Urinary Tract Infection

Infection control refers to policies and processes established in hospitals and other healthcare facilities in order to control and reduce the spread of infections. Priority was given to the surveillance of HAIs (healthcare-associated infections) and the integration of fundamental epidemiological concepts for the identification of HAI risk factors in infection control programmes. Patients as well as health care workers might be affected by preventable illnesses if they are not protected by infection prevention (IPC) (Carter et.al, 2014). A comprehensive approach to IPC must be taken at all levels of the health care system—from policymakers and facility administrators to health professionals and patients—to ensure its success. When it comes to the safety and quality of treatment of patients, IPC is a one-of-a-kind approach since it applies to every health care professional and every patient. Inadequate IPC is dangerous and can even be fatal. Without efficient IPC, delivering high-quality health care is difficult. There must be an emphasis on infection control in all health care settings to avoid the spread of infectious illnesses (Hernandez er.al, 2019). It is necessary to have a basic grasp of the epidemiology of illnesses, risk factors which enhance patient vulnerability to infection, and practices, processes, and therapies that may lead in infections in order to effectively prevent and manage infection. In the UK, 23% of all illnesses are caused by urinary tract infections (UTIs). About 80% of all hospital-acquired bacteremia is caused by urinary tract infections (UTIs) contracted while using a catheter (Liang er.al, 2019)

Healthcare-associated infections (HAIs) can be transmitted by CDI, SSI, CRE, MRSA, or any other infectious agent. The infection rate depends upon the type of patient care activities or treatment, as well as the patient’s host defences. It basically affects all the aspects of healthcare ranging from surgical site infections, hand hygiene, antimicrobial resistance, safety for injections as well as how hospitals have been operating in respect of emergencies (Karadag and Berivan, 2018).  One such infection is catheter associated UTI which can significantly affect the health of an individual and thereby it is required that appropriate measures are undertaken to reduces the causes for such infection such that suitable care is provided to patients in an infection free environment.

As the most prevalent cause of hospitalisation amongst some of the elderly as well as the most obvious cause of antibiotic prescription in primary care, urinary tract infection (UTI) has a huge influence on every country’s economy (Liang et.al, 2019). In light of the high frequency of upper and lower levels of UTI, the possibility of recurrence and poor treatment, as well as the global rise in antibiotic resistance, a robust antibiotic stewardship programme has long been a concern for clinicians. Compared to men, females are twice as likely to have a urinary infection, and the frequency rises with age. The phrase “urinary tract infection” (UTI) is referred to as an infection of the urinary tract as a whole. Local primary care physicians report it as one of the most common infections they see. Adult males under the age of 50 have a minimal risk of developing a urinary tract infection (UTI) (Carter et.al, 2014). Adult women, on the other hand, are 30 times more likely to have a UTI. It can be an infection of the kidneys, bladder, ureters, or urethra which affects all or part of the urinary system (Hernandez et.al, 2019).  Infection Control And Prevention Of Urinary Tract Infections Essay Paper

Catheter Associated UTI

Infection withi any region of the urinary system, involving the urethra, uretus or bladder, is referred to as a urinary tract infection (UTI). The WHO reports that urinary tract infections (UTIs) are the most prevalent kind of healthcare related illness. Around 75% of hospital-acquired UTIs are linked to the use of a urinary catheter, a tube used to drain urine from the bladder into the urethra. An estimated 15 to 25 percent of patients in the hospital are given urinary catheters at some point during their stay (Mukakamanzi, 2017). Prolonged usage of a catheter increases the chance of acquiring the catheter-associated urinary tract infection (CAUTI). Because of this, catheters should be used when necessary and discarded as soon as the necessity has passed.

