Literature Evaluation Table

Literature Evaluation Table

The nursing problem of interest in this research paper is infection prevention among female patients who seek medical services from medical-surgical units, particularly those who require catheterization. In most cases, the common infections associated with catheterization are urinary tract infections, which sometimes prove fatal when they are not managed effectively (Flores-Mireles et al., 2019). There are several reasons why such infections are not managed effectively, and they include: medical practitioners assigned roles in the medical-surgical units are understaffed or undertrained (Gad & AbdelAziz, 2021). This research project will focus on the second instance of the staff needing to be more experienced. They might need to use more effective techniques to handle the patients, thus leading to the occurrence of such infections. Prevention of catheter-associated urinary tract infections is key to improved patient outcomes in the medical-surgical unit (Werneburg, 2022). The incidence of catheter-associated urinary tract infections (CAUTIs) has increased in female medical-surgical units, which necessitates the development of plans to curb this. Developing a framework of implementation is essential in reducing the incidences of such infections. Staff education will help the patients and the unit managers reduce their occurrence. Catheter-associated urinary tract infections put patient safety at risk, cause patient discomfort, negatively affect the quality of healthcare delivery, and increase the length of hospital stay (Werneburg, 2022).

PICOT Question:

In medical-surgical nurses (P), how does education on female urinary catheter insertion and catheter-associated urinary tract infection prevention strategies (I) compared to no education (C) impact female urinary catheter insertion skills and infection prevention knowledge (O) over four weeks (T)?

 

