CLC Assignment Blue Group EBP Identification of Clinical Question.docx

CLC Assignment Blue Group: EBP Identification of Clinical
Question 1
2
CLC EBP Identification
CLC EBP Identification of Clinical Question
PICO Question
For patients on a Pediatric Intensive Care Unit at a hospital,
does the implementation of a UTI prevention bundle reduce the
future risk of a CAUTI compared to not implementing the
bundle?

P- PICU patients
I- urinary tract infection (UTI) prevention bundle
C- not implementing the UTI bundle
O- reduction of catheter associated urinary tract infection
(CAUTI) rates
Problem Statement
A unitary tract infection (UTI) refers to an inflammatory
response of the urothelium when invaded by microorganism
associated with the presence of bacteria in urine (Shergill &
Mundy, 2010). A UTI should be distinguished from the mere
presence of bacteria in the urinary stretch. A Catheter
Associated Urinary Tract Infection (CAUTI) happens when a
subject with the device shows two or more indications of a
UTI (Parida & Mishra, 2013). The risk of acquiring a UTI
depends on the methods of catheterization a doctor uses, the
length of time a patient uses the catheter, the quality of catheter
care offered, and the susceptibility of the patient. There is a
steady relationship between the development of a UTI and
period of use of catheterization (Gordon & Katlic, 2017). Due
to the association between UTIs and CAUTIs, the research aims
at determining whether the implementing a UTI prevention
bundle reduces the risk of a CAUTI.
Catheter associated urinary tract infections (CAUTIs) are
preventable in the hospital setting with the proper care and
prevention strategies. CAUTIs can cause a longer
hospitalization admission, increased costs, and even mortality
(Davis, et. al., 2014). CAUTIs are ranked among the most
common hospital-acquired infections in the ICUs (Amine, Helal
, & Bakr, 2014). The daily risk of developing a CAUTI has been
estimated to range between 3% to 7% and the risk escalates with
prolonged catheterization period. The occurrence of CAUTIs is
prevalent in the critical and intensive care units where there is
widespread use of indwelling catheters.
Research and quality improvement strategies have been
implemented to prevent CAUTIs in Adult patients, while very

little is known about the causes and prevention in Pediatric
patients. Urinary Tract Infections are common in pediatric
patients that are seen in the emergency rooms. If these UTIs are
untreated they can lead to more severe conditions with the
insertion of a urinary catheter. Urinary catheters increase the
patients risk for infections due to the increase of bacteria
traveling up the catheter into the bladder. Catheters can become
blocked or can create urinary complications that can cause urine
to be blocked in the bladder causing CAUTIs with every
indwelling catheter.
Currently we have a lot of information on how to manage and
prevent CAUTIs in Adult patient, while very little is known on
how to treat and manage CAUTIs in pediatric patients. The
research will look to understand how CAUTIs occur in pediatric
patients and develop methods and processes on how to minimize
and prevent CAUTIs in pediatric patients with the
implementation of a prevention bundle. Failure to understand
how to diagnoses and prevent CAUTIs in pediatric patients can
be detrimental to the health of future pediatric patients.
References
Amine, A. E., Helal, M. O., & Bakr, W. M. (2014). Evaluation
of an intervention program to
prevent hospital-acquired catheter-associated urinary tract
infections in an ICU in a rural
Egypt hospital. GMS Hygiene and Infection Control.
Black, M., Singh, V., Belostotsky, V., Roy, M., Yamamura, D.,
Gambarotto, K., & ... Kam, A. J.
(2016). Process Mapping in a Pediatric Emergency Department
to Minimize Missed
Urinary Tract Infections. International Journal Of Pediatrics ,
1-4.
doi:10.1155/2016/2625870 Retrieved from
https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com
/login.aspx?direct=true&db=a9h&AN=119493418&site=eds-