Among the most prevalent diseases in health care institutions is a urinary tract infection which is caused by the use of an indwelling urine catheter. The length of time a patient is catheterized is the most integral part of the development of bacteriuria. Peter et.al, (2018) asserts that despite the low incidence of symptomatic infection in bacteriuric patients, the widespread use of indwelling urinary catheters implies that these infections are a noteworthy cause of morbidity and mortality. There are around 20 percent of cases of health care bacteremia in acute care facilities and over 50 percent in long-term care institutions when catheter-acquired urine infection is the primary cause of the infection. With respect to limiting the use of indwelling catheters as well as discontinuing them as soon as clinically early as possible are the most essential preventative measures against bacteriuria and infection. As part of an infection control programme at a hospital, it is critical to monitor catheter usage, the appropriateness of catheter causes, and any issues that may arise. Eventually, catheter materials that resist biofilm development will be necessary to prevent these infections. A urinary infection is caused by a number of interrelated elements, particularly host parameters, the quantity of the inoculum, and the virulence of the bug that causes it. The inoculation is the first thing that happens to cause a UTI. The ascending route is the most often used inoculation theorem. Once in the urethra and bladder, enteric bacteria can spread throughout the body (Peter et.al, 2018).

Source: Peter et.al, (2018)

There are several variables that contribute to the recurrence of a urinary tract infection (UTI). One argument is that a decline in peroxide-producing lactobacilli has led to an increase in the colonisation of enteric bacteria that are harmful. In addition, there is the theory that bacteria that seem to be resistant to antibiotics develop clusters in the urothelium, which renders the individual more vulnerable to enteropathogenic illness. Young, middle-aged, as well as elderly women all have different rUTI risk factors to consider. Due to the high frequency with which young women have sex, they have higher rates of urethral and vaginal colonisation. High urine residue and atrophic vaginitis are risk factors for older women, whereas cystocele is a risk factor for younger women (Galiczewski, 2016).

Catheter Risk Aversion

One of the most frequent health care-associated illnesses, catheter-associated urinary tract infection (UTI) is prevalent in the United Kingdom and across the world. To avert up to 69 percent of catheter-associated UTIs, it is suggested that infection-prevention procedures are followed. UTIs linked with indwelling urinary catheters can be prevented by adhering to recognised procedures including hand cleanliness, such as proper usage and prompt withdrawal of indwelling urinary catheters (Jain et.al, 2015). Along with these more purely technical components of prevention, the socio-adaptive aspect of preventive has also been given attention in the quest for quality improvement. There has been a rise in the importance of managing healthcare-associated infections, including catheter-associated UTI in specific, in the United Kingdom (Durant, 2017).

All healthcare-associated diseases, including urinary tract infections (UTIs), can be prevented by practicing strict hand cleanliness. Most occurrences of urinary infections have been attributed to poor hand hygiene by employees. Hospitalized patients’ urinary tracts, particularly those in intensive care units, serve as a major repository for microorganisms drug-resistant (MDRO) (Lo er.al, 2014). MDRO can be prevented by reducing the use of indwelling devices, like urinary catheters, which increase vulnerability to infection. Urinary catheter-related antibiotic resistance can be prevented by decreasing the usage of broad-spectrum antimicrobials being a part of comprehensive antimicrobial stewardship programme. There is a high risk of MDRO colonisation with long-term catheterization, yet part of this usage may be inappropriate (Tenke et.al, 2017).

Purvis et.al, (2014) depicts that since catheterization is the significant risk factor underlying healthcare-associated urinary tract infections (CAUTIs), limiting or avoiding catheterization is the most effective technique for CAUTI prevention. The main risk factor for healthcare associated UTIs is based upon indwelling urinary catheters which is considered as one of the most effective strategies for CAUTI prevention. In paediatric medical intensive care units, catheter usage rates range from 0.16 urine catheter days per patient-day to 0.80 urinary catheter days per patient-day. In trauma intensive care units, catheter use rates range from 0.16 urinary catheter days per patient-day to 0.80 urinary catheter days per patient-day. Interventions at various points in the lifetime of a urinary catheter may be necessary to reduce catheter use. Starting with reducing the installation of indwelling urinary catheters is the first step toward lowering catheter use (Purvis et.al, 2014). Despite these precautions, research show that urinary catheters are inappropriately inserted in up to 50% of patients. Based on these widely acknowledged reasons, healthcare organisations should adopt documented policies and guidelines for indwelling urinary catheterization (Meddings et.al, 2019).

