Epidemiological factors associated with catheter-associated urinary tract infection (CAUTI) in acute care hospitals and long-term care settings.

1. Dr. Obumneke Amadi-Onuoha_Scripts
Specific Aims
Epidemiological factors associated with catheter-associated urinary tract infection
(CAUTI) in acute care hospitals and long-term care settings.
Urinary tract infection is the most common hospital acquired infection at 80% rate and are
attributable to catheter-associated urinary tract infection (CAUTI) (Miller, 2016, p.1, Haque,
Sartelli, McKimm & Abu Bakar, 2018, p.2321). Patients of healthcare facilities such as acute
and nursing homes are described as vulnerable to acquiring catheter associated urinary tract
infection (CAUTI), regrettably, preventable complications, such as infection, are commonly seen
in these settings. This problem is regarded as a safety hazard causing unwanted pain, distress,
extended hospital stays, complications and puts the health care facility at risk. Even though it
can be prevented, 75% to 80% of CAUTI occurs and remains in healthcare facilities (Javier,
2019, p.3, Lo et al.,2014, p. 465). Hospital-based infection and CAUTI preventing, monitoring
and control programs are categorized as basic practices adopted by all acute care hospitals or
special approaches considerable for use in locations and/or populations within hospitals where
non basic practice HAIs control are used (Lo et al., 2014, p.467). According to research, even
though there are high level of awareness in catheter utility, knowledge regarding appropriate
catheter management to prevent CAUTI is often incomplete or inconsistent, and other aspects of
catheter-related knowledge were concerning, as a result, improving these gaps may help
improve knowledge about CAUTI such as the risk factors (Drekonja, Kuskowski, & Johnson,
2010, p.36), moreover, knowledge about CAUTI (HAIs) control measures is critical to ensuring
integration within in acute care hospitals and long-term care settings, especially among providers
and care givers such as routine educational interventions (Haque, Sartelli, McKimm & Abu
Bakar, 2018, p.2321). Inability to successfully manage CAUTI in healthcare setting can cause
elevated patient safety issues and poor patient satisfaction for the providers and the public,
however, assessing the effectiveness of quality improvement interventions through patient’s
outcome measures and providers management may promote reduced CAUTI (HAIs) in
healthcare facilities (Yoko & Classen, 2008, p.S6). Therefore, it is important to know what other
factors are associated with CAUTI occurrence in acute care hospitals and long-term care settings
that may have effect in patients CAUTI prevention and intervention strategies.
Because of the complex nature for identifying other risk factors associated with CAUTI
infection, many researchers have examined the problem from different perspectives e.g. Kiegial
et.al (Letica-Kriegel et al., 2019, p.1) examined CAUTI risk factors from the perspective CAUTI
changes over time from catheter insertion in association with age, sex, patient type (surgical vs
medical) and comorbidities. Based on this reference and others not listed, this proposed
research, seeks to tackle the gap identified from the perceptive other than have been previously
used. Therefore, this proposed research is a patient safety outcome research study that seeks to
understand provider efficacy and effectiveness of care management/ operation process on