live&scope=site
Carter, N. M., Reitmeier, L., & Goodloe, L. R. (2014). An
Evidence-Based Approach To the
Prevention of Catheter-Associated Urinary Tract
Infections. Urologic Nursing, 34(5),
238-245. doi:10.7257/1053-816X.2014.34.5.23
Davis, K. F., Colebaugh, A. M., Eithun, B. L., Klieger, S. B.,
Meredith, D. J., Plachter, N.,
& Coffin, S. E. (2014). Reducing catheter-associated
urinary tract infections: a quality-
improvement initiative. Pediatrics, peds-2013. Retrieved from
http://pediatrics.aappublications.org/content/pediatrics/early/20
14/08/06/peds.2013-3470.full.pdf
Gesmundo, M. (2016). "Enhancing nurses’ knowledge on
catheter-associated urinary tract
infection (CAUTI) prevention." Kai Tiaki Nursing
Research 7, no. 1: 32-40. CINAHL
Complete, EBSCOhost (accessed June 28, 2017).
Gordon, D. A., & Katlic, M. R. (2017). Pelvic Floor
Dysfunction and Pelvic Surgery in the
Elderly: An Integrated Approach. Berlin: Springer.
Parida, S., & Mishra, S. K. (2013). Urinary tract infections in
the critical care unit: A brief
review. Indian Journal of Critical Care Medicine, 370-374.
Shergill, I., & Mundy, A. R. (2010). Viva Practice for the
FRCS(Urol) Examination. Abingdon:
Radcliffe Publishing.
Williams, L. (2016). Zeroing in on Safety: A Pediatric
Approach to Preventing Catheter-
Associated Urinary Tract Infections. AACN Advanced
Critical Care , 27 (4), 372-378.
doi:10.4037/aacnacc2016297

Re:Module 3 DQ 1 Kendrick
Review the document defining the Dissertation Roles and
Responsibilities on the DC Network. Find it using the DC
Network search function. Identify any questions you have on the
responsibilities. How does the role of your chair differ from the
role of instructors in previous classes you have taken? How is
your role different? Are these roles different than you expected?
Why or why not? Why is it very important to you, personally
and professionally, to be proactive in establishing a positive
working relationship with your chair and committee members?
Knowing that professional difference of opinion or conflict is
inevitable on dissertation committees, how will you leverage
these to improve creativity?
The DC network is a resource for doctoral learners to gain
understanding of the dissertation process, timeline, and
templates to utilize when writing the dissertation. It also
provides resources on methodology resources and content
experts. In addition to this, the Grand Canyon University
website provides, the role of the dissertation chair is to guide
you through the finish line and helps you address all the issues
and get through that bump in the road. The role of the instructor
is to provide you with the information and rules of the game,
and then coordinate between the doctoral learner and the chair
and bridge the gap.
My role is to take constructive criticism and apply all the
changes necessary to complete the dissertation. An interesting
study by Black (2017) discusses some of the challenges of
faculty who mentor online doctoral candidates and opportunities
that also arise from the mentor/mentee relationship in the online
doctoral journey. The only difference in the online mentorship
is the interaction of only online space rather than the traditional
face to face and sitting in the classroom. However, Black (2017)
says online doctoral mentoring and dissertation prospectus

process is that it can be structured, coaching, and develop close
relationship even in the online space and can be just as
meaningful as if the doctoral journey was in a classroom setting
and face to face.
Conflict between different personalities in a group setting can
get explosive, it is just the same potential possibility when
working and dealing with the dissertation committee. My plan is
to lose the ego, follow the templates and the guidelines, then
make myself an empty shell and absorb all the knowledge and
information and criticism to complete the dissertation.
Reference(s)
Black, R. (2017). E-MENTORING THE ONLINE DOCTORAL
STUDENT FROM THE DISSERTATION PROSPECTUS
THROUGH DISSERTATION COMPLETION. Journal of
Learning in Higher Education, 13(1).
www.gcu.edu. (n.d.). GRAND CANYON UNIVERSITY .
Retrieved July 20, 2017, from https://www.gcu.edu/college-of-
doctoral-studies/doctoral-resources.php
1
CLC EBP Research Table