Therefore, urinary catheters should only be used by those who have received the appropriate training in order to reduce the risk of introducing bacteria into the bladder. In order to avoid infection, hand hygiene should be undertaken promptly before to and following catheter insertion or any other catheter-related activity. Catheters should indeed be placed aseptically and with sterile instruments. Sterilized gloves, drapes, sponges, an antiseptic or sterile solution for periurethral washing, and a single-use package of lubricating jelly are all necessary during insertion. Patients in the non-acute care environment can conduct sterile intermittent catheterization. Perineum cleanliness should be done daily or more frequently when faecal or other wastes are present, as well as catheters should be cleaned before each usage. Hands should also be washed with soap and water. Cleansing the perineal region is essential for reducing microorganisms in the immediate vicinity (Gesmundo, 2016).

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Evidence Based Practice Analysis- Averting Risks For Infection

Efforts should be taken to reduce discomfort and stress throughout the catheterization operation as well. Catheters should be used that are the correct length and are lubricated adequately to prevent any urethral tissue damage during inflation of the retention balloon. Andrade and Fernandes (2016) within their study depicted that catheter with a narrow diameter should be used to provide proper drainage. Increased erosion of bladder neck and urethral mucosa, development of constrictions, and inadequate drainage of periurethral gland secretions are all risks associated with using large-size catheters (18 Fr or bigger). A balloon volume of 30 mL is not recommended. Infection or discomfort can develop from the accumulation of these fluids. For safety, it is indeed best to keep the indwelling catheter in place by securing it on the thigh or abdomen once it’s been inserted. Pressure ulcers on the perineum and buttocks can also be caused by catheters that are not properly fastened or misplaced (Andrade and Fernandes, 2016).

Catheters should only be placed with a doctor’s approval, as well as healthcare facilities should have a system in place to track where they are being placed. Hutton et.al, (2018) asserts within their study that efforts to reduce the installation of urinary catheters in hospitals, such as in emergency rooms as well as operating rooms, have the most impact. Urinary catheter-day prevalence decreased significantly after a multimodal strategy that included education, system reform, incentives, and feedback was administered by a dedicated nurse. Whenever catheters are inserted, early removal procedures are critical. As a result, physicians are sometimes uninformed that their patient has a urinary catheter when they order catheter care. Patients with catheters are often misdiagnosed by doctors, and the percentage who are ignorant of their presence increases as the doctor’s education level rises (Hutton et.al, 2018).  Additionally, less than half of catheters have physician authorization for catheter insertion or evidence of the catheter’s existence.  It has been shown that nurse-driven initiatives can shorten catheterizations. The use of urinary catheters following surgery can be reduced by following certain rules for the management of postoperative catheters. Intermittent urine catheterization minimises the incidence of bacteriuria and UTI when compared to indwelling urinary catheterization. These patients may benefit from intermittent catheterization, especially if they have neurogenic bladders or long-term urinary catheters. It has been found that intermittent catheterization, as opposed to indwelling catheterization, is safer for individuals who have undergone hip or knee surgery (Advani and Fakih, 2019). A portable bladder ultrasound scanner used in conjunction with intermittent catheterization might decrease the requirement for an indwelling catheter. Condom catheters can be used instead of indwelling catheters in male patients who do not have urine retention or blockage of the bladder outlet. It was shown that patients using condom catheters were less likely to get urinary tract infections (UTIs) or die from them, compared to those with indwelling catheters; the effect was most noticeable in males without dementia. Additionally, condom catheters may be less uncomfortable to certain men than indwelling catheters.

Saint et.al, (2000) within their research says that when an indwelling catheter is inserted with the use of aseptic techniques, all necessary measures are required to be deployed to ensure that close drainage system is there. Disconnection, leakage, or a breakage occurs then in case of aseptic practice should necessitate the replacement of the catheter and collecting system with sterile equipment (Charis McCoy et.al, 2017). Catheter-tubing junctions that are preconnected and sealed can help prevent connection problems in urinary catheter systems that employ these junctions. The catheter accompanying collecting tube ought to be free of kinking, as well as the collecting bag should be kept below the level of the bladder at all times and should never be put on the floor. Emptying the collection bag into a fresh container on a regular basis is recommended (Saint et.al, 2000).

