Catheter-Associated Infections: Systematic Review Research Paper

Abstract

The systematic review is devoted to the consideration of the reasons for urinary tract infection and the measures which are to be taken in order to reduce the cases of contamination. The focus of this paper is the research based on defining a minimized introduction of microorganisms for adult patients with short-term insertion or removal of a catheter in comparison with no risk of infection. The review shows that there is no specific difference whether sterile or nonsterile catheter technique takes place as simple water cleaning may help. Besides, the review shows that personal hygiene around the meatal area is important as failure to do it may cause serious urinary tract infections. Additionally, the review points to several techniques which are to be utilized in order to reduce infection.

Pico Question

What would minimize the introduction of microorganisms for adult patients with short-term insertion or removal of a catheter in comparison with no risk of infection?

Discussion of Systematic Review for the PICO Components

P: adult patients

I: short-term insertion or removal of a catheter

C: no risk of infection during insertion or removal of a catheter

O: minimized introduction of microorganisms for adult patients with short-term urinary catheter

The authors’ objectives for the systematic review

The main objective of the selected review conducted by Sandeep Moola and Rie Konno (2008) was to consider as much research in the sphere of the reasons of the urinary tract infection as possible with the purpose to define the best evidence aimed at preventing contamination associated with the utilization of sterile catheter technique vs. nonsterile one in a short-term period. The review gathered information devoted not only to the sterile catheterization as one of the ways of infection but also to the “introduction of microorganisms into the urinary system during catheterization” was used along with the preventing intraluminal and extraluminal contamination of urinary catheters (Moola & Konno, 2008, p. 698).

The authors’ search process and the criteria to include studies in the review.

Criteria. The review was based on the credible published and unpublished studies found in the following databases, MEDLINE, CINAHL, Current Contents, Expanded Academic Index, Cochrane Library, Embase EBM Reviews, EMBASE, Scopus, TRIP, and Biomed Central. The selection of the studies lies in consideration of the keywords which were noticed in the titles of the studies and abstracts. This was the first stage of the review. At the second stage of the study, the authors referred to the index terms. Finally, at the third stage, the reference lists and biographies were considered for identifying relevant articles. The articles are included only in case all the following aspects are included: the guidelines, the case-study control, the relevant intervention, and the firm outcomes.

Data Collection and Evaluation. As a result, Moola and Konno (2008) selected the following data from the studies, the year of the intervention and publishing of the research results, design, setting and sample, age and gender of the participants, intervention, and its outcomes. Having gathered all the relevant information from the studies in the mentioned databases, which contained the necessary information and met the stated criteria, the authors of the review used the checklist developed by the Joanna Briggs Institute. All the articles were considered in accordance with that checklist.

Synthesis of the Findings. The data gathered and considered was synthesized by means of the Cochrane Collaboration Review Manager Software meta-analysis. Moola and Konno (2008) did not find comparable studies. Therefore, it was impossible for them to create a statistical analysis of the study. As a result, the outcomes of the research were presented in a narrative way. However, a table was created where the main categories of the six selected studies were presented.

Effectiveness of the Interventions

Six selected interventions used for this review were effective for several reasons. First, the sample size allowed Moola and Konno (2008) to generalize the results, which was very important. Second, the interventions were effective and argumentative. Moreover, the outcomes and outcome measures also met the requirements. The authors of the review considered the following intervention issues, “catheterization technique, meatal care, bladder irrigation, drainage systems, indwelling versus intermittent catheterization, and education” (Moola & Konno, 2008, p. 701).

Similarities and Differences of the Effects Found between the Studies

Dwelling upon similarities and differences in the research, it is important to state that the research objectives in different studies were various. Therefore, the comparison was impossible. Focusing on different aspects and possible reasons for urinary tract infection, the authors of the review managed to find one new technique applicable to the removal of the catheter system. In most cases, the studies under consideration supported the hypotheses aimed at reducing the cases of urinary tract infection and creating a supportive environment for faster recovery and absence of extra movement. Thus, the research helped to prove that many of the contemporary used techniques and solutions were unnecessary. The research results which may be applied in practice are considered in the following section.

How the Results Could Be Applied to the PICO Question in Clinical Practice

The review offers the following implications for practice. First, water is enough for cleaning genitalia as a part of the hygiene around the meatal area. Besides, to be effective, the procedure is to be conducted daily. Second, the authors of the review state that the silver-impregnated catheters may be more effective. However, the study has not shown the category of patients who may benefit from this application as well as the cost efficiency is not calculated. Third, sealed drainage systems are not to be used as the sole mechanism for the elimination of the infection case. Fourth, antibacterial solutions should not be added to the drainage bags due to their inefficacy as well as the authors of the research do not see the efficiency of the drainage changes for any reason apart from the clinical need. Finally, the catheter should be removed as early as possible as this prevents urinary tract infection.

Conclusion

Therefore, it should be concluded that the review conducted by Moola and Konno (2008) was effective and credible. The authors excluded numerous research projects and studies that did not correspond to the selected criteria and analyzed only the ones whose results were credible and could be generalized. The research question was answered in the review. The intervention is one of the studies that proved that it did not matter whether sterile or nonsterile catheterization was applied. Personal hygiene of the meatal area was crucial. The process could be provided using tap water with the requirement that the procedure is taken every day. Therefore, the case under consideration where nurses used nonsterile techniques of catheterization was not harmful and did not put the patient in the group of increased risk for urinary tract infection.

Reference List

Moola, S., & Konno, Rie. (2008). A systematic review of the management of short-term indwelling urethral catheters to prevent urinary tract infections. JBI Library of Systematic Reviews, 8(17), 695-729.