Analytical Paper
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Analytical Paper
In the US, Urinary Tract Infections (UTIs) are among the most common hospital-acquired infections (HAIs). An infection of the ureter, urethrae, bladder, or kidney is known as a UTI (Anggi et al., 2019). In the US, UTIs have roughly 560,000 incidence rates per annum, with roughly 387,550 of these cases being Catheter-Associated Urinary Tract Infections (CAUTIs) (Blanck et al., 2014). CAUTIs are infections in patients who utilize urine catheters for at least three days and are more prevalent among critically ill patients in the Intensive Care Unit (ICU). They are determined by urine culture with over 105 Colony Forming Units (CFU)/mL of a single bacterial species, an indwelling urinary catheter for at least three days, and at least one sign or symptoms such as urgency or dysuria, fever, hypotension, costovertebral angle tenderness, suprapubic tenderness, and increased urinary frequency (Podkovik et al., 2019). This paper presents a substantive analysis of Anggi et al. (2019) study, which examined the CAUTIs risk factors and causative pathogens for CAUTIs among ICU patients. Usually, CAUTIs are connected with various complications including pyelonephritis, bacteremia, prostatitis, cystitis, sepsis, longer stay in the hospital, and a higher risk of death; thus, CAUTIs among patients in the ICU need to be reduced. Understanding CAUTIs risk factors and the CAUTIs causative pathogens assist in reducing CAUTIs among critically ill patients.
The REPLACEion of a urinary catheter causes the development of UTIs. Before examining the CAUTIs risk factors and pathogens causing CAUTIs, and how these may help in reducing UTIs among critically ill patients, it is important to first understand how the REPLACEion of catheters causes UTIs. According to Anggi et al. (2019), REPLACEing urinary catheters interrupts the innate immune defense by destroying the mucous barrier responsible for preventing uropathogenic movement to vesica urinary as well as its adhesion. Also, once a urinary catheter is REPLACEed, it stimulates an inflammatory response and causes trauma within the mucous of the bladder, neck, and urethra. The mechanical damage and inflammation in the urinary tract increase the risk for UTIs and weakens a patient’s immune response to uropathogenic (Anggi et al., 2019). Urinary catheters also promote the development of UTIs by allowing direct inoculation of microorganisms into the bladder during catheter REPLACEion, during the drainage system, or during the catheter’s post-placement manipulation. Therefore, nurses should be more careful during catheter REPLACEion to avoid exposing patients to infections.
The prolonged duration of catheter use increases the risk of developing CAUTIs. After evaluating the risk factors of CAUTI, Anggi et al. (2019) found that patients who used catheters for at least six days had a higher risk of developing UTI (78.6%) than those who used them for less than 6 days (32.5%). Meddings et al. (2014) advocate for the removal of unnecessary urinary catheters. According to the authors, urinary catheters are frequently left in body when they are no longer needed. This prolonged duration of catheter REPLACEion increases the risk of developing CAUTUIs. As such, nurses should ensure that catheters are removed within the shortest time possible to prevent critically ill patients from developing UTIs. Parker et al. (2017) also agree that prolonged duration of catheterization increases the risk of CAUTI and recommends that catheters are left in place only when need be to reduce the risk of developing CAUTIs. Thus, identifying prolonged catheter use as a risk factor for developing CAUTIs may help reducereduce UTIs among critically ill patients.
Age is also a risk factor for developing CAUTIs. Anggi et al. (2019) established that older patients are at a higher risk of developing CAUTIs than younger patients. Rowe and Juthani-Mehta (2013) reveal that aging increases the risk of developing CAUTIs due to the age-associated changes in the immunity system, a condition known as immunosenescence. By definition, immunosenescence refers to changes in the adaptive and immune response linked with increased age. It increases susceptibility to infections by making the immune system slower to respond. Since older patients are susceptible to infections, using catheters places them at a higher risk of developing CAUTIs. Therefore, nurses should minimize urinary catheter use and the duration of catheterization for the aging population since they are at a higher risk of developing CAUTIs.