Criteria	Article 1	Article 2	Article 3
APA-formatted article citation with permalink	Bizuayehu, H., Bitew, A., Abdeta, A., & Ebrahim, S. (2022). Catheter-associated urinary tract infections in adult intensive care units at a selected tertiary hospital, Addis Ababa, Ethiopia. PLOS ONE, 17(3), e0265102. https://doi.org/10.1371/journal.pone.0265102	Flores-Mireles, A., Hreha, T. N., & Hunstad, D. A. (2019). Pathophysiology, Treatment, and Prevention of Catheter-Associated Urinary Tract Infection. Topics in Spinal Cord Injury Rehabilitation, 25(3), 228–240. https://doi.org/10.1310/sci2503-228	Gad, M. H., & AbdelAziz, H. H. (2021). Catheter-associated urinary tract infections in the adult patient group: A systematic qualitative review on the adopted preventative and interventional protocols from the literature. Cureus, 13(7). https://doi.org/10.7759/cureus.16284
How does the article relate to the PICOT question?	The article analyzes cases of catheter-associated urinary tract infections in adult intensive care units using Addis Ababa as the area of study. In that case, it is crucial in the picot question in that it helps determine measures that can be taken to prevent the incidence of catheter-associated urinary tract infections.	This article provides specific and detailed information on various ways catheter-associated urinary tract infections can be prevented and describes the pathophysiology of the infections as well as their treatment. It is, therefore, essential since it gives some insight into measures that can be taken to prevent catheter-associated urinary tract infections and how to treat them should they occur.	This article is related to the PICOT question in that it provides a fundamental analysis of preventative and interventional protocols in the occurrence of catheter-associated urinary tract infections from the literature. It is essential in this case since it gives an all-round analysis of existing literature which will be highly beneficial in carrying out this research project.
Is the article qualitative, quantitative, or mixed methods? Justify your selection.	The article uses quantitative methods to present its data. This is because it presents its data numerically using percentages and bar charts illustrating the prevalence of catheter-associated urinary tract infections among adults in intensive care units in Addis Ababa.	The article utilizes qualitative methods to present its data. This is justified by the article’s focus on presenting information about the critical issues of pathophysiology, treatment, and prevention of catheter-associated urinary tract infections.	The article uses qualitative methods to present its data. This is because it does not work with any numeric data. Instead, it deals with the key issues of preventative and interventional protocols in catheter-associated urinary tract infections.
Purpose statement	To determine the prevalence of catheter-associated urinary tract infection, the spectrum of etiological agents, antibiotic sensitivity profile of bacterial pathogens among adult patients admitted to intensive care units.	Here, we will review the epidemiology, pathogen prevalence, differential mechanisms used by uropathogens, and treatment and prevention of uncomplicated UTI and CAUTI.	To summarize the current strategies and interventions in reducing urinary tract infections associated with urinary catheters, use, and the need for re-catheterization on the rate of CA-UTIs.
Research question(s)	What is the prevalence of catheter-associated urinary tract infection, the spectrum of etiological agents, and the antibiotic sensitivity profile of bacterial pathogens among adult patients admitted to intensive care units?	What are the epidemiology, pathogen prevalence, and differential mechanisms used by uropathogens, and what are the various treatment and prevention methods of uncomplicated UTI and CAUTI?	What are the current strategies and interventions in reducing urinary tract infections associated with urinary tract infections, use, and the need for re-catheterization on the rate of CAUTIs?
Outcome(s)	In all 220 patients included in the study, the development of significant bacteriuria/candiduria was not affected by sex, age, and prior antibiotic therapy. However, the length of stay in the intensive care unit was significantly associated with bacteriuria /candiduria (P-value < 0.001). The overall prevalence of bacteriuria/candiduria was 51.4%, among which 21.0%, 19.1%, and 11.4% were bacteriuria, candiduria, and polymicrobial infections, respectively. About 138 organisms were recovered, of which 79 (57.25%) were bacteria, and 59 (42.75%) were yeast isolates. Acinetobacter species, Pseudomonas species, Klebsiella species E. coli, and Enterococcus species were the dominant bacterial isolates. Candida. albicans, Candida. krusei and Candida. tropicalis were the commonest yeasts. Many gram-negative bacterial isolates were resistant to ceftriaxone 36(94.7%), ampicillin 21(91.3%) followed by cefotaxime34(89.5%), amikacin (16.0%), nitrofurantoin (17.4%), meropenem (20.0%) and imipenem (20.0%). Out of 79 bacterial pathogens, 52(65.8%) were multiple antibiotics resistant, of which 37(71.0%) were Gram-negative bacteria, and 15(29%%) were Gram-positive bacteria. About 13(86.7%) isolates of Acinetobacter, all isolates of Klebsiella species (100%) and E. coli (100%) were multiple antibiotic-resistant. Out Of 18,10(55.56%) isolates of Enterococcus were multiple antibiotic-resistant.	Urinary tract infections (UTIs) are among the most common microbial infections in humans and represent a substantial burden on the health care system. UTIs can be uncomplicated, as when affecting healthy individuals, or complicated, when affecting individuals with compromised urodynamics and host defenses, such as those with a urinary catheter. There are apparent differences between uncomplicated and catheter-associated UTIs (CAUTIs) in clinical manifestations, causative organisms, and pathophysiology. Therefore, uncomplicated UTI and CAUTI cannot be approached similarly, or the risk of complications and treatment failure may increase.	