Phillip December 10, 2025 No Comments

D219 PA – Evidence-Based Practices to Reduce CAUTIs in Nursing

Name

Western Governors University

D219 Scholarship in Nursing Practice

Prof. Name

Date

Review of Evidence-Based Practice to Decrease CAUTIs

Impact of the Problem on the Patient

Catheter-associated urinary tract infections (CAUTIs) remain a significant and preventable complication for hospitalized patients across the United States. Research shows that approximately 15% to 25% of patients admitted to hospitals receive an indwelling urinary catheter during their stay. Moreover, about 75% of all hospital-acquired urinary tract infections (HAUTIs) are attributed to catheter use (Shadle et al., 2021). The presence of these catheters greatly increases the likelihood of bacterial colonization and infection, leading to longer hospital stays, higher rates of morbidity and mortality, and increased treatment costs—estimated to be around $14,000 per patient affected by CAUTIs (Shadle et al., 2021).

Patients suffering from CAUTIs commonly experience symptoms such as pain, discomfort, and fever, with the potential progression to serious complications like sepsis. These conditions can delay recovery and reduce the overall quality of life. Hence, preventing CAUTIs is vital to improving patient health outcomes, boosting satisfaction with care, and reducing avoidable medical expenses. Beyond direct patient benefits, rigorous infection control fosters a culture of safety and quality within healthcare facilities.

Impact of the Problem on the Organization

From the organizational perspective, CAUTIs are classified as hospital-acquired infections (HAIs) and require mandatory reporting to regulatory bodies such as the National Healthcare Safety Network (NHSN) and the Centers for Medicare & Medicaid Services (CMS). The occurrence of CAUTIs influences key hospital performance metrics, reimbursement rates, and accreditation statuses (Rubi, Mudey, & Kunjalwar, 2022).

Healthcare institutions invest heavily in infection prevention through staff education, surveillance programs, and ongoing quality improvement efforts aimed at lowering CAUTI rates. Achieving reductions aligns with national patient safety objectives and value-based purchasing incentives that reward improved clinical outcomes and reduced hospital readmissions. Successfully managing CAUTIs enhances an organization’s reputation, operational effectiveness, and financial stability by decreasing penalties and shortening patient lengths of stay.

B.1 Identify the PICO Components

PICO Element	Description
P (Population/Problem)	Adult patients admitted to medical-surgical units or intensive care units in acute care hospitals.
I (Intervention)	Removal of indwelling urinary catheters as soon as they are no longer clinically necessary.
C (Comparison)	Implementation of evidence-based interventions such as daily chlorhexidine bathing and alternative urinary devices.
O (Outcome)	Decreased incidence of hospital-acquired CAUTIs in adult inpatient populations.

B.2 Evidence-Based Practice Question

What evidence-based interventions can be implemented to reduce the incidence of hospital-acquired catheter-associated urinary tract infections (CAUTIs)?

A. Research Article

C.1 Background Introduction

Palloto et al. (2019) conducted a randomized controlled trial to evaluate the effectiveness of daily bathing with 4% chlorhexidine gluconate (CHG) in preventing hospital-acquired infections, focusing particularly on ICU settings. This investigation was motivated by prior studies suggesting that CHG reduces microbial colonization and transmission of multidrug-resistant organisms, thereby lowering infection rates including CAUTIs and ventilator-associated pneumonia (VAP).

C.2 Methodology

This single-blinded, parallel-group randomized controlled trial took place between August 2015 and April 2016 in two intensive care environments: a general ICU and a post-cardiac surgery ICU. The study included adult patients (aged 18 and above) admitted for at least one night. Participants were randomly assigned either to receive daily CHG baths or standard bathing care (Palloto et al., 2019).

C.3 Level of Evidence

Based on the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model, this study is classified as Level I evidence, indicating the highest reliability due to its rigorous experimental design.

C.4 Data Analysis

Statistical analysis was performed using R software, with significance established at p < 0.05. Normality of data was assessed via the Kolmogorov–Smirnov test, while group comparisons employed Mann–Whitney and chi-square tests with Yate’s correction (Palloto et al., 2019).

C.5 Ethical Considerations

Ethical approval was granted by the institutional review board prior to study initiation. Written informed consent was obtained from participants capable of providing it, with consent waivers used when necessary. Patients initially unable to consent were re-consented as soon as possible, adhering to the Declaration of Helsinki’s ethical standards (Palloto et al., 2019).

C.6 Quality Rating

The study was awarded a Grade A (High Quality) rating using the JHNEBP appraisal tool, reflecting its methodological rigor, ethical soundness, and appropriate statistical techniques.

