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    Indwelling urinary catheter on gastro ward

    Introduction

    I am a nurse associate working in the gastroenterology ward. My current responsibility is to provide care to those patients having an indwelling urinary catheter in their body admitted to the gastroenterology ward. The patients admitted in the gastroenterology ward are likely to be infected by Urinary Tract infection (UTI). This can be due to the inaccurate catheterization and inefficiency of the nurses. Thus, the essay aims to denote the threats associated with indwelling urinary catheter and generation of effective medical care to those patients admitted in the gastroenterology ward of the hospital. Additionally, the essay highlights the importance of effective nursing practices that can help the patients to get rid of the threats associated with catheterization. As UTI is a common infection associated with catheterization, the effective nursing approach can solve this problem.        

    Discussion

    Indwelling Urinary Tract Catheterization

    IUTC (Indwelling Urinary Tract Catheterization) is a serious intervention that is normally required by the patients admitted to the gastroenterology department of the hospital. It is calculated that more than 12% of the patients admitted in the hospitals and more than 3.5% person in the community encounter indwelling urinary catheter at any given time (Al Nasser et al., 2016). About 55 of the catheterized patients develop UTI each day on a global basis. Additionally, this infection is associated with bacteremia in more than 4% of the patients. UTI is a common problem of the patients of the gastroenterology ward as the hospital units have the presence of numerous bacteria. The infection is mainly recognized when symptoms such as fever, stones in the urinary tract, chronic renal inflammation and pyelonephritis are observed (Chandramohan et al., 2018). Moreover, IUTC increases the duration of the patient's stay in the hospital that increases the healthcare cost for the patient. However, the inaccuracy of the input of indwelling catheters is observed in the hospitals and thus, promotion of care regarding this subject has become significant. Thus, the risks of UTI infection increases and this can occur due to inefficiency or incompetence of the nurses. Hence, an effective promotional strategy like social media promotional events, implementation of posters outside the gastroenterology ward, awareness slogan through brochures or flyers, etc. can create awareness among the patients and the medical practitioners. Nurses and healthcare practitioners must be reminded of the removal of unnecessary urinary catheters. This will help to reduce the chances of urinary tract infections in the gastroenterology ward of the hospitals. The gastroenterology ward is responsible for treating patients with severe gastrointestinal problems and ineffective care of the patients undergoing surgeries can lead to serious health issues. The UTIs are severe in these patients and the infection can reach the intestinal parts if not treated effectively. Besides promotional care, basic training must be provided to the nurses and other medical practitioners so that they can carry out the IUTC approach effectively. Asymptomatic catheter must not be treated associated with bacteriuria. In comparison to this, hospital-acquired UTIs are enormous in patients who are admitted in the gastroenterology ward after operations. In this regard, BCFC (Bacterial Colonization on Foley's (urethral) Catheters) shows positive responses for UTIs as compared to a culture report of urine (Falcone et al., 2019). The rate of UTIs is increasing due to the ineffective handling of the catheters by the nurses. Hence, promotional events are necessary for both the nurses and patients so that they can understand the importance of safe and hygienic practices in leading a healthy life after surgeries. Thus, after the initial days of post-surgeries, the patients of the gastroenterology ward are tested with BCFC so that the rate of UTIs can be identified. Indwelling urinary catheters are attached to the patients once they are admitted to the hospital for gastroenterology surgeries (Saint et al., 2016). This helps in the natural excretion process of the patients. As the catheter is directly attached to the inner side of the body, any bacterial infection can reach the inner parts of the body through the Urinary tract. This can cause either urinary tract infections or significant blood infections. The inner side of the patient's body is directly exposed to the bacteria and thus, can lead to chronic infection in the body. Thus, numerous policies and frameworks are developed by the medial council so that nurses deliver quality medical care to the UTI affected patients. Inappropriate care and unethical practices that can affect the patient's health can lead to severe punishment for the nurses and other healthcare practitioners associated with the patient. Different IUTC placement guidelines are developed by the medical ethical committees that create a distinction between inappropriate and accurate catheterization obscure. 

