a fecal impaction and yet none of the five physicians who previously evaluated Amy’s grandmother had thought about or assessed for it.

What the nurses said. Amy’s post generated many comments, both on the blog and on our Facebook page. What was interesting to me was how many nurses knew to first check for a UTI, electrolyte disturbance, or fecal impaction as a reason for confusion. Here are a few samples:

“Though not conclusive, in every case I have seen a change in cognition or behavior it was either a UTI or fecal impaction. I work in home health as a CNA and I am a nursing student.”

“The first thing I think to check is infection (UTI) with elderly, confused patients.”

“I’m a senior nursing student…and this material is on our exam that we are taking Friday. With acute confusion, always check for UTI and constipation.”

“Possible UTI. Possible dehydration &/or  constipation. Poor nutrition. All can (and do) manifest as “altered mental status.” Think I’d start with those, and then evaluate further for more complex issues.”

“I would check for fecal impaction, that tends to be a common tendency especially in long term care facilities and a urine sample for UTI.”

So why did none of the physicians who saw Amy’s grandmother think of those potential causes? Is it that none were astute in geriatric medicine, or is it that it’s easier to dismiss the rantings of an older woman as dementia and move on to a “more interesting” case? Was it a case of what one commenter suggested—“simply lazy health care”?

Some resources. Or might it perhaps be that nurses are ahead of physicians in working with the aged?  The John A. Hartford Foundation, which is “dedicated to improving health care for older Americans,” has funded educational programs for nurses through the Hartford Institute of Geriatric Nursing at New York University College of Nursing (you may be familiar with the Nurses Improving Care for Healthsystem Elders [NICHE] program); has fostered leadership building through the Building Academic Geriatric Nursing Capacity initiative with the American Academy of Nursing; and also supports nine Hartford Centers for Geriatric Nursing Excellence. And AJN was pleased to be a partner in the How to Try This series on geriatric assessment (a practical series of articles and videos on recognizing and treating common conditions among the elderly). There are also programs for physicians and social workers. Let’s hope people take advantage of them—it’s painfully apparent that the need is urgent.

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