For patients undergoing intermittent catheterization, it is critical that they stay on top of their catheterization schedule to prevent bladder volume and the need for further procedures. Mody et.al, (2015) says that as CAUTIs are more common in individuals with high remaining pee volumes at the time of catheterization than in those with lower residual urine volumes, the urine volume should be used to set the catheterization schedule. As a general rule, a person’s bladder capacity should not exceed 400 mL Urinary retention can be prevented by doing intermittent catheterization at regular intervals. There is also the option of using portable ultrasonography instruments to measure urine volume and thereby reduce the number of needless catheter insertions.’ An infection control strategy that is both affordable and successful is needed in patients who have catheters in place for an extended period of time. Infection Control And Prevention Of Urinary Tract Infections Essay Paper As long as the urinary drainage bags are cleaned daily with a 1:10 household bleach solution, they can be used for an additional month without any substantial rise in urine or drainage bag colonisation or urinary tract infection rates. Among 20 patients, distilled white vinegar and 3 percent hydrogen peroxide irrigation was tested in single research. Vinegar irrigation significantly reduced bacteriuria in patients, as opposed to hydrogen peroxide irrigation, according to the results of the study (Mody et.al, 2015).

Hebl (2006) says that aseptic catheter insertion as well as management are critical for the prevention of CAUTI if urinary catheterization is required. Aseptic catheter insertion is the recommended method for administering urinary catheters. Pre-catheter meatal cleaning has been found to reduce the risk of bacteriuria, but continued daily meatal cleaning with an antiseptic has not been proven to have the same effect. To minimise urethral damage, lubricant jelly must be inserted; the jelly ought to be sterile, although antiseptic characteristics are not required. Urinary catheters should not be routinely exchanged, save for technical reasons, because the reduction in bacteriuria is only temporary. However, it is likely useful to exchange long-term catheters during the treatment of symptomatic UTI (Hebl, 2006).

Chenoweth and Saint (2013) assert that urinary catheters with antiseptic or antibacterial agents have been widely researched as an additional strategy to reduce CAUTI. Most antimicrobial catheters are covered with nitrofurazone, minocycline, or rifampin, however novel catheters are being tested with different agents. Using a comprehensive meta-analysis, silver alloy catheters dramatically reduced the frequency of asymptomatic bacteriuria among adult patients catheterized for less than 7 days, however the benefit was lessened among those catheterized for longer than 7 days. It was discovered that antibiotic-impregnated catheters reduce the incidence of asymptomatic bacteriuria in patients catheterized for less than 7 days, but showed no effect when the length of catheterization was higher than 7 days (Lo et.al, 2008). CAUTI incidence may be evaluated when existing evidence-based measures are not reducing them, or in individuals who are regarded to be at high risk for the infection and associated sequelae. Regardless of the fact that anti-infective urinary catheters appear to minimise bacteriuria in patients undergoing short-term urine catheterization, there is no definitive proof that such catheters prevent CAUTI, UTI-related bloodstream infection, or death. As a result, frequent use of anti-infective urinary catheters to prevent CAUTI is not recommended.

It is necessary to keep the drainage system blocked at all times. The catheter-to-collection unit may become infected earlier if there is a break in it. Fevers greater than 38.3°C [100.9°F] for more than one day, disturbances in mental state, and hypertension all point to pyelonephritis with in catheterized patient.  Nosocomial outbreaks of catheter-related illnesses can be prevented by avoiding cross-contamination. Prior to and after handling a patient’s catheter or other collecting device, healthcare providers should wash their hands thoroughly. Emptying bags should be done with sterile, patient-specific instruments whenever at all practicable. Catheters should not be replaced on a routine basis (Fakih et.al, 2010). Certain clinicians advocate for monitoring patients’ urinary catheter time-to-obstruction and changing the catheter shortly before the patient is likely to obstruct. Catheter adjustments were necessary by some patients as frequently as one a week, while others waited several weeks before needing one. A policy like this will result in fewer catheter changes and much less urinary system stress and symptomatic infections. A blocked catheter should be replaced immediately if the urine flow stops after four to eight hours. When a urinary infection is symptomatic, some doctors advocate changing the catheter.