    Policies and procedures

    Numerous policies must be considered by a nurse while treating a patient with an indwelling urinary catheter. In my gastroenterology ward, different hygiene policies are maintained so that the patients are not infected by severe UTI. These policies are:

    Replacement of catheters- The replacement of catheters is associated with the assigned time and it varies according to the local policies set by the hospitals. In my hospital, the catheter replacement procedure is related to numerous hygienic policies and thus, demands on-time catheter replacements of the patients (Redder et al., 2016). This is because patients are likely to encounter UTIs post-surgery. Thus, policies are implemented in every ward of my hospital to alert the nurses and other healthcare practitioners of the adverse outcomes of UTIs. However, an appropriate time interval for catheter replacement varies among patients depending on their medical conditions and their respective departments. My role is to maintain the replacement time of the catheters so that biofilm development is reduced that acts with harbor bacteria (Girard et al., 2015). Additionally, it also reduces the affinity to mechanical blockage. However, my training suggests me to keep a track of the patient's catheter replacement schedule, as a frequent replacement can develop UTIs.

    Prophylactic measures via Antibiotics- The patients subjected to the long-term indwelling urinary catheter are given antibiotics to prevent UTIs. However, prescribing prophylactic antibiotics is increasing the rate of resistant microorganisms (Liu et al., 2018). However, as there is a lack of adequate literature that can provide help so that this step can be altered is still under discussion phase. Thus, as a nurse associate my responsibility is to check the patients' conditions after providing prophylactic measures to them.

    Cleaning solutions- Numerous solutions are in practice that can be used while replacing catheters. This includes sterilized water, povidone?iodine, and chlorhexidine gluconate. The cleaning method must include cleaning of the periurethral area, as well as the perineal region (Herzig et al., 2016). Thus, as a nurse associate my responsibility is to ensure that all the catheters being supplied to the gastroenterology ward are cleaned with appropriate cleaning solutions.   

    Infection control through hygiene- The manipulation of the urinary catheter can lead to serious infections of the urinary tract. Sterile gloves must be used before applying an indwelling urinary catheter (Jones et al., 2019). Additionally, the drainage system must be accessed so that urine bags are not contaminated. This is of prior importance so that the patients, as well as the nurses, are not infected by harmful germs.

    Catheter replacement techniques- The long-term indwelling urinary catheters can be restored by personal carers, nurses or other medical care personnel. This procedure can be carried out either at their homes or in hospitals or other medical centers. At home, this procedure is assisted by healthcare professionals or by healthcare clinicians at nursing homes (Lenherr et al., 2016). In my gastroenterology ward, catheter replacement is performed using an aseptic or a clean approach. A clean approach is usually referred to as the use of non-sterile gloves. Additionally, this also involves cleaning of the exterior external urethral opening and its surroundings using a non-antiseptic solution. Moreover, an aseptic approach involves the usage of sterile gloves, antiseptic cleaning solutions, non-touch methods, and sterile barriers. The gastro ward of my hospital has specific clinical settings so that they can provide hygienic care to the indwelling urinary catheter issues.

    Use of lubricants- The use of lubricants is a common approach to apply urethral catheterization. This is due to the easy insertion of catheters so that patients experience comforts (Jump et al., 2018). Additionally, it contains a local anesthetic and antiseptic solutions. The application of lubricants can be easily incorporated into a clean or aseptic catheterization technique.

    As a nurse associate my responsibility is to maintain effective hygienic conditions within the gastroenterology ward. This will help both the patients, as well as the medical practitioners to remain unaffected from the harmful microorganisms. This is especially applicable to the patients who have been implemented with an indwelling urinary catheter.