2. CAUTI preventive strategies and interventions. The overall goal is to examine and observe the
efficiency and effectiveness of the hospital staff, caregivers, and provider engagement to identify
potential risk factors associated with CAUTI care control efforts in target care settings caring for
catheterized patients. To address this problem, I propose a retrospective data review and a
randomized pilot trial in the clinical settings. The target population for the study will include
three medical centers, three community hospitals and a pediatric hospital with patient population
at approximate over 2000 beds, data will be collected for analysis of patients who were
catheterized from 2015 to 2019, all of those who did and did not develop CAUTI, including
hospital staff, care givers and provider engagement towards the management, delivery and
coordination of the intervention programs. The retrospective analysis of emergency medical
records (EMR) /CAUTI data will be collected as part of care and treatment; therefore, there will
be no direct involvement of patients in design, recruitment and conduct of the study. A
qualitative survey questionnaire of hospital staff, caregivers, and provider engagement
perceptions on CAUTI care will be used a measurement tool, and a quantitative data will be used
to collect patient demographic characteristics and health status and care factors. 2) a pilot trial of
care givers, providers, staff, that will evaluate the delivery and coordination of the intervention
programs that will consist of eight weekly center observations of 2 hours duration each.
Observation of care givers will focus on CAUTI care management bundles on patients, emphasis
may be placed on observing test types of catheters: intermittent catheters, indwelling catheter
suprapubic catheter, others. CAUTI patient care would be randomly assigned to an experimental
group or a control group. Observation will be stratified based on CAUTI care protocol adherence
by care givers between the experimental groups. While observation on providers, staff, will
focus on procurement, inspections and delivery of CAUTI care management bundle for use on
patients. The primary outcome is to identify CAUTI care management protocol adherence in the
population examined and observe the effectiveness of the care bundles, that may help to identify
risk factors distinctly. Each observation will be led by two co-investigators with expertise in the
subject area, such as a healthcare professional or doctorate focused on CAUTI (HAIs) research.
I hypothesize that some specific epidemiological factors examined in this study may contribute
to the know the gap towards attaining an effective and efficient CAUTI prevention and
intervention strategies in patients in acute care hospitals and long-term care settings.
The proposed study will establish the CAUTI care capabilities and it will provide greater insights
into clearly defining CAUTI controls in the patient’s settings studied. The results of this study
will improve the current knowledge of CAUTI (HAIs) control and intervention delimitation
which can be used roadmap to elimination (HAI Action Plan) by health professionals, and
diseases & infection control managements/organizations to explore the variety of potential risk
factors to help strengthen monitoring capabilities and guide them towards creating new
intervention strategies of the CAUTI (HAIs) control and prevention in acute care hospitals and
long-term care settings. However, this current study could serve as the foundation for future
research on CAUTI prevention and patient-safety outcomes research.

3. Study question: What hospital staff, caregiver, and provider engagement factors are associated
with catheter-associated urinary tract infection (CAUTI) in acute care hospitals and long-term
care settings?
Specific Aims
1. To assess the hospital staff, caregiver, and provider engagement and management factors
associated with CAUTI prevention and intervention strategies in targeted settings. The
study will analyze 1)EMR / list of patients with HA-CAUTI data for provider
engagement interventions, 2) staffing data for staff awareness of CAUTI control
measures and 3) environmental data of care givers quality indicators from the health care
providers national database and care process and 4) list of patients with HA-CAUTIs for
care efficiency and effectiveness.
2. Initiate a pilot test to evaluate CAUTI patients comprehensive care delivery and
management by providers, hospital staff and care givers and families. The study will
analyze observations of care givers care management bundle process & efforts towards
CAUTI prevention.
3. To analyze the correlation between the frequencies, also employing a convergent parallel
design of, 1) CAUTI risk factors identified between the different care settings. and 2)
CAUTI risk factors of the two intervention groups, between the different care settings

4. Reference
Drekonja, D. M., Kuskowski, M. A., & Johnson, J. R. (2010). Internet survey of Foley catheter
practices and knowledge among Minnesota nurses. American journal of infection control,
38(1), 31-37.
Haque, M., Sartelli, M., McKimm, J., & Abu Bakar, M. (2018). Health care-associated infections
- an overview. Infection and drug resistance, 11, 2321–2333. doi:10.2147/IDR.S177247
Javier, L. (2019). Prevention of Catheter Acquired Urinary Tract Infection in Long Term Care
Facility.
Letica-Kriegel, A. S., Salmasian, H., Vawdrey, D. K., Youngerman, B. E., Green, R. A., Furuya,
E. Y., ... & Perotte, R. (2019). Identifying the risk factors for catheter-associated urinary
tract infections: a large cross-sectional study of six hospitals. BMJ open, 9(2), e022137.
Lo, E., Nicolle, L. E., Coffin, S. E., Gould, C., Maragakis, L. L., Meddings, J., ... & Yokoe, D. S.
(2014). Strategies to prevent catheter-associated urinary tract infections in acute care
hospitals: 2014 update. Infection Control & Hospital Epidemiology, 35(5), 464-479.
Miller, A. D. (2016). Associations Between Healthcare Facility Types and Healthcare-
Associated Infections.
Yokoe, D. S., & Classen, D. (2008). Introduction: improving patient safety through infection
control: a new healthcare imperative. Infection Control & Hospital Epidemiology,
29(S1), S3-S11.