This project, which was also a quality improvement effort, was devoted to the topic of catheter-associated urinary tract infections (CAUTIs), as well as their prevention and rate reduction. The general aim was to decrease the likelihood of developing CAUTIs among the residents of a long-term care facility, as well as testing an intervention that is evidenced to achieve such an outcome (2% chlorhexidine washcloths) (Huang, Chen, Wang, & He, 2016). Long-term care residents, especially if they are older adults, are a vulnerable population when CAUTIs are concerned (Jump et al., 2018), which justified the interest in the topic. The project employed the staff and residents of the facility. The former group of participants was trained to ensure the correct usage of the intervention; the latter group was subjected to regular washcloth bathing. The effectiveness of both the training and intervention were measured before and after their application with the statistical analysis applied as appropriate. In this section, the results and conclusions will be summarized, and the possibility of future projects will be examined.
A Likert-scale questionnaire was used to test the staff’s CAUTI knowledge. It allowed determining the impact of the training on the participants’ ability to prevent CAUTI, and the application of the Wilcoxon signed ranks test indicated that the training was indeed effective (p=0.004). The residents’ urinalysis results were employed to assess their health. Their state did not change by the end of the procedures, which implied that the washcloths might have been successful in lowering the likelihood of CAUTI development. Thus, the project managed to achieve the objective of ensuring a decreased probability of CAUTIs, and it also successfully improved the staff’s knowledge in an attempt to enable the correct usage of the tested intervention.
It should be emphasized that the project’s sample may have caused significant limitations. Regarding the staff, 26 members (nurses and nursing assistants) were available. While the differences in their knowledge prior to and after the training were statistically significant, it is still a relatively small sample that comes from one specific site. Residents were even less numerous; given the project’s extensive eligibility criteria, only five people were recruited. Moreover, one of them was transferred before the washcloth implementation; the project only managed to collect the pre-test urinalysis results for that resident. Consequently, four residents constituted the final sample of the project, which implies that the findings should not be treated as very generalizable.
Moreover, all the urine samples that were collected throughout the project had leukocytes in them, and two of them also had nitrite. Initially, the project was supposed to involve the residents who tested negative, but the site did not have such residents. As a result, the residents who did not exhibit CAUTI symptoms were viewed as eligible, and the project tracked changes in their health. Since none were recorded, the intervention appears to have prevented the development of new CAUTIs. Still, this feature of the sample needs to be considered.
Finally, it should be mentioned that the project did not take very long; it cannot yield any information about the long-term application of the washcloths. In summary, the ability of this project to offer generalizable results is limited (Polit & Beck, 2017). In this connection, future projects should be discussed; they would be able to rectify the presented concerns and expand the knowledge on CAUTI reduction and prevention.
First, a larger sample, as well as samples from several sites, could be a good opportunity to investigate the application of washcloths in long-term care. This suggestion is especially true for the resident’s data, which were not sufficiently robust for conclusive statements in this project. In addition, it would be very helpful to attempt to introduce a sample of residents who test negative for leukocytes and nitrite. Finally, extending the timeframe of the application of washcloths would yield the long-term data that this project cannot offer.
It should be noted that this project did not view the training of the nurses and nursing assistants as its primary aspect, but this activity was still important for the correct use of the intervention. In addition, the training allowed the project to advance the participants’ CAUTI knowledge, which is a significant outcome for a quality improvement effort. Therefore, a large or more diverse sample of staff members would also be useful in further investigating the efficacy of the training. A future project might focus exclusively on this aspect of CAUTI prevention as well. In general, additional research can produce evidence that will complement this project’s findings and avoid its limitations.
To summarize, the project focused on improving an important quality-related aspect of caring for residents in a long-term care facility by implementing an evidence-based solution. The solution appeared to be effective in reducing the CAUTI likelihood in the four residents that it was applied to; the associated training of the staff was efficient as well. The findings need to be considered along with the restrictions of the project, including its small duration and samples. However, future research may assist in rectifying the issue, and the current project has achieved its objectives while also improving the quality of care delivered by the site’s nurses and nursing assistants.
References
Huang, H., Chen, B., Wang, H., & He, M. (2016). The efficacy of daily chlorhexidine bathing for preventing healthcare-associated infections in adult intensive care units. The Korean Journal of Internal Medicine, 31(6), 1159-1170.
Jump, R., Crnich, C., Mody, L., Bradley, S., Nicolle, L., & Yoshikawa, T. (2018). Infectious diseases in older adults of long-term care facilities: Update on approach to diagnosis and management. Journal of the American Geriatrics Society, 66(4), 789-803.
Polit, D.F., & Beck, C.T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.