Question

Bella is the nurse manager on a 30-bed rehabilitation unit. She has just been notified by the infection control department that in the past 6 months, there has been a significant increase in the number of urinary tract infections (UTIs) on her unit. Bella must decide the best approach to finding out the cause of the increase in UTIs.

1.Who on the unit should she ask to assist her in identifying the cause of the increase?

2.When meeting with the staff, what approach should Bella use to discuss and resolve the issue?

Answer 1

Q#1 Whom on the unit should she ask to assist her in identifying the cause of the increase?

The nurse manager should ask for the help of the registered nurses and Licensed Practical Nurse under in her unit for the control of the infection. It takes a team effort of all health care workers involved in the care of the patient. If the hospital provides Hospital infection control nurses their service to be utilized.

Q2 2. When meeting with the staff, what approach should Bella use to discuss and resolve the issue?

knowledge attitude and practice approach should be utilized for the infection control

knowledge

Education of the hospital staff can include in-person sessions or educational material available in paper format or electronically. The educational sessions may outline the evidence behind the guidelines, indicate the goals of the program, and target specific aspects of UTI prevention

• Provide educational sessions
• Appropriate catheter care
• Appropriate indications for catheter insertion
• Insertion technique
• Hand hygiene education
• Physician-directed education
• Alternatives for indwelling catheters

.Education for staff hand hygiene may be needed given the nurses’ responses to how frequently they believed other nurses washed their hands before interacting with the patient. The most important risk factor for developing a catheter-associated UTI (CAUTI) is prolonged use of the urinary catheter. Therefore, catheters should only be used for appropriate indications and should be removed as soon as they are no longer needed. Direct healthcare providers (such as physicians, nurses, aides, and therapists) and ancillary personnel (such as environmental service and equipment processing personnel) are responsible for ensuring that appropriate practices are used at all times (including hand hygiene, standard and isolation precautions, and cleaning and disinfection of equipment and the environment).enior management is responsible for ensuring that the healthcare system supports an infection prevention and control (IPC) program that effectively prevents healthcare-associated infections (HAIs) and the transmission of epidemiologically important pathogens

attitude

Multiple studies identify that nurses while having a positive attitude about evidence-based practice, have difficulty accessing evidence due to workload and lack of knowledge. This concern has to be addressed adequately with care.IPC (infection prevention and control) leadership is responsible for ensuring that an active program to identify HAIs is implemented, that HAI data are analyzed and regularly provided to those who can use the information to improve the quality of care (eg, unit staff, clinicians, and hospital administrators), and that evidence-based practices are incorporated into the program

practice

The process for making quality improvement changes employs new protocols and algorithms. Interventions may be grouped into “bundles” of practices to be implemented simultaneously. Computer order entry is also increasingly being used to prompt change.

• Standardize care processes
• Provide daily nursing reminders to physicians to remove unnecessary catheters
• Standardize indications for urinary catheter placement
• Develop a nurse-driven protocol to discontinue catheter if no longer meeting criteria
• Employ computerized order entry
• Admitting physician alert requiring confirmation of continued indication for previously placed catheters
• Change of physician order set from “insert Foley catheter” to patient-initiated “void on call” for appropriate procedures
• Mandatory order to remove the catheter at 5 days
• Use prewritten stop orders
• Standardize products
• Increase availability of bedside commodes
• Conduct individual case reviews