1. PICO Presentation Angela McColl COHP 450: Evidence Based Health Practice
Introduction
PICO- In hospitalized patients will shorter catheter duration periods with prompt removal compared to routine removal decrease incidence of catheter associated urinary tract infections (CAUTI)?
The purpose of this presentation is to construct a PICO (Patient, Intervention, Comparison, Outcome) question specific to my area of study, and evaluate 2 associated research studies that relate to the PICO question.

2. Search Words- Reducing, indwelling urinary catheters, duration, catheterization, nosocomial urinary tract infection, prevention Search Engines- CINAHL off of the Ferris University Library Website Results of Search Reducing use of indwelling urinary catheters and associated urinary tract infections. (Article 1) 2. Control of the duration of urinary catheterization: impact on catheter-associated urinary tract infection. (Article 2)
Using a combination of the search words the search results retrieved 42 articles at one point and 74 articles with a different combination.

3. Research Article Citations- Elpern, E. , Killeen, K. , Ketchem, A
Research Article Citations- Elpern, E., Killeen, K., Ketchem, A., Wiley, A., Patel, G., & Lateef, O. (2009). Reducing use of indwelling urinary catheters and associated urinary tract infections. American Journal Of Critical Care, 18(6), doi: /ajcc Crouzet, J., Bertrand, X., Venier, A., Badoz, M., Husson, C., & Talon, D. (2007). Control of the duration of urinary catheterization: impact on catheter-associated urinary tract infection. Journal Of Hospital Infection, 67(3),

4. The PICO question I constructed focuses on duration of catheterization and occurrence of catheter associated urinary tract infections. The articles I chose studied the relationship between duration (number of days catheterized) and incidence of catheter associated urinary tract infections. The articles provide a relationship between prompt removal compared to routine removal. The articles also identified other risk factors, but for the purpose of this presentation I focused on the duration of catheterization.

5. Findings of Studies Relating to PICO Question Study Designs- Both articles used cohort-studies. A group of individuals were examined with a suspected risk factor (number of days catheterized) to see who does and who does not develop the urinary tract infection. The studies are considered prospective studies- planned ahead of time with clinical trials.

6. Findings of Studies Relating to PICO Question Sample Population- Article 1- Rush University Medical Center on a critical/intermediate care unit. December 1, 2007 to May 31, patients studied, 58% were woman Age range between years. Article 2- Besancon Hospital. Five departments were included in the study- neurosurgery, cardiovascular surgery, orthopedic surgery, neurology and geriatrics. January 2015 to June patients studied, 49.6% were woman Age range between years.
Research was performed at Rush University Medical Center on a critical/intermediate care unit. Sample population consisted of all consecutive patients admitted from December 1, 2007 to May 31, 2008 who had an indwelling urinary catheter during their admission. There were a total of 337 patients studied, 58% were woman with an age range between years.
Research was performed at Besancon Hospital. Five departments were included in the study- neurosurgery, cardiovascular surgery, orthopedic surgery, neurology and geriatrics. All patients hospitalized undergoing non-chronic urinary catheterization were included. Data was collected from January 2015 to June There were a total of 234 patients studied, 49.6% were woman with an age range between years.

7. Findings of Studies Relating to PICO Question Variables and analytical approach- Article 1- Independent variable- duration of catheterization Dependent variable- Urinary tract infection CAUTI rates were compared by using unpaired t-tests. Results- Reductions in CAUTIs by limiting duration of catheter use Article 2- Independent variable- duration of catheterization Dependent variable- Urinary tract infection. Bivariate analysis was used using, chi-squared tests, t-test, analyses of variance, and logistic regression analyses Results- duration of catheterization was associated with CAUTI.
Article 1- Independent variable- duration of catheterization, Dependent variable- Urinary tract infection. CAUTI rates were compared by using unpaired t-tests. The study is a before and after evaluation of a low-technology intervention to reduce duration of urinary catheterization and occurrence of CAUTIs. Results indicated reductions in CAUTIs can be realized through a nurse-based intervention to avoid unnecessary catheter placement and limit duration of catheter use. Article 2- Independent variable- duration of catheterization, Dependent variable- urinary tract infection. Bivariate analysis was used using, chi-squared tests, t-test, analyses of variance, and logistic regression analyses was used to identify risk factors predictive of CAUTI. Results showed that duration of catheterization was associated with CAUTI.

8. Ethical Considerations- Article 1- This article mentioned approval from the institutional review board that was obtained before the study began and informed consent was not required. Article 2- Study did not mention whether or not approval was obtained from the institutional review board or if informed consent was required. The authors cited peer reviewed literature throughout the article.

9. Relevance to practice Reducing the number of days catheterized Decrease incidence of catheter associated urinary tract infections Monitored by any floor nurse. Clinical indicator of quality of care, and are largely preventable. Close monitoring of duration and appropriateness of catheterization Standard of care across the continuum Patients advocates Actual need verses convenience of catheterization.
Reducing the number of days catheterized to decrease incidence of catheter associated urinary tract infections is relevant to my clinical practice and is something that can be monitored by any floor nurse. CAUTIs are considered a clinical indicator of quality of care, and are largely preventable. Close monitoring of duration and appropriateness of catheterization should be communicated as a standard of care across the continuum. As nurses we are our patients advocates and play a major role in determining actual need verses convenience of catheterization.

10. Relevance to practice High cost health care issue that can be avoidable. Strategies to prevent CAUTIs- standard of care. Duration is the number one risk factor for a CAUTI Resulting in prolonged hospitalization, additional hospital costs, and advanced infections (sepsis). Interventions at bedside to eliminate unnecessary catheter days. Autonomy to discontinue the catheter based on need without a physicians order. Communicating appropriateness for continuation daily to physicians for indwelling catheters.
CAUTIs are a high cost health care issue that can be avoidable. Strategies to prevent CAUTIs should be carried out as a standard of care. Duration is the number one risk factor for a CAUTI, resulting in prolonged hospitalization, additional hospital costs, and advanced infections (sepsis). Interventions can be carried out at the bedside to eliminate unnecessary catheter days. Nurses should have the autonomy to discontinue the catheter based on need without a physicians order. Nurses should be communicating the appropriateness for continuation daily to physicians for indwelling catheters.

11. Conclusion According to the two research articles the answer to my PICO question is yes. Decreased duration periods and prompt removal of catheters as compared to routine removal times does decrease the incidence of catheter associated urinary tract infections. Nurses play a vital role in limiting duration of catheter use through daily catheter needs assessments, patient advocating and communication with the physician appropriateness of catheterization.

12. References Elpern, E. , Killeen, K. , Ketchem, A. , Wiley, A
References Elpern, E., Killeen, K., Ketchem, A., Wiley, A., Patel, G., & Lateef, O. (2009). Reducing use of indwelling urinary catheters and associated urinary tract infections. American Journal Of Critical Care, 18(6), doi: /ajcc Crouzet, J., Bertrand, X., Venier, A., Badoz, M., Husson, C., & Talon, D. (2007). Control of the duration of urinary catheterization: impact on catheter-associated urinary tract infection. Journal Of Hospital Infection, 67(3),