In order to reduce infection, a number of methods have been employed. For instance, meatal disinfectants and antibacterial urethral lubricants are useless. You may get rid of accumulated dirt by using soap and water to wash your face and body. Prophylactic bladder flushes with antibiotics and hydrogen peroxide, as well as povidone-iodine, are not beneficial. Colonization or infection by resistant organisms happen as a consequence of this process (Conybeare er.al, 2002). Fakih et.al, (2008) asserts within their research that dilution of urine with acetic acid has been suggested by some doctors for individuals with recurrent catheter blockages who have not responded to increased fluid intake or acidity of urine. In addition, no studies have shown that antibiotics, methenamine (Hiprex), or acidifying drugs reduce bacteriuria or infection. The addition of agents to collecting bags has also failed to work as per the CDC’s recommendations for avoiding catheter-associated illnesses. Bladder catheters can be used to empty the bladder or collect urine for testing, depending on the patient’s needs. Catheters can be utilised in a variety of therapeutic conditions, although they are often misused or used for longer periods of time than necessary. Constant monitoring of the catheter’s requirement is critical to preventing problems. External sheath (e.g., condom) catheters, intermittent catheterization, suprapubic catheters, as well as protective clothing should be investigated as alternatives to indwelling urethral catheterization. Cath-associated urinary tract infection prevention is a key emphasis of the suggestions for urinary bladder catheter insertion and management (Chenoweth and Saint, 2013).

There has also been new information about catheter management procedures that lack clinical evidence. For example, the drainage bag may be infused with antibiotics or another addition. The meatus may also be treated with antiseptic substances. It is also important to avoid routine use of systemic antibiotics in individuals requiring short- or long-term catheterization (Gesmundo, 2016).  ICU patients are particularly vulnerable to CAUTIs, which are prevalent and expensive. When CAUTIs occur, the bacteria that cause them tend to be resistant to antimicrobials. Despite research indicating the benefits of measures to prevent CAUTI, many UK healthcare institutions have not implemented these practises. Preventive strategies aimed at restricting the insertion and early removal of urinary catheters have a considerable influence on reducing the incidence of CAUTI. Collaboration, bundling, and hospital leadership are all effective instruments for preventing healthcare-associated infections, such as CAUTI. All healthcare-associated infections (HAIs) account for roughly 40 percent of CAUTIs. Preventing urinary catheter implantation and encouraging early catheter removal are by far the most effective therapies for healthcare-associated UTIs (Saint et.al, 2005). Intermittent catheterization as well as condom catheters should indeed be examined as alternative to long-term indwelling catheter use. To avoid CAUTI, good aseptic catheter insertion, its maintenance, as well as a closed catheter collection system, are critical. Patients at a high risk of CAUTI or its consequences may also benefit from the use of anti-infective catheters if CAUTI rates continue consistently high after compliance to other evidence-based interventions.

Conclusion

Urine catheterization is a frequent treatment for urinary retention and incontinence in individuals receiving home healthcare. However, the widespread use of this procedure does not indicate that catheterization is without major complications or that it is always administered effectively. When all other approaches to urinary system management have been shown to be ineffective or ineffective, catheterization should be seen as a last resort. The catheter should be withdrawn as soon as feasible if an indwelling catheterization is necessary in order to limit the likelihood of problems occurring. It is possible to help reduce catheter-related problems in all contexts where catheterization is performed by following the rules given in this article and sticking to the suggestions. Clinically, infection control refers to the identification and containment of illnesses in order to limit their spread. Even before a definitive diagnosis is made, precautionary measures must be taken to prevent the spread of the infectious virus. Clinically, fewer infections and a decreased chance of the emergence of multidrug-resistant organisms are the consequences of an effective infection control programme.

