D219 PA – Evidence-Based Practices to Reduce CAUTIs in Nursing

Grace J.
November 10, 2025November 10, 2025
BSN, D219, Western Governors University

Student Name

Western Governors University

D219 Scholarship in Nursing Practice

Prof. Name

Date

Review of Evidence-Based Practice to Decrease CAUTIs

Impact of the Problem on the Patient

Catheter-associated urinary tract infections (CAUTIs) are a persistent source of preventable harm among hospitalized patients in the United States. Research indicates that between 15% and 25% of inpatients require an indwelling urinary catheter at some point during their hospitalization, and approximately 75% of hospital-acquired urinary tract infections (HAUTIs) are linked to catheter use (Shadle et al., 2021). The use of indwelling catheters significantly elevates the risk of bacterial colonization and infection, contributing to longer hospitalizations, increased morbidity and mortality rates, and a surge in treatment-related costs—estimated at approximately $14,000 per affected patient (Shadle et al., 2021).

Patients with CAUTIs often experience pain, discomfort, fever, and potential complications such as sepsis, which can prolong recovery and diminish overall quality of life. Preventing these infections is, therefore, critical for improving clinical outcomes, enhancing patient satisfaction, and decreasing unnecessary healthcare expenditures. Effective infection control practices not only protect patients but also foster a culture of safety and quality within healthcare systems.

Impact of the Problem on the Organization

From an institutional standpoint, CAUTIs are categorized as hospital-acquired infections (HAIs) and must be reported to both the National Healthcare Safety Network (NHSN) and the Centers for Medicare & Medicaid Services (CMS). These infections directly affect hospital performance indicators, reimbursement models, and accreditation status (Rubi, Mudey, & Kunjalwar, 2022).

Healthcare organizations dedicate substantial resources to infection control initiatives, continuous staff training, and surveillance programs aimed at reducing CAUTI incidence. Successfully decreasing CAUTI rates aligns with national patient safety goals and value-based purchasing programs that financially incentivize improved outcomes and decreased readmission rates. Ultimately, reducing CAUTIs contributes to enhanced institutional credibility, operational efficiency, and cost savings through reduced penalties and shorter lengths of stay.

B.1 Identify the PICO Components

PICO Element	Description
P (Population/Problem)	Adult patients admitted to medical-surgical or intensive care units in acute care hospitals.
I (Intervention)	Discontinuation of indwelling urinary catheters when no longer medically indicated.
C (Comparison)	Utilization of evidence-based interventions such as daily chlorhexidine bathing, timely catheter removal, and use of alternative urinary devices.
O (Outcome)	Reduction in the occurrence of hospital-acquired CAUTIs among adult inpatients.

B.2 Evidence-Based Practice Question

What evidence-based interventions can be implemented to decrease the number of hospital-acquired catheter-associated urinary tract infections (CAUTIs)?

A. Research Article

Daily Bathing with 4% Chlorhexidine Gluconate in Intensive Care Settings: A Randomized Controlled Trial

C.1 Background Introduction

Palloto et al. (2019) conducted a randomized controlled trial (RCT) to investigate whether daily bathing with 4% chlorhexidine gluconate (CHG) effectively prevents hospital-acquired infections, particularly in intensive care unit (ICU) settings. The study was prompted by mounting evidence indicating that CHG reduces microbial colonization and prevents the transmission of multidrug-resistant organisms, thereby decreasing the incidence of infections such as CAUTIs and ventilator-associated pneumonia (VAP).

C.2 Methodology

This single-blind, parallel-group RCT was carried out from August 2015 to April 2016 in both an ICU and a post-cardiac surgery ICU (PC-ICU). Adult patients aged 18 years and older admitted for at least one night were considered eligible. Participants were randomly allocated to the CHG intervention group or to the control group receiving standard bathing care (Palloto et al., 2019).

C.3 Level of Evidence

According to the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model, the study qualifies as Level I evidence, representing the highest standard of reliability in research design.

C.4 Data Analysis

Data were analyzed using R statistical software, with a significance threshold set at p < 0.05. The Kolmogorov–Smirnov test was used to verify the normal distribution of data, while the Mann–Whitney and chi-square tests (with Yate’s correction) were used for group comparisons (Palloto et al., 2019).

C.5 Ethical Considerations

Institutional ethical approval was obtained prior to data collection. Written informed consent was secured from capable patients, and consent waivers were utilized when necessary. Patients unable to provide immediate consent were re-consented once capable, consistent with the ethical guidelines of the Declaration of Helsinki (Palloto et al., 2019).

C.6 Quality Rating

Using the JHNEBP appraisal tool, this study received a Grade A (High Quality) rating, signifying a robust research design, ethical rigor, and reliable statistical analysis.