Identification of the pathogens causing CAUTIs may also help in reducing CAUTIs among critically ill patients. After exploring the uropathogen bacteria associated with CAUTIs, Anggi et al. (2019) found that a variety of pathogens causes CAUTIs. The researchers identified 11 microorganisms, including Staphylococcus scour, Pseudomonas aeruginosa, Klebsiella pneumonia, Enterococcus faecalis, Acinetobacter lwoffi, Escherichia coli, Burkholderia cepacian, Acinobacter hemolytic, MRSA, Acinetobacter baumanii, and Salmonella enteric. The most common bacteria identified by researchers was Pseudomonas aeruginosa, followed by Enterococcus faecalis, and then Escherichia coli ESBL (Anggi et al., 2019). Research reveals that accurate identification of the causative pathogen for infectious diseases is vital in finding and prescribing effective treatment (Le Doare et al., 2015). Therefore, identifying the causative pathogens for CAUTIs will make identifying the type of antibiotics for treating these infections among critically ill patients easier. In effect, this will help reduce CAUTIs prevalence and incidence rates among critically ill patients.
Overall, to reduce the risk of developing CAUTIs among critically ill patients, it is important to understand CAUTIs risk factors and the causative pathogens for these infections. This is because a comprehensive understanding of CAUTIs’ risk factors will help nurses to know what actions or factors places a patient at a higher risk and how such risks can be minimized. For instance, since the extended duration of catheterization increases the risk of developing CAUTI, nurses can reduce this risk by ensuring that catheters are left in place only when they are needed. Also, since older patients have a higher risk of developing CAUTIs, nurses can ensure catheter use and the duration of catheterization are reduced to reduce the risk of developing CAUTIs among this population.
Reference
Anggi, A., Wijaya, D. W., & Ramayani, O. R. (2019). Risk factors for catheter-associated urinary tract infection and uropathogen bacterial profile in the intensive care unit in hospitals in Medan, Indonesia. Open Access Macedonian Journal of Medical Sciences, 7(20), 3488-3492. https://doi.org/10.3889/oamjms.2019.684Blanck, A. M., Donahue, M., Brentlinger, L., Stinger, K. D., & Polito, C. (2014). A quasi-experimental study to test a prevention bundle for catheter-associated urinary tract infections. Journal of Hospital Administration, 3(4), 101. DOI: 10.5430/jha.v3n4p101
Le Doare, K., Barker, C. I., Irwin, A., & Sharland, M. (2015). Improving antibiotic prescribing for children in the resource‐poor setting. British journal of clinical pharmacology, 79(3), 446-455. https://doi.org/10.1111/bcp.12320Meddings, J., Rogers, M. A., Krein, S. L., Fakih, M. G., Olmsted, R. N., & Saint, S. (2014). Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review. BMJ quality & safety, 23(4), 277-289. https://doi.org/10.1136%2Fbmjqs-2012-001774Parker, V., Giles, M., Graham, L., Suthers, B., Watts, W., O’Brien, T., & Searles, A. (2017). Avoiding inappropriate urinary catheter use and catheter-associated urinary tract infection (CAUTI): a pre-post control intervention study. BMC health services research, 17(1), 1-9. https://doi.org/10.1186/s12913-017-2268-2Pera, A., Campos, C., López, N., Hassouneh, F., Alonso, C., Tarazona, R., & Solana, R. (2015). Immunosenescence: implications for response to infection and vaccination in older people. Maturitas, 82(1), 50-55. https://doi.org/10.1016/j.maturitas.2015.05.004Podkovik, S., Toor, H., Gattupalli, M., Kashyap, S., Brazdzionis, J., Patchana, T., … & Wang, S. (2019). Prevalence of catheter-associated urinary tract infections in neurosurgical intensive care patients–the overdiagnosis of urinary tract infections. Cureus, 11(8), 1-9. https://doi.org/10.7759%2Fcureus.5494Rowe, T. A., & Juthani-Mehta, M. (2013). Urinary tract infection in older adults. Aging Health, 9(5), 519-528. https://doi.org/10.2217%2Fahe.13.38