The article researched studies including CA-UTI from the usage of an indwelling Foley urinary catheter or CA-UTI due to other catheter types such as intermittent or suprapubic catheters. A total of 1145 articles were identified, of which 59 studies that met the inclusion criteria were selected. Studies of relevance to CA-UTIs were based on: the duration of catheterization, indication for catheterization, catheter types, UTI prophylaxis, educational proposals and approaches, and mixed policies and interventions. The duration of catheterization is the contributing risk factor for CA-UTI incidence; longer-term catheterization should only be undertaken where needed. The indications for catheterization should be based on individual base-to-base cases. The evidence for systemic prophylaxis instead of when clinically indicated is still equivocal. However, antibiotic-impregnated catheters reduce the risk of symptomatic CA-UTIs and bacteriuria and are more cost-effective than other impregnated catheter types. Antibiotic resistance, potential side effects, and increased healthcare costs are potential disadvantages of implementing antibiotic prophylaxis.
Setting (Where did the study take place?)	The study took place in intensive care units around hospitals in Addis Ababa.	The study took place across randomly sampled hospitals in the  United States.	The study took place in the United States and utilized the Medline (Via OVID) and Cochrane Library databases.
Sample	220 Patients.	Healthy individuals with complicated urodynamics, for example, those with a urinary catheter.	Evidence was presented in Medline (via Ovid) and the Cochrane Library for January 2005 to April 2021.
Method	Urine specimens were aseptically collected and processed as per standard protocols. Microorganisms were isolated, identified, and subjected to antibiotic susceptibility testing.	Compare the complicated and uncomplicated nature of urinary tract infections between healthy individuals and those with complicated urodynamics/host defenses.	The two authors of this review (HA and MG) independently reviewed and abstracted data from the 1145 articles that met the inclusion criteria. Extracted data included primary study objectives, patient population characteristics, inclusion criteria, terms and definitions, and quality issues. The first author evaluated and shortlisted the data from the literature search according to methodological/theoretical rigor and trustworthiness and data relevance on CA-UTI as a primary or secondary outcome.
Key findings of the study and implications for nursing practice	A very high prevalence of bacteriuria/ candiduria was demonstrated in this study. This warrants establishing a multidimensional infection control approach for catheter-associated urinary tract infections in ICU. In addition to a high prevalence of candiduria, recovery of non-albicans candida species almost in equal proportion with candida albicans in the present study was an important finding as non-albicans candida species distinct to C. albicans are intrinsically resistant to the commonly used azole antifungal drugs in Ethiopia. The prevalence of rate MDR bacteria in our ICU, particularly of E. coli, Klebsiella spp, Pseudomonas, and Acetobacter spp, was very high.	The study found that Catheter-associated urinary tract infections in individuals with compromised host defenses (having a catheter attached) are associated with: E. coli, Candida spp, Enterococcus spp, P. aeruginosa, Klebsiella spp, and S. aureus.	In terms of implications to clinical practice, the results of this review suggested that healthcare workers should think of 2 strategies to reduce rates of CA-UTI: limit catheter use and shorten the duration of catheterization. The literature also supported either daily scheduled reviews or stop orders to safely reduce the duration of inappropriate urinary catheterization in hospitalized patients. Based on the current evidence, there is insufficient data to determine whether transurethral or suprapubic routes are most appropriate for catheterization. The reduced morbidity rate of suprapubic catheterization is offset by higher rates of catheter-related complications and does not necessarily mean a shorter hospital stay. No good evidence exists to adequately conclude if washouts were beneficial or harmful due to poor methodological quality and the substantial risk of bias in the included studies. No significant difference was found between the clamping and unclamping groups. Given the scant evidence, procedures relating to the clamping of indwelling urinary catheters should not be favored over free drainage. No significant differences have been demonstrated among the various methods of cleansing or disinfecting the external urethral orifice. Evidence from studies that, before intermittent or indwelling catheterization, used either anti-septic or non-medicated agents to clean peri-urethral or meatal areas showed no statistical significance in reducing its association with the incidence rate of UTI. Compared to standard uncoated catheters, evidence of antiseptically coated catheters is equivocal. Antibiotic-impregnated catheters are more documented in the literature and reduce the catheter-associated symptomatic urinary tract infection rate.
Recommendations of the researcher	In order to combat this problem, proper antibiotic policies should be formulated.	Better hygienic measures should be adopted in patients with compromised host defenses to prevent catheter-associated urinary tract infections.	The current evidence on phytotherapy using cranberry extracts to prevent UTIs remains debatable, partly because the trials were small and methodological weaknesses were shown. Therefore, the evidence was not a reliable basis for any clinical conclusions. So, there is no well-justification for recommending it highly.

