Running head: AN INTEGRATIVE REVIEW

An Integrative Review
Katherine Sheppard
Bon Secours Memorial College of Nursing
NUR 4222: Nursing Research
Dr. Turner

Honor Code:
On my honor, I have neither given nor received aid on this assignment or test, and I
pledge that I am in compliance with the BSMCON Honor System.

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Abstract

The aim of this integrative review is to analyze articles related to catheter associated
urinary tract infections and to determine if nursing guided protocols help in eliminating the risks.
Urinary tract infections account for many hospital acquired infections so it is important as nurses
to be aware of the interventions to prevent them. The research design used is an integrative
review. That articles that were used in this review include of information from searching
computer-based search engines such as PubMed and Nursing Reference Center within the Bon
Secours elibrary. The five articles that have been chosen for this review demonstrate many ways
that help to support nurses guided protocols in eliminating the risks of urinary catheter
infections.

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An Integrative Review: Catheter Associated Urinary Tract Infection

The purpose of this integrative review is to search the literature of nursing guided
protocols in order to prevent or reduce the rate of catheter associated urinary catheter infections.
Urinary tract infections account for 40% of all hospital associated infections (Saint, et al., 2008).
There is a great need to help reduce the risks of catheter associated infections to help reduce
healthcare costs and the amount of time that a patient is hospitalized. The researcher is interested
in the PICOT question, In an adult surgical patient how does following a nursing guided
protocol versus no or out of date protocols affect urinary catheter infection rate postoperatively.
With thorough research, the articles demonstrated many ways that help reduce infections.
Research Design, Search Methods, & Search Outcomes
The research was gathered using Bon Secours computer-based search engines. The search
engines included CINAHL, PubMed, Nursing Research Center, and EBSCO. Within the search
engines the researcher used the terms CAUTI, CAUTI prevention nursing, CAUTI
prevention bundle, and CAUTI prevention guidelines. There were many articles that were
found in relation to these findings but the researcher wanted to maintain an up-to-date research
study that was guided with quantitative and qualitative reviews. The articles were selected based
on the researchers PICOT question and which articles related more specifically to guide
protocols.

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Findings/Results

The findings of the studies indicated a need to follow prevention strategies that included
of aseptic techniques, documentation of maintenance, and following a specified bundle
implementation when inserting or removing urinary catheters (Meddings, et al., 2013). One of
the research articles was a qualitative research article that focused on background information
that identified the importance of addressing urinary tract infections such as percentages of how
many urinary tract infections occur yearly. The article offered four themes on addressing the
results of the study that include: Theme 1: Preventing Catheter related UTI was a low priority,
although there was substantial recognition of the value of early catheter removal; Theme 2:
Hospitals that made UTI prevention a high priority also focused on noninfectious complications
and had committed champions; Theme 3: Hospital-Specific Pilot Studies Often Influenced the
Use of Antimicrobial-Impregnated Catheters; and Theme 4: External Forces Influence the
Decision of Whether to Adopt UTI Preventive Practices and Surveillance Activities (Saint, et
al., 2008). By following these themes and improving upon them as nurses, there can be
improvement on the rates of infection. The articles seem to have different approaches to why and
how urinary tract infections are a problem. Each of the problems associate with not following a
protocol or a need for a more defined nursing protocol. Therefore, the findings of the article
address the researchers PICOT question in stating that following a protocol will help to reduce
the rates of infection.
Catheter Associated Urinary Tract Infection Prevention Intervention
Within the five research studies the interventions ranged in ways to reduce infections by
following protocols on reducing the placement of unnecessary use of the catheters. Catheter

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placement and duration put patients at risk for developing urinary tract infections (UTI).
According to Hamdan Al-Hazmi article he states, With a catheter in place, the daily risk of
developing UTI ranges from 3% to 7% (Al-Hazmi, 2015). Thus, indicating a timely removal by
following protocols help to reduce the risks associated. In the quantitative research article,
Catheter-associated urinary tract infection in primary and community health care, the lack of
surveillance on documentation and reporting were reviewed as an outcome of urinary tract
infections (Saint, et al., 2008). It is important to be able to follow nursing guided protocols to
help reduce urinary tract infections. The research studies are consistent in stating that to prevent
infections protocols for placing the catheters and timely removal are necessary. Some other
techniques that help to reduce the amount of urinary tract infections associated with catheter
placements include following proper hand hygiene, using standard precautions, sterilization,
maintaining a closed system technique, and ensuring the urinary drainage bag remains below the
bladder (Magers, 2013). In the study conducted by Tina Magers (2013), the efficiency of a nurse
driven protocol helped to reduce catheter-associated urinary tract infections (CAUTI) rates.
Discussion/Implications
The findings of the integrative review address the effects of a nurse guided protocol on
CAUTI. The PICOT question and articles that were reviewed were reliable and valid. There were
connections between the articles that helped the researcher define ways to prevent urinary tract
infections. The quantitative article by Hamdan Al-Hazmi (2015) indicated that the reduction of
length of catheter use and protocols help in reducing catheter-related UTI (Al-Hazmi, 2015). The
qualitative research article, A Multicenter Qualitative Study on Preventing Hospital-Acquired
Urinary Tract Infections in the US Hospitals, focused on patient advocates and infections control
personnel (Saint, et al., 2008).

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Limitations/Conclusion
The integrative review has many limitations that may be acknowledged by the researcher.
Some limitations include the time of the articles that were found. The research was mainly
associated with U.S. protocols that were received from hospitals within the states. The review
was reviewed under a timely manner that was not given a lot of additional information. If given
more time, the researchers could have addressed many other issues associated with catheter
placements. However, the findings of the integrative review give the reader many ways to help
reduce risks associated with catheter placement. The findings from the review include that with
proper placement the rate of urinary tract infections are reduced. Nurses will be able to use this
information to implement protocols to help the health of their patients.

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References
Al-Hazmi, H. (2015). Role of Duration of Catheterization and Length of Hospital Stay on the
Rate of Catheter-Related Hospital-Acquired Urinary Tract Infections. Research and
Reports in Urology, 41-47.
Magers, T. L. (2013, June). Using Evidence-Based Practice to Reduce Catheter-Assoicated
Urinary Tract Infections. American Journal of Nursing, 113, 34-42. Retrieved July 2015,
from http://www.nursingcenter.com/CEArticle?an=00000446-20130600000027&Journal_ID=54030&Issue_ID=1552701
Meddings, J., Rogers, M., Krein, S., Fakih, M. G., Olmsted, R. N., & Saint, S. (2013,
September 27). Reducing Unnecessary Urinary Catheter Use and other
Strategies to Prevent Catherter-Associated Urinary Tract Infection: An
Integrative Review. Retrieved from US National Library of Medicine National
Institute of Health: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3960353/
Saint, S., Kowalski, C. P., Forman, J., Damschroder, L., Hofer, T., Kaufman, S. R., . . . Krein, S.
L. (2008). A Multicenter Qualitative Study on Preventing Hospital-Acquired Urinary
Tract Infection in US Hospitals. Infection Control and Hosptial Epidemiology, 333-341.
Saint, S., Kowalski, C. P., Kaufman, S. R., Hofer, T. P., Kauffmanm Carol, A., Olmsted, R.
N., . . . Krein, S. L. (2008). Preventing Hospital-Associated Urinary Tract Infection in the
United States: A National Study. Oxford Journals: Medicine & Health, 243-250.