The key to reducing CA-UTIs is the introduction of national preventative programmes. The CA-UTIs preventive programme enables medical professionals to recognise the size of the problem, the interventions required and the methods successful in avoiding CA-UTIs. Some of the most effective preventative tactics include ensuring that health care personnel are adequately trained and educated about infection control basics, such as correct hand hygiene practises and ways for managing indwelling catheters and urine collection systems, as well as fastening catheters and ensuring that urine flows freely and then a sterile drainage system is securely closed using sterile technique. To alleviate confusion in the treatment of long-term indwelling catheters, data of high methodological quality detailing specific results is required, such as the frequency with which indwelling catheters should be changed in patients without UTIs and techniques for preventing or managing catheter occlusion. Guidelines and policies pursuant to the catheter indications, its selection as well as insertion or maintenance are required to be developed for creating an efficient programme.

Staffing and training, as well as adequate and suitable supplies, are essential. The use of a urinary catheter should be documented, including rationale and times of insertion and removal, as well as a system for storing this information. An electronic patient record should include a record of catheter use, as well as automated reminders for catheter removal. These bundles have been reported as a means of preventing catheter-acquired urinary tract infections. Incorporation of a urinary catheter bundle that includes instruction, catheter placement, and maintenance recommendations are some of the measures which can help in reducing infection risks.

References

Advani, S.D. and Fakih, M.G., 2019. The evolution of catheter-associated urinary tract infection (CAUTI): is it time for more inclusive metrics?. Infection Control & Hospital Epidemiology, 40(6), pp.681-685.

Andrade, V.L.F. and Fernandes, F.A.V., 2016. Prevention of catheter-associated urinary tract infection: implementation strategies of international guidelines. Revista latino-americana de enfermagem, 24.

Carter, N.M., Reitmeier, L. and Goodloe, L.R., 2014. An Evidence-Based Approach To the Prevention of Catheter-Associated Urinary Tract Infections. Urologic Nursing, 34(5).

Charis McCoy, M.S.N., Monica Paredes, B.S.N., Sara Allen, B.S.N., Jennifer Blackey, B.S.N., Carol Nielsen, B.S.N., PhN, R.N., Amy Paluzzi, B.S.N. and Brittney Jonas, B.S.N., 2017. Catheter-Associated Urinary Tract Infections: Implementing a protocol to decrease incidence in oncology populations. Clinical Journal of Oncology Nursing, 21(4), p.460.

Chenoweth, C. and Saint, S., 2013. Preventing catheter-associated urinary tract infections in the intensive care unit. Critical care clinics, 29(1), pp.19-32.

Conybeare, A., Pathak, S. and Imam, I., 2002. The quality of hospital records of urethral catheterisation. Annals of the Royal College of Surgeons of England, 84(2), p.109.

Davis, K.F., Colebaugh, A.M., Eithun, B.L., Klieger, S.B., Meredith, D.J., Plachter, N., Sammons, J.S., Thompson, A. and Coffin, S.E., 2014. Reducing catheter-associated urinary tract infections: a quality-improvement initiative. Pediatrics, 134(3), pp.e857-e864.

Durant, D.J., 2017. Nurse-driven protocols and the prevention of catheter-associated urinary tract infections: a systematic review. American journal of infection control, 45(12), pp.1331-1341.

Fakih, M.G., Dueweke, C., Meisner, S., Berriel-Cass, D., Savoy-Moore, R., Brach, N., Rey, J., DeSantis, L. and Saravolatz, L.D., 2008. Effect of nurse-led multidisciplinary rounds on reducing the unnecessary use of urinary catheterization in hospitalized patients. Infection Control & Hospital Epidemiology, 29(9), pp.815-819.

Fakih, M.G., Pena, M.E., Shemes, S., Rey, J., Berriel?Cass, D., Szpunar, S.M., Savoy?Moore, R.T. and Saravolatz, L.D., 2010. Effect of establishing guidelines on appropriate urinary catheter placement. Academic Emergency Medicine, 17(3), pp.337-340.