    Conclusion

    The essay explores my responsibilities as a nurse associate in the gastroenterology ward so that the patients are not affected by UTIs who have been applied with an indwelling urinary catheter. The most important part of this essay is the policies adopted by the gastroenterology ward of my hospital to promote the adversities associated with UTIs. It usually occurs when the patients develop from long term indwelling urinary catheters. Thus, a nurse's responsibility is crucial to handle the patients so that they do not develop serious UTIs during their stay in the hospital.

     

     

    References

    Al Nasser, W., El-Saed, A., Al-Jardani, A., Althaqafi, A., Alansari, H., Alsalman, J., Al Maskari, Z., El Gammal, A., Al-Abri, S.S. and Balkhy, H.H., 2016. Rates of catheter-associated urinary tract infection in tertiary care hospitals in 3 Arabian Gulf countries: A 6-year surveillance study. American journal of infection control44(12), pp.1589-1594.

    Chandramohan, S., Navalkele, B., Mushtaq, A., Krishna, A., Kacir, J. and Chopra, T., 2018, July. Impact of a multidisciplinary infection prevention initiative on central line and urinary catheter utilization in a long-term acute care hospital. In Open forum infectious diseases (Vol. 5, No. 7, p. ofy156). US: Oxford University Press.

    Falcone, M., Tiseo, G., Dentali, F., Foglia, E., Campanini, M., Menichetti, F. and Mazzone, A., 2019. Early alert from microbiology laboratory improves the outcome of elderly patients with Enterococcus spp bacteremia: results from a multicenter prospective study. Journal of global antimicrobial resistance.

    Girard, R., Gaujard, S., Pergay, V., Pornon, P., Gaujard, G.M., Vieux, C., Bourguignon, L. and Group, U.T.I.C., 2015. Controlling urinary tract infections associated with intermittent bladder catheterization in geriatric hospitals. Journal of Hospital Infection90(3), pp.240-247.

    Herzig, C., Dick, A., Castle, N. and Stone, P., 2016. Policies and Practices to Reduce Urinary Tract Infections in Nursing Homes. American Journal of Infection Control44(6), p.S20.

    Jones, L.F., Meyrick, J., Bath, J., Dunham, O. and McNulty, C.A.M., 2019. Effectiveness of behavioural interventions to reduce urinary tract infections and Escherichia coli bacteraemia for older adults across all care settings: a systematic review. Journal of Hospital Infection102(2), pp.200-218.

    Jump, R.L., Crnich, C.J., Mody, L., Bradley, S.F., Nicolle, L.E. and Yoshikawa, T.T., 2018. Infectious Diseases in Older Adults of Long?Term Care Facilities: Update on Approach to Diagnosis and Management. Journal of the American Geriatrics Society66(4), pp.789-803.

    Lenherr, S.M., Clemens, J.Q., Braffett, B.H., Cleary, P.A., Dunn, R.L., Hotaling, J.M., Jacobson, A.M., Kim, C., Herman, W., Brown, J.S. and Wessells, H., 2016. Glycemic control and urinary tract infections in women with type 1 diabetes: results from the DCCT/EDIC. The Journal of urology196(4), pp.1129-1135.

    Liu, Y., Xiao, D. and Shi, X.H., 2018. Urinary tract infection control in intensive care patients. Medicine97(38).

    Redder, J.D., Leth, R.A. and Møller, J.K., 2016. Analysing risk factors for urinary tract infection based on automated monitoring of hospital-acquired infection. Journal of Hospital Infection92(4), pp.397-400.

    Saint, S., Greene, M.T., Krein, S.L., Rogers, M.A., Ratz, D., Fowler, K.E., Edson, B.S., Watson, S.R., Meyer-Lucas, B., Masuga, M. and Faulkner, K., 2016. A program to prevent catheter-associated urinary tract infection in acute care. New England Journal of Medicine374(22), pp.2111-2119.

     

     

    Appendix

     

     

     

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