C.7 Analysis of Results and Conclusions

The RCT demonstrated that daily CHG bathing significantly reduced the incidence of hospital-acquired infections, including CAUTIs and VAP, without increasing adverse effects or mortality. Over the study period, 108 HAIs occurred among 91 patients, and CAUTI rates decreased to 4.9 per 1,000 patient-days (Palloto et al., 2019). These findings affirm the clinical effectiveness and safety of daily CHG bathing in reducing infection risks in high-acuity environments.

C.7.a Alignment to the EBP Question

This study directly addresses the EBP question by confirming that daily CHG bathing constitutes an effective evidence-based intervention for reducing CAUTI rates among hospitalized patients (Palloto et al., 2019).

D. Non-Research Article

Short-Term Urinary Catheters and Their Risks: An Integrated Systematic Review

D.1 Background Introduction

Gyesi-Appiah, Brown, and Clifton (2020) conducted an integrated systematic review to examine the risks associated with short-term urinary catheterization. Their findings revealed a direct relationship between the duration of catheterization and the risk of infection, estimating a 3–7% daily increase in the likelihood of developing a urinary tract infection when the catheter remains in situ.

D.2 Type of Evidence

The review synthesized evidence from 12 primary studies conducted between 2013 and 2018 that explored urinary catheter use, duration, and related complications (Gyesi-Appiah et al., 2020).

D.3 Level of Evidence

Following the JHNEBP model, this integrative review is classified as Level V evidence, reflecting a synthesis of non-experimental studies.

D.4 Quality Rating

The review received a Grade B (Good Quality) rating based on its comprehensive search strategy and methodological rigor. Databases utilized included CINAHL, Medline, and the British Nursing Index (Gyesi-Appiah et al., 2020).

D.5 Authors’ Recommendations

The authors emphasized the necessity of removing urinary catheters as soon as they are no longer medically justified. Early removal was identified as a crucial strategy for decreasing CAUTI rates, supporting the premise of the current EBP question.

E. Recommended Practice Change

Both research and non-research findings advocate for the implementation of daily CHG bathing and prompt catheter removal to effectively reduce CAUTI prevalence. A multifaceted infection prevention bundle—incorporating staff training, regular auditing, and adherence monitoring—should be instituted to achieve sustainable outcomes. Demonstrating both the clinical benefits and cost-efficiency of these interventions will facilitate stakeholder engagement and institutional buy-in.

E.1 Key Stakeholders

Stakeholder	Role and Importance
Patients	Central to the initiative; benefit from reduced infection rates, shorter hospitalizations, and improved comfort.
Nurses	Serve as primary implementers of CHG bathing and catheter monitoring protocols.
Physicians	Authorize catheter insertion and ensure timely removal when no longer medically indicated.
Hospital Administration	Monitors compliance, manages infection reporting, and evaluates financial outcomes.

E.2 Barriers to Implementation

A key barrier to the adoption of CHG bathing and early catheter removal practices is staff workload. High patient-to-nurse ratios and time constraints may lead to delayed catheter removal. Additionally, patient comfort preferences and clinical uncertainty about catheter necessity can hinder compliance with established protocols.

E.3 Strategies to Overcome Barriers

Hospitals can mitigate these challenges through staff education programs highlighting the benefits of infection prevention, daily interdisciplinary safety huddles, and enhanced communication among care teams. Continuous feedback mechanisms, performance tracking, and recognition for compliance can further motivate staff engagement (Palloto et al., 2019; Gyesi-Appiah et al., 2020).

E.4 Indicators to Measure Outcomes

Success of CAUTI prevention initiatives should be measured using the following indicators:

Audit frequency: Documentation of daily CHG baths and catheter duration.
Infection rates: Number of CAUTI cases per 1,000 catheter-days.
System metrics: Readmission and reimbursement data monitored through CMS and NHSN systems.

Ongoing assessment of these indicators provides tangible evidence of progress and ensures the continuity of quality improvement initiatives.

Conclusion

CAUTIs represent a critical yet preventable healthcare challenge that impacts both patient outcomes and organizational efficiency. Evidence supports that the combined use of daily chlorhexidine bathing and timely catheter removal significantly decreases infection rates in hospitalized populations. Sustained interprofessional collaboration, patient involvement, and continuous monitoring are essential to maintain reductions in CAUTI incidence and promote high-quality, safe patient care.

References

Gyesi-Appiah, E., Brown, J., & Clifton, A. (2020). Short-term urinary catheters and their risks: An integrated systematic review. British Journal of Nursing, 29(9), S16–S22.

Palloto, C., Fiorio, M., De Angelis, V., Ripoli, A., Franciosini, E., Quondam Girolamo, L., Volpi, F., Iorio, P., Francisi, D., Tascini, C., & Baldeli, F. (2019). Daily bathing with 4% chlorhexidine gluconate in intensive care settings: A randomized controlled trial. Clinical Microbiology and Infection, 25(6), 705–710.