Reducing CAUTI With 2% Chlorhexidine Washcloths: Data Analysis and Discussion

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Data Analysis

This section will report the analysis of the data gathered as a part of a project which investigates reducing catheter-associated urinary tract infections (CAUTIs) in older patients. The project had two samples: the staff, who were involved in CAUTI prevention training, and the patients, who were bathed with 2% chlorhexidine gluconate washcloths. For the staff, the demographic data were collected, and their CAUTI prevention abilities were measured before and after the training session (see Appendix A for the tool). Table 1 summarizes the demographics of the sample, as well as the averages of their scores.

Table 1. Demographics Summary (Staff).

Category Numbers of Participants
Profession
CNA 13
Nurse 13
Experience
Experience: 1 Year 3
Experience: 2-5 Years 6
Experience: 6-10 Years 9
Experience: >10 Years 8
Age
Age: 18-30 6
Age: 31-40 9
Age: 41-50 6
Age: 51-60 5
Age: 61-70 1
Gender
Female 26
Male 0
Scores
Average Pre-Training Score 8
Average Post-Training Score 10

Having computed the CAUTI prevention scores of the participants prior to and after training (see Table 1), the project searched for a statistically significant difference between them. The Wilcoxon Signed Ranks Test was chosen for the purpose due to the specifics of the datasets (Polit & Beck, 2017). It showed that p=0.004 (see Table 2), which proves that the training has had an impact on this variable.

Table 2. Wilcoxon Signed Ranks Test for the CAUTI Nurse Survey Results.

Post  Pre
Z -2.909b
Asymp. Sig. (2-tailed) .004
a. Wilcoxon Signed Ranks Test
b. Based on negative ranks.

The patient CAUTI status was determined with the help of dipstick urinalysis. As can be seen from Table 3, which summarizes the results and specifies the dates of data collection, tests returned positive for leukocytes for 100% of the patients; 40% of them also had nitrite in their urine. However, none of them presented with any CAUTI symptoms, which is why it was determined that they could be enrolled in the project. One of the patients (Star 9093) had to be transferred to another site for reasons that were not related to the project. The rest of the patients showed no changes in their analyses (or symptoms) during the post-test data collection. Since no differences between the measurements exist, no statistical analysis beyond descriptive statistics (percentages) has been applied to these data.

Table 3. Pre and Post Urinalysis Results for Patients.

Patient Code Leukocyte
Pretest
Nitrite
Pretest
Date Leukocyte
Posttest
Nitrite
Posttest
Date
Star 9090 +  8/22/19 +  8/30/19
Star 9091 + + 8/22/19 + + 9/07/19
Star 9092 + + 8/22/19 + + 9/07/19
Star 9093 +  8/22/19 N/A N/A N/A
Star 9094 +  8/23/19 +  9/06/19

Data Discussion

This section will present a discussion of the findings of the CAUTI prevention project. The analysis of the nursing staffs data suggests that the nurses and nursing assistants were all women; the majority of them were older than 30 and relatively experienced. Furthermore, their scores showed a statistically significant improvement as a result of the CAUTI prevention training that they received. The purpose of this part of the project was to ensure that the nursing staff could employ the projects intervention (washcloths) correctly. The analysis results prove that the training was effective, the implication being that the staff should have been able to apply the washcloths.

In addition, the training was helpful as a quality improvement effort since it resulted in some meaningful improvement of the participants knowledge; the implication is that it can be recommended for future efforts. However, the training was tested with a limited sample (26 people) in one institution; also, all of the participants were female, although a level of diversity in age and experience could be observed. Therefore, this implication should be considered with all the related limitations.

The patient data demonstrate no changes in the patients health before and after the application of chlorhexidine washcloths. Therefore, the findings suggest that the patients did not develop new CAUTIs during the project, which is in line with the very strong evidence that indicates the effectiveness of the washcloths bathing in CAUTI prevention (Huang, Chen, Wang, & He, 2016; Noto & Wheeler, 2015). However, the intervention was applied to only a few patients who had already tested positive for leukocytes prior to the interventions implementation, which is a limitation.

To summarize, the project presents relatively strong evidence to the effectiveness of the projects training, but its evidence to the preventative qualities of 2% chlorhexidine gluconate washcloths is less notable. The sampling limitations are the main ones to consider when discussing the implications of the project. The training can be recommended in other similar cases, and the lack of CAUTI development in the sample can be considered a contribution to the pool of the data indicating the effectiveness of washcloths in preventing CAUTIs.

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. Web.

Noto, M., & Wheeler, A. (2015). Understanding chlorhexidine decolonization strategies. Intensive Care Medicine, 41(7), 1351-1354. Web.

Polit, D.F., & Beck, C.T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.

Appendix A

Data Collection Tool (Self-Assessment)

Demographic Characteristics (circle)

Gender Age Category
Male Female 18-30
Employment role 31-40
Nurse 41-50
CNA 51-60
PCT 61-70
Experience 1 year or < 2-5 years, 6-10 years >10 years
Response Key (Circle Response to each question/statement below)

1. Strongly agree 2. Agree 3. Neither agree
Nor disagree
4. Disagree 5. Strongly
disagree
6. Do not know
Long-term use of Urinary catheters, such as Foley or suprapubic is appropriate for the following conditions:
  • Urinary retention that cannot be managed by intermittent catheterization

1 2 3 4 5 6

  • Large pressure ulcers

1 2 3 4 5 6

  • Terminal illness that makes bed clothing changes uncomfortable for the resident

1 2 3 4 5 6

The following questions concern personal hygiene when caring for residents with indwelling urinary catheters:
  • I cleanse my hands with soap and water or alcohol-based hand rub before urinary catheter manipulation

1 2 3 4 5 6

  • It is not necessary to cleanse hands after casual contact, such as taking pulse or adjusting their position with residents with urinary catheter

1 2 3 4 5 6

  • If my hands are not soiled, hand hygiene with alcohol-based hand rub is adequate after manipulation of catheter site

1 2 3 4 5 6

  • It is not necessary to wash my hands with soap and water after removing gloves

1 2 3 4 5 6

  • Gloves must be worn when caring for residents with indwelling urinary catheter

1 2 3 4 5 6

The following measures should be taken for care of residents with indwelling urinary catheter
  • Area around urinary catheter cleansed at least once a day

1 2 3 4 5 6

  • Catheter should be changed once a month

1 2 3 4 5 6

  • Catheter and its bag can be temporarily disconnected

1 2 3 4 5 6

  • Catheter should be irrigated once per week

1 2 3 4 5 6

  • Catheter can be inserted for nursing staff convenience

1 2 3 4 5 6

  • CAUTI is not a very serious illness

1 2 3 4 5 6

  • Education regarding basic catheter care helps prevent CAUTI

1 2 3 4 5 6

  • Catheter care is done in a one-way manner from the meatus to the connection to the drainage bag

1 2 3 4 5 6

  • Catheter should be removed whenever it is convenient for hospital care professionals

1 2 3 4 5 6

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