Galiczewski, J.M., 2016. Interventions for the prevention of catheter associated urinary tract infections in intensive care units: an integrative review. Intensive and critical care Nursing, 32, pp.1-11.

Gesmundo, M., 2016. Enhancing nurses’ knowledge on catheter-associated urinary tract infection (CAUTI) prevention. Kai Tiaki Nursing Research, 7(1), pp.32-40.

Hebl, J.R., 2006. The importance and implications of aseptic techniques during regional anesthesia. Regional Anesthesia & Pain Medicine, 31(4), pp.311-323.

Hernandez, M., King, A. and Stewart, L., 2019. Catheter-associated urinary tract infection (CAUTI) prevention and nurses’ checklist documentation of their indwelling catheter management practices. Nursing Praxis in New Zealand, 35(1).

Hutton, D.W., Krein, S.L., Saint, S., Graves, N., Kolli, A., Lynem, R. and Mody, L., 2018. Economic evaluation of a catheter?associated urinary tract infection prevention program in nursing homes. Journal of the American Geriatrics Society, 66(4), pp.742-747.

Jain, M., Dogra, V., Mishra, B., Thakur, A. and Loomba, P.S., 2015. Knowledge and attitude of doctors and nurses regarding indication for catheterization and prevention of catheter-associated urinary tract infection in a tertiary care hospital. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine, 19(2), p.76.

Karadag Arli, S. and Berivan Bakan, A., 2018. Development of the catheter-associated urinary tract infections control precautions scale. The Journal of Continuing Education in Nursing, 49(11), pp.507-513.

Liang, C.C., Huang, T.J., Yang, S.H., Su, J.Y., Mu, P.F. and Curia, M., 2019. Prevention of catheter-associated urinary tract infection in neurological post-operation patients: a best practice implementation project. JBI Evidence Synthesis, 17(6), pp.1256-1267.

Lo, E., Nicolle, L., Classen, D., Arias, K.M., Podgorny, K., Anderson, D.J., Burstin, H., Calfee, D.P., Coffin, S.E., Dubberke, E.R. and Fraser, V., 2008. Strategies to prevent catheter-associated urinary tract infections in acute care hospitals. Infection Control & Hospital Epidemiology, 29(S1), pp.S41-S50.

Lo, E., Nicolle, L.E., Coffin, S.E., Gould, C., Maragakis, L.L., Meddings, J., Pegues, D.A., Pettis, A.M., Saint, S. and Yokoe, D.S., 2014. Strategies to prevent catheter-associated urinary tract infections in acute care hospitals: 2014 update. Infection Control & Hospital Epidemiology, 35(5), pp.464-479.

Meddings, J., Manojlovich, M., Fowler, K.E., Ameling, J.M., Greene, L., Collier, S., Bhatt, J. and Saint, S., 2019. A tiered approach for preventing catheter-associated urinary tract infection. Annals of internal medicine, 171(7_Supplement), pp.S30-S37.

Mody, L., Meddings, J., Edson, B.S., McNamara, S.E., Trautner, B.W., Stone, N.D., Krein, S.L. and Saint, S., 2015. Enhancing resident safety by preventing healthcare-associated infection: a national initiative to reduce catheter-associated urinary tract infections in nursing homes. Clinical Infectious Diseases, 61(1), pp.86-94.

Mukakamanzi, J., 2017. Knowledge, attitude and practices of nurses towards the prevention of catheter-associated urinary tract infection in selected Referral Hospitals in Rwanda (Doctoral dissertation, University of Rwanda).

Peter, S., Devi, E.S. and Nayak, S.G., 2018. Effectiveness of Clinical Practice Guidelines on Prevention of Catheter-associated Urinary Tract Infections in Selected Hospitals. Journal of Krishna Institute of Medical Sciences (JKIMSU), 7(1).  Infection Control And Prevention Of Urinary Tract Infections Essay Paper