CLC: EBP Research Table
Citation
Include the APA reference note.
Abstract/Purpose
Craft a 100-150 word summary of the research.
Research/Study
Describe the design of the relevant research or study in the
article.
Methods
Describe the methods used, including tools, systems, etc.
Setting/Subject
Identify the population and
the setting in which the study was conducted.
Findings/Results
Identify the relevant findings, including any specific data points
that may be of interest to your EBP project.
Variables
Describe the independent and dependent variables in the
research/study.
Implication for Practice
Articulate the value of the research to the EBP project your

group has chosen.
Independent Variable
Dependent Variable
Black, M., Singh, V., Belostotsky, V., Roy, M., Yamamura, D.,
Gambarotto, K., & ... Kam, A. J. (2016). Process Mapping in a
Pediatric Emergency Department to Minimize Missed Urinary
Tract Infections. International Journal Of Pediatric , 1-4.
doi:10.1155/2016/2625870
/login.aspx?direct=true&db=a9h&AN=119493418&site=eds-
live&scope=site
A quality improvement initiative was undertaken to reduce
CAUTIs in tertiary pediatric ER. A retrospective study was
done on children less than 3 years old with positive urinary
cultures. In 12% of the children presented with a UTI there was
not treatment of follow up. A process map was implemented to
determine how many UTI where missed. After the
implementation of the PM, it was noted that only 1% of those
patients had a missed UTI.
A QI study was put together from a retrospective study was
used to collect data and to review current practices used to
identify and manage current UTI’s in the pediatric ER. Patients
that where seen by a subspecialist where removed from the
study. The ER used paper charts that where scanned
electronically. These charts where then review by two
researchers. The main focus was to evaluate if the wrong
antibiotic was used or if a follow up was performed using a PM

(process mapping) tool.
A follow up chart review was performed to evaluate the impact
of mapping process (MP) as an analytical tool. This MP tool can
be used to effectively reduce missed UTI diagnosis and reduce
future UTIs in pediatric ER patients.
All children less than 3 years old coming to the ER with a UTI
where considered.
In the initial chart review, identified 159 patients under 3 years
of age. Of the 159 cases, 82 charts where eligible for the study.
46 percent of the cases, or 38 cases received antibiotics. In 17
percent of the cases, 14 cases, antibiotics where given but no
follow up was conducted. In 18 percent of the cases, or 15
cases no antibiotics where given, but a follow up was arranged
with a pediatrician. Of the 15 cases, 5 did not have a UTI, 4
had a possible, and 6 had a UTI.
In the subsequent chart review, of the 80 qualified charts it was
revealed that 76 cases had a follow up and 4 cases did not have
a follow up.
Identifying Patient coming into the ER, with urinary tract
infections.
Pediatric patient coming into the ER.
ER with high pediatric volume are at risk for inefficiency.
Improving the process in reporting the inefficiency of missed
laboratory diagnosis in the ER can lead to a major decrease of
UTIs in pediatric patients.
Davis, K. F., Colebaugh, A. M., Eithun, B. L., Klieger, S., B.,
Meredith, D. J., Plachter, N., ... & Coffin, S. E. (2014).
Reducing catheter-associated urinary tract infections: a quality-
improvement initiative. Pediatrics, peds-2013. Retrieved from
http://pediatrics.aappublications.org/content/pediatrics/early/20
14/08/06/peds.2013-3470.full.pdf
This article discusses Catheter Associated Blood Stream
Infections (CAUTIs) and interventions to prevent this
occurrence in hospitalized children over the course of three

years. The study about CAUTIs was conducted by an
observational study with a retrospective analysis. The
researchers implemented a CAUTI prevention bundle to see if
this would help reduce the CAUTI rates on the pediatric unit
studied. The prevention bundle includes primary interventions
or “drivers,” such as, “minimize exposure to devices, evidence-
based practices of catheter insertion, communication and
transparency, infrastructure support, compliance with basic
standards of urinary catheter care, and education/training”
(Davis, 2014, p. 859). The result of the prevention bundle was
favorable and showed a decrease of 50% of CAUTI rates in the
chosen population.
Observational study: “assess changes in infection rates before
and after a multidisciplinary QI project was initiated (July
2010) to reduce the rate of pediatric CAUTI throughout the
institution, a 500-bed tertiary care children’s hospital where
∼40% of beds are in ICUs” (Davis, 2014, p. 858). Data
collection was done by “CHOP Department of Infection
Prevention and Control to identify all CAUTIs and capture
hospital-wide urinary catheter device days” (Davis, 2014, p.
860)
Retrospective analysis: “For our analysis of epidemiologic
characteristics of CAUTI, we performed univariate analyses to
summarize patient-level demographic, clinical, and
microbiologic characteristics. We summarized results as
frequencies and percentages. Comparisons were made by using
Fisher’s exact test or Wilcoxon rank-sum (Mann-Whitney) test”
(Davis, 2014, p. 861).
“An observational study was conducted to assess the impact of a
CAUTI quality improvement prevention bundle that included
institution-wide standardization of and training on urinary
catheter insertion and maintenance practices, daily review of

