1. Describe the health problem. Using data and statistics support your claim that the issue you selected is a problem. What specifically will you address in your proposed health promotion program? Be sure your proposed outcome is realistic and measurable.
2. Describe the vulnerable population and setting. What are the risk factors that make this a vulnerable population? Use evidence to support the risk factors you have identified.
3. Provide a review of literature from scholarly journals of evidence-based interventions that address the problem. After completing a library search related to effective interventions for your chosen health promotion activity, you will write a review that evaluates the strengths and weaknesses of all the sources you have found. You might consult research texts for information on how to write a review of the literature found in your search.
4. Select an appropriate health promotion/disease prevention theoretical framework or conceptual model that would best serve as the framework guiding the proposal. Provide rationale for your selection which includes discussion of the concepts of the selected model
5. Propose a health promotion program using an evidence-based intervention found in your literature search to address the problem in the selected population/setting. Include a thorough discussion of the specifics of this intervention which include resources necessary, those involved, and feasibility for a nurse in an advanced role. Be certain to include a timeline. (2 to 4 paragraph. You may use bullets if appropriate).
6. Thoroughly describe the intended outcomes. Describe the outcomes in detail concurrent with the SMART goal approach. (1 paragraph).
7. Provide a detailed plan for evaluation for each outcome. (1 paragraph). 
8. Thoroughly describe possible barriers/challenges to implementing the proposed project as well as strategies to address these barriers/challenges. (1 paragraph).
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Infection Prevention and Spread in Patients with Foley Catheters
Katrina Collazo de Armas
Florida National University
Health Promotion and Development: NRG6636
Prof. Alexander Garcia Salas
07/02/2022
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Infection Prevention and Spread in Patients with Foley Catheters
The health problem is catheter-associated urinary tract infections (CAUTI). According to
the Center for Disease Control and Prevention (2019), UTIs are commonly reported healthcareassociated infections. Over 75% of UTIs are directly associated with using a foley catheter.
About 15-25% of patients use foley catheters (CDC, 2019). Over 150 million people are
diagnosed with CAUTIs every year across the globe. As of 2019, consultation of CAUTI was
6% of all medical visits (Medina & Castillo-Pino, 2019). Healthcare providers manage over
seven million CAUTI cases, which increases healthcare costs by over $1.6 billion annually
(Medina & Castillo-Pino, 2019). The specific issue to address is preventing the spread of CAUTI
in a patient using foley catheters. The promotion program will stress the importance of using
foley catheter for appropriate indication and immediate removal of foley catheters when it is no
longer needed. The outcomes are: reduced prevalence of CAUTI, improved communication
between clinicians, and high compliance with CDC guidelines to prevent the spread of infections
among patients using foley catheters.
Vulnerable Population
There is an increasing number of patients with urine-related problems who use foley
catheters because they cannot urinate on their own. A Foley catheter can be placed in the catheter
to help drainage of urine, increasing the risk of catheter-associated urinary tract infections
(CAUTI) (Menegueti et al., 2019). The vulnerable population identified is the patient using a
foley catheter. CAUTI occurs when bacteria enter the body through the indwelling foley
catheters. The bacteria causes an infection in the bladder, kidney, and urethra (CDC, 2019). The
healthcare providers recommend using foley catheters for patients with urinary retention, urinary
incontinence, and surgical operation of the genitals or prostrate (Anggi et al., 2019). Urinary
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incontinence is