C.7 Analysis of Results and Conclusions

Results indicated that daily bathing with CHG significantly reduced hospital-acquired infections, including CAUTIs and VAP, without elevating adverse events or mortality. The study recorded 108 infections among 91 patients, and CAUTI incidence dropped to 4.9 per 1,000 patient-days, demonstrating the intervention’s clinical efficacy and safety in intensive care settings (Palloto et al., 2019).

C.7.a How Does This Study Address the EBP Question?

This research provides direct evidence that daily chlorhexidine bathing is an effective measure to reduce CAUTI rates among hospitalized adult patients, thereby aligning perfectly with the evidence-based practice question (Palloto et al., 2019).

D. Non-Research Article

D.1 Background Introduction

Gyesi-Appiah, Brown, and Clifton (2020) performed an integrative systematic review examining risks related to short-term urinary catheter use. Their review found a clear correlation between the length of catheterization and infection risk, estimating a daily increase of 3–7% in urinary tract infection likelihood for catheters remaining in place (Gyesi-Appiah et al., 2020).

D.2 Type of Evidence

The review synthesized findings from 12 primary studies published between 2013 and 2018 that investigated catheter use duration and associated complications.

D.3 Level of Evidence

According to the JHNEBP framework, this review is considered Level V evidence, representing an integration of non-experimental research.

D.4 Quality Rating

The review earned a Grade B (Good Quality) rating for its extensive search methods and sound methodology. Databases searched included CINAHL, Medline, and the British Nursing Index (Gyesi-Appiah et al., 2020).

D.5 What Did the Authors Recommend?

The authors strongly recommended removing urinary catheters promptly once they are no longer medically necessary, emphasizing that early removal is a key strategy for lowering CAUTI incidence. This recommendation supports the evidence-based practice question posed in this review.

E. Recommended Practice Change

Based on the collective research and review findings, implementing a combined strategy of daily CHG bathing and prompt catheter removal is highly effective in reducing CAUTI rates. To sustain these improvements, healthcare facilities should introduce a comprehensive infection prevention bundle that includes:

Ongoing staff education and training
Routine auditing of adherence to protocols
Continuous monitoring of catheter usage and infection rates

Demonstrating the clinical advantages and cost-saving potential of these interventions will help engage stakeholders and secure organizational commitment.

E.1 Key Stakeholders

Stakeholder	Role and Importance
Patients	Primary beneficiaries; experience fewer infections, reduced discomfort, and shorter hospital stays.
Nurses	Main executors of daily CHG bathing and catheter care protocols.
Physicians	Responsible for catheter insertion decisions and ensuring timely removal.
Hospital Administration	Oversees compliance, infection reporting, and financial impact management related to CAUTIs.

E.2 Barriers to Implementation

Common obstacles include high nursing workloads and time constraints, which may delay catheter removal. Patient comfort concerns and clinical uncertainty about catheter necessity can also hinder adherence to best practices.

E.3 Strategies to Overcome Barriers

To address these challenges, hospitals should implement:

Staff education emphasizing infection prevention benefits
Daily interdisciplinary safety briefings to foster communication
Real-time feedback and performance tracking
Recognition programs to encourage protocol compliance

These strategies enhance staff engagement and improve protocol adherence (Palloto et al., 2019; Gyesi-Appiah et al., 2020).

E.4 Indicators to Measure Outcomes

The effectiveness of CAUTI reduction initiatives should be monitored through:

Indicator	Description
Audit frequency	Documentation of daily CHG baths and catheter duration
Infection rates	Number of CAUTI cases per 1,000 catheter-days
System metrics	Readmission and reimbursement data from CMS and NHSN

Regular tracking of these indicators ensures progress and supports continuous quality improvement.

Conclusion

CAUTIs pose a substantial yet avoidable threat to patient health and healthcare system efficiency. Strong evidence supports that daily chlorhexidine gluconate bathing combined with timely catheter removal can markedly reduce CAUTI incidence in hospitalized patients. Success depends on interprofessional collaboration, patient engagement, and persistent monitoring, all of which are essential to uphold quality, safety, and optimal clinical outcomes.

References

Gyesi-Appiah, E., Brown, J., & Clifton, A. (2020). Short-term urinary catheters and their risks: An integrated systematic review. British Journal of Nursing, 29(9), S16–S22.

Palloto, C., Fiorio, M., De Angelis, V., Ripoli, A., Franciosini, E., Quondam Girolamo, L., Volpi, F., Iorio, P., Francisi, D., Tascini, C., & Baldeli, F. (2019). Daily bathing with 4% chlorhexidine gluconate in intensive care settings: A randomized controlled trial. Clinical Microbiology and Infection, 25(6), 705–710.