 

 

 

Criteria	Article 4	Article 5	Article 6
APA-formatted article citation with permalink	Warren, C., Fosnacht, J. D., & Tremblay, E. E. (2020). Implementation of an external female urinary catheter as an alternative to an indwelling urinary catheter. American Journal of Infection Control, 49(6). https://doi.org/10.1016/j.ajic.2020.10.023	Werneburg, G. T. (2022). Catheter-Associated Urinary Tract Infections: Current Challenges and Future Prospects. Research and Reports in Urology, Volume 14(14), 109–133. https://doi.org/10.2147/rru.s273663	Zavodnick, J., Harley, C., Zabriskie, K., & Brahmbhatt, Y. (2020). Effect of a Female External Urinary Catheter on Incidence of Catheter-Associated Urinary Tract Infection. Cureus, 12(10). https://doi.org/10.7759/cureus.11113
How does the article relate to the PICOT question?	The article related to the PICOT question in that it discusses the implementation of an external female urinary catheter as an alternative to an in-dwelling one. This is important since it presents the case that medical practitioners must be trained to implement preventative measures best to reduce catheter-associated urinary tract infections.	The article relates to the PICOT question since it evaluates current challenges and prospects concerning catheter-associated urinary tract infections. This is justified by the fact that seeking to come up with a way to reduce catheter-associated urinary tract infections addresses the issue’s current challenges and future prospects.	The article is related to the PICOT question in that it focuses on the effect of a female external urinary catheter on the incidence of catheter-associated urinary tract infection. This is justified by the fact that the aim of this research project, together with the PICOT question, is to develop a framework to reduce the incidences of catheter-associated urinary tract infections in female patients in medical-surgical units.
Is the article qualitative, quantitative, or mixed methods? Justify your selection.	The article utilizes quantitative methods since it assesses the impact of using an external female urinary catheter instead of an indwelling one. It expresses the results numerically, stating the difference statistically.	The article utilizes quantitative methods since it seeks to evaluate the current challenges and prospects in dealing with catheter-associated urinary tract infections which do not encompass numeric data as the primary evaluation medium.	The article utilizes quantitative methods since it focuses on the effect of an external female urinary catheter on the incidence of urinary tract infections. This is justified by the fact that numerical data is used to evaluate the incidence of catheter-associated urinary tract infections.
Purpose statement	Until recently, there has been a viable alternative to an indwelling urinary catheter for female patients requiring precise urine output measurements. With the introduction of external female urinary catheters, we can now substitute this type of device for an indwelling urinary catheter in many patients, decreasing their risk of catheter-associated urinary tract infections.	Catheter-associated urinary tract infection (CAUTI) is the most common healthcare-associated infection and cause of secondary bloodstream infections. Despite many advances in diagnosis, prevention, and treatment, CAUTI remains a severe healthcare burden, and antibiotic resistance rates are alarmingly high.	Background Catheter-associated urinary tract infections (CAUTIs) can be fatal and are a source of avoidable expense for patients and hospitals. Prolonged catheterization increases infection risk, and avoiding catheters is crucial for infection prevention.
Research question(s)	What is the impact of using an external female urinary catheter instead of an indwelling one?	What are the current challenges and prospects in dealing with catheter-associated urinary tract infections?	What is the effect of an external female urinary catheter on the incidence of urinary tract infections?
Outcome(s)	There was a statistically significant decrease in catheter-associated urinary tract infections.	Diagnosis of CAUTI relies upon both urine culture and symptoms, both problematic and controversial in the population with indwelling catheters. Catheter coatings, catheter materials, and vaccination are novel preventive strategies. Another promising prevention strategy is bacterial interference, wherein nonvirulent microbial strains are designed to outcompete pathogens for the urinary tract niche to reduce CAUTI risk.	There was a statistically significant decrease in the incidences of urinary tract infections in female patients in intensive care units.
Setting (Where did the study take place?)	A large academic medical center in the United States.	The study was a review that utilized data from the United States.	The study took place in several intensive care units in various hospitals in the United States.
Sample	Female patients greater than 18 years	The sample used in this study was data available publicly in the United States.	Female patients in intensive care units.
Method	This retrospective study analyzed the impact of a hospital-wide implementation of an external female urinary catheter at a large academic medical center. The study included female patients, greater than 18 years of age. We compared 12 months before and after device implementation to assess the impact on indwelling urinary catheter utilization and catheter-associated urinary tract infections rate.	Clinical and translational evidence and critical basic science studies underlying preventive and therapeutic approaches were evaluated.	Female external urinary catheters (FEUCs) were introduced to intensive care units.
Key findings of the study and implications for nursing practice	Data included over 220,000 patient days, over 10,000 external urinary catheter days, and 33,000 indwelling urinary catheter days. A statistically significant decrease in indwelling urinary catheter utilization following the implementation of the external female urinary catheter was found, but only in intensive care units.	Novel diagnostic strategies and treatment decision aids under development will decrease the time to diagnosis and improve antibiotic accuracy and stewardship. These include several classes of biomarkers often coupled with artificial intelligence algorithms, cell-free DNA, and others. New preventive strategies are being developed and investigated, including catheter coatings and materials, vaccination, and bacterial interference. The antibiotic pipeline remains insufficient, and new strategies for the identification of new classes of antibiotics, and rational design of small molecule inhibitor alternatives, are under development for CAUTI treatment.	CAUTI rates decreased from 3.14 per 1000 catheter days to 1.42 per 1000 catheter days (p=0.013). Female indwelling catheter days decreased, while overall intensive care patient days increased.
Recommendations of the researcher	The researchers recommended that facilities first implement the device in ICUs as this level of care was where we observed the most significant impact.	Understanding the critical challenges in the field and the current evidence will inform the next generation of CAUTI management.	Additional studies should be conducted to ascertain the impact and benefits of utilizing female external urinary catheters.