catheter necessity, and rapid review of all CAUTIs” (Davis, et.
al, 2014, p. 857).
Pediatric patients of a tertiary care children’s hospital from
June 2009- June 2012
“50% reduction in the mean monthly CAUTI rate (95%
confidence interval:
21.28 to 20.12;
P= .02) from 5.41 to 2.49 per 1000
catheter-days. The median monthly catheter utilization ratio
remained
unchanged;
∼90% of patients had an indication for urinary
catheterization. Forty-four patients experienced 57 CAUTIs
over the
study period. Most patients with CAUTIs were female (75%),
received care in the pediatric or cardiac ICUs (70%), and had at
least 1 complex chronic condition (98%). Nearly 90% of
patients
who developed a CAUTI had a recognized indication for initial
catheter placement” (Davis, 2014, p. 857).
CAUTI prevention bundle
Reduced CAUTI rates in hospitalized children
The value this EBP practice has on nursing practice is
substantial. With reduction in CAUTI rates, children can have
improved outcomes and experienced decreased lengths of stay
in the hospital compared to not implementing the EBP practices
described in the bundle.
(Quantitative article)
Marra, A. R., Camargo, T. Z., Goncalves, P., Sogayar, A. M.,
Moura Jr, D. F., Guastelli, L. R., . . . Edmond, M. B. (2011).
Preventing catheter-associated urinary. American Journal of
Infection Control, 1-6.

The article identifies CAUTIs one of the major illnesses that
affect patients in the critical care setting. Research undertakes a
quasi-experimental study with several interferences that lessen
the occurrence of CAUTI in an intensive care unit (ICU). The
study also analyzes the differences in causative microorganisms
and CAUTI rates. The conclusions of the survey were that there
was a statistically meaningful decline in the cases of CAUTI in
the ICU. The other results of the investigation are that lessening
the rates of CAUTI in the ICU context is a complicated process
that requires the health professionals to make multiple
performance measures and interventions.
The study utilized the quasi-experimental design. This design is
applied in the study because the study involves a group of the
patients in the ICU and SDU but do not use any random pre-
selection processes.
The investigation was conducted in two phases. In the first
stage, the nurses and physicians in the ICU implanted urinary
catheters (UCs) using the aseptic procedure. The insertion and
maintenance of the catheters were done according to the CDC
requirements. UCs were replaced regularly with the patient’s
physician having the sole responsibility of making the decision
to remove the UC. The catheters maintained up to the point
where the occurrence of an adverse effect requires its removal.
The nurses working in these two units were assigned to directly
observe UC insertion in a convenience representation of
subjects and provide feedback on how the ICU team
implemented the practices. The second phase of the process
involved continuing the processes started in step 1 but included
undertaking monthly audits of the processes in a small sample
of subjects using the UC. The phase also included the
implementation of a bladder bundle. The collected data include

the quantity of CAUTI incidents before and after the
interventions and interventions.
The population was the patients in a 38-bed ICU and two 20-bed
SDUs with a similar that had similar features in a private
hospital that offers tertiary care. The investigation was
conducted at the hospital in the two units.
The results of the survey are that most of the CAUTIs cases that
occurred in the SDUs and the ICU in both stages of the
investigations were in the form of monomicrobial infections,
but the implementation of the interventions led to a statistically
notable decline in the CAUTI rate in both hospital settings used
for the investigation.
The independent variable is the periods before and after the
interventions.
The dependent variable was the quantity of CAUTI instances
The value if this research to the EBP project is that it provides
evidence that implementation of evidence-based practices can
make significant contributions to the reduction of CAUTIs in
the inpatient acute care setting for pediatric patients in the ICU.
(Qualitative Article)
Safdar, N., Codispoti, N., Purvis, S., & Knobloch, M. J. (2015).
Patient perspectives on indwelling urinary catheter use in the
hospital. American Journal of Infection Control, 1-2.
The article starts by stating that UTIs are one of the most
common infections acquired in a hospital with most of them
resulting from the CAUTIs. The purpose of this research was to
find out the perspectives of patients on the indwelling urinary

catheters. The investigations figured out that there was the need
to improve the awareness and patient engagement concerning
the use of indwelling urinary catheters. The findings of this
research were that the health care sector requires implementing
educational programs for both patients and health care workers.
The implementation has the potential to increase the
involvement of patients in making decisions about the use of
catheters and may lead to a decline in the occurrence of
CAUTIs in the hospitals and the ICU.
The study uses the grounded theory qualitative research design.
The study uses this model because it derives its interpretations
from raw data collected using qualitative methods.
The methods of the study involved the use of a semi-structured
interview guide that the investigators used for interviewing
patients in their rooms one at a time where there were no
visitors in the rooms but after getting the treating team’s
approval. Each patient gave a written consent before the
participation in the study. The interviews were recorded and
transcribed. After data collection, a systematic textual inquiry
was used to code the qualitative data to detect trends.
The population was twenty adults. The relevant findings that
may be of interest to my EBP project were that most of the
participants had got been informed about any risks they faced
for the use of the catheter and were not notified of any
alternative ways of excretion. The study also found out
improving patient awareness and engagement on the use of
catheters has the potential to reduce the occurrence of CAUTIs
in patients hospitalized with indwelling urinary catheters. The
study was conducted in a hospital setting in the patient rooms.
The relevant findings that may be of interest to my EBP project
were that most of the participants had got been informed about
any risks they faced for the use of the catheter and were not

notified of any alternative ways of excretion. The study also
found out improving patient awareness and engagement on the
use of catheters has the potential to reduce the occurrence of
CAUTIs.
The independent variable was being hospitalized and using a
urinary catheter
The dependent variable is the patient’s perspectives on urinary
catheters
The value of this research to the EB project is that if provides
vital information on how patients and health care workers can
assist in reducing the rates of CAUTIs in the inpatient care
setting for pediatric patients in ICU.
Palmer, J. A., Lee, G. M., Maya Dutta-Linn, M., Wroe, P., &
Hartmann, C. W. (2013). Including Catheter-Associated Urinary
Tract Infections in the 2008 CMS Payment Policy: A
Qualitative Analysis. Urologic Nursing, 33(1), 15-23.
doi:10.7257/1053-816X.2013.33.1.15
The Centers for Medicare and Medicaid Services (CMS) aimed
to study “views about the inclusion of CAUTIs in the 2008 CMS
payment policy and its potential impact on hospital practices”
(Palmer, et. al, 2014). The policy change took place as a result
of increased costs of preventable hospital-acquired ailments,
such as, Catheter-Associated Urinary Tract Infections
(CAUTIs). If there was no longer a reimbursement for such
ailments, the CMS wanted to see if this would encourage a
change in practices to decrease the number of CAUTIs in their
patients served. Thirty-six infection preventionists were
interviewed nationwide. The participants offered a variety of
reviews. Some stated that they felt CAUTIs do not have as much
of an impact to cost, while others felt the impact was large.
Some felt that this change would create a change among all staff

involved with the care of the indwelling catheter and ensuring
the proper techniques are used in its’ care.
Cross sectional qualitative study with “open coding and
constant comparative analysis” (Palmer, et. al, 2013).
“Participants were interviewed between September 2009 and
February 2010” (Palmer, et. al, 2013). “Specific interview
questions and probes that pertained to CAUTIs in relation to the
CMS policy were reviewed in the analytic process” (Palmer, et.
al, 2013).
Infection preventionists nationwide with a “nursing, medical,
public health, or epidemiology degree. They perform such tasks
as gathering and analyzing trend data on hospital infection
rates, designing and implementing evidence-based infection
prevention interventions, and teaching hospital personnel and
the public about how to contain the spread of infectious
disease” (Palmer, et. al. 2013).
“Two main themes emerged: 1) participants’ attitudes toward
the inclusion of CAUTIs in the CMS policy, including issues of
the infection’s significance, opportunity costs, and financial
incentives; and 2) participants’ views about advances in clinical
organizational behaviors and limited defensive practice”
(Palmer, et. al, 2013). Other themes gathered describe that the
study about CAUTI: “focuses on a relatively minor
complication, may divert resources away from other prevention
activities, may have minimal financial impact on hospitals’
bottom line, [result in] less frequent use of catheters for staff
convenience, [improve] CAUTI prevention activities” and also
show no impact (Palmer, et. al, 2013).
Inclusion of CAUTI in the CMS payment policy regarding
reimbursement
Decreased incidents of CAUTIs
Based on this article, the value of the research to our EBP
project is important. This article describes that if the payments
for CAUTIs are not reimbursed, there can be an influence on
creating changes in the methods of prevention.

Williams, L. (2016). Zeroing in on Safety: A Pediatric
Approach to Preventing Catheter-Associated Urinary Tract
Infections. AACN Advanced Critical Care, 27 (4), 372-378.
doi:10.4037/aacnacc2016297
/login.aspx?direct=true&db=ccm&AN=120221582&site=eds-
live&scope=site
An interdisciplinary team approach was taken to study CAUTI’s
and how to reduce CAUTI’s in future Foley catheter insertion.
The EBP research was conducted in Wisconsin Hospital where,
85 of 100 patients where noted as incurring a CAUTI, that’s an
8.5 percent in a 6 month period. The majority of the units where
CAUTIs were identified where considered to be
underperforming based on the NDNQI database. In a two-year
period, several interventions where implemented and rigorously
followed to minimize and even prevent future CAUTIs. The
interventions included the re-educating of staff on the insertion
of Foley catheters. Other measures that where implemented
including establishing a strict bladder protocol to properly
document and manage all future Foley insertions. This included
mandatory data reporting and identifying when it is best to
discontinue the Foley.
The implementation of the EBP was modeled from successful
CAUTI studies performed in the adult hospital.
A team made up of administrative supportive personnel, clinical
nurse specialist, pediatric urologist, infection control clinician,
nursing staff trained with CAUTIs where all selected to reduce
or eliminate future CAUTIs in the children hospital. A sterile

process was developed and implemented with every Foley
insertion. Every Foley remaining after the procedure was
completed was followed by the team assuring those Foley
catheters received meticulous care to avoid infection or
complications.
The population studied were all pediatric patient needing a
Foley insertion. This included patients coming into the
emergency room, and patients in the perioperative arena, where
most of the Foleys where inserted.
This study helps eradicate any CAUTI in the pediatric patient
concurrently for two years in the children’s hospital. Foleys
were not inserted for convenience purposes, instead a straight
cath was performed when necessary. Strict mandatory
documentation assured that every patient receiving a Foley was
followed throughout their hospital stay. This assured that
multidisciplinary rounds where conducted with every Foley
patient, and that the Foley was discontinued if it was no longer
required. Alternatives were readily available, such as condom
catheters, urinals and other products.
Identify patient coming into the ER, with urinary tract
infections.
Every Foley inserted was performed with meticulous care, using
sterile drapes, sterile gloves. Providers hands where cleaned
with hand scrub solution prior to donning sterile gloves.
Cultures were ordered routinely prior to a Foley being inserted.
Adding a specialized multidisciplinary team to every Foley
insertion will help reduce or eradicate future CAUTIs in
pediatric patients. Closely monitoring and documenting in the
EMR will increase multidisciplinary team to proactively reduce
all future pediatric CAUTIs.
© 2016. Grand Canyon University. All Rights Reserved.

CLC Assignment Blue Group EBP Identification of Clinical Question.docx

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