Introduction
Urinary tract infections are a significant problem in today’s healthcare setting and need to be addressed. This fact is especially relevant for long-term facilities and intensive care units, where indwelling catheters are often used (Menegueti et al., 2019). In turn, a decrease in the duration of the use of catheters, as well as the rational use of antibiotics, leads to a decrease in the risk of infection. Health professional education and regulatory measures have the most significant impact on improving the situation. The purpose of the paper is to address aspects that need to be included in protocols to improve patient outcomes about urinary tract infections.
Objectives
One of the priority objectives for increasing the level of patient care is to provide training for medical personnel and create specific guidelines for the prevention of infection. Menegueti et al. (2019) report two fundamental aspects: “training or re-training of the clinical staff and the daily evaluation of the need for or continuation of use the urinary catheter in patients” (p. 5). Thus, educational and regulatory measures should be aimed at reducing the frequency and duration of the use of urethral catheters. As part of the education of medical personnel, the techniques available to reduce the risk of infection among patients should also be introduced. Objectives can be measured by analyzing the statistics of the occurrence of infections among patients; the time frame should be set depending on the length of hospital stay.
Strategies
The main strategy for preventing urinary tract infections is to reduce the length of time that the catheter is used continuously. The most effective measure is “placing catheters when necessary and removing them whenever possible” (Ashraf et al., 2020, p. 22). The research indicates that providing nurses with educational materials, as well as frequently receiving feedback, leads to a “reduction of percent of the time with the catheter from 15.2% to 9.3%” (Menegueti et al., 2019, p. 5). Thus, the main strategy is to develop guidelines by which medical professionals can assess the need for the use of catheters. Additionally, it is necessary to provide them with information on how to monitor the current state of the patient to prevent the development of infection.
These protocols should also include guidelines for the implementation of meatal cleaning. Fasugba et al. (2017) emphasize that the use of antiseptics, antibacterial and antimicrobial agents leads to a significant reduction in the risk of infection. Such data should be presented as guidelines for daily meatal cleaning. They are most important for patients with indwelling catheters who are most susceptible to the condition. This measure is the standard, but it is necessary to train nurses on its most effective application.
Along with reducing the duration of catheter use and daily cleaning, it is also necessary to monitor the antibiotic intake of patients. The study by Kranz et al. (2018) underlines that the rational use of antibiotics helps prevent the development of infection. Additionally, the proper antibiotic treatment allows for better control of an already advanced condition. At the same time, inappropriate use of antibiotics contributes to the development of resistant bacterial microflora, which increases the risk of developing and re-emerging infection. Thus, it is also necessary to educate the medical profession regarding the effects of antibiotics and the development of urethral infections.
Background
Healthcare-associated infections are now a significant problem in reducing patient outcomes. Urinary tract infections are the most common type of infection occurring in long-term care facilities (Menegueti et al., 2019). In turn, the most common cause of their development is urethral catheterization and, especially. The bacterial infection develops after 24-48 hours of continuous catheterization of the patient (Gould et al., 2017, p. 471). The risk of infection increases with the length of time the catheter is used.
Reducing the duration of catheter use, as well as training medical personnel, leads to a decrease in the incidence of infection. In particular, the surveillance system plays a significant role, which makes it possible to assess the dynamics (Menegueti et al., 2019). Ashraf et al. (2020) report that a comprehensive prevention effort involving staff education, monitoring systems, and patient awareness reduces the risk of urinary tract infections. Thus, guidelines and protocols in combination with the training of medical professionals are a major focus of attention. Catheter management also includes quality monitoring and frequent cleaning efforts.
Despite these measures, there is also a link between the risk of infection and the use of antibiotics. Kranz et al. (2018) report that in connection with urethral infections, the problem of antibiotic resistance continues to grow. Antibiotics can be effectively used for daily meatal cleaning, reducing the risk of infection (Fasugba et al., 2017). However, long-term use of antibiotics leads to the development of resistant microflora, which makes it relevant to reduce the duration of catheter use. Thus, it is necessary to introduce protocols for the rational use of catheters and drugs, as well as staff education.
Conclusion
The education of health professionals, together with the provision of protocols, are the most effective measures to reduce the risk of urinary tract infections among patients. The main reason for the development of infection is the excessive use of catheters, “which is exacerbated by poor management” (Gould, 2017, p. 471). These factors also include an insufficient level of surveillance and feedback, which allows for better tracking of incidence rates. Finally, reduced attention to the rational use of antibiotics leads to an increased risk of infection. Therefore, appropriate training and guidelines should be provided to health professionals to stabilize the situation.
References
Ashraf, M., Gaur, S., Bushen, O., Chopra, T., Pharm, P. C., Pharm, C. K., Hames, E., Hertogh, C., Krishna, A., Mahajan, D., Mehr, D., Nalls, V., Rowe, T. A., Schweon, S. J., Sloane, P. D., Trivedi, K. K., van Buul, L., & Jump, R. (2020). Diagnosis, treatment, and prevention of urinary tract infections in post-acute and long-term care settings: A consensus statement from AMDA’s infection advisory subcommittee. The Journal of Acute and Long-Term Care Medicine, 21(1), 12-24.
Cloud, D., Gaze, S., Drey, N., & Cooper, T. (2017). Implementing clinical guidelines to prevent catheter-associated urinary tract infections and improve catheter care in nursing homes: Systematic review. American Journal of Infection Control, 45(5), 471- 476.
Fasugba, O., Koerner, J., Mitchell, B. G., & Gardner, A. (2017). Systematic review and meta-analysis of the effectiveness of antiseptic agents for meatal cleaning in the prevention of catheter associated urinary tract infections. Journal of Hospital Infection, 95(3), 233-242. Web.
Kranz, J., Schmidt, S., Lebert, C., Schneidewind, L., Mandraka, F., Kunze, M., Helbig, S., Vahlensieck, W., Naber, K., Schmiemann, G., & Wagenlehner, F. M. (2018). The 2017 update of the German Clinical Guideline on epidemiology, diagnostics, therapy, prevention, and management of uncomplicated urinary tract infections in adult patients. Part II: Therapy and prevention. Urologia Internationalis, 100, 271-278.
Menegueti, M. G., Ciol, M. A., Bellissimo-Rodrigues, F., Auxiliadora-Martins, M., Gaspar, G. G., da Silva Canini, S., Basile-Filho, A., & Laus, A. M. (2019). Long-term prevention of catheter-associated urinary tract infections among critically ill patients through the implementation of an educational program and a daily checklist for maintenance of indwelling urinary catheters: A quasi-experimental study. Medicine, 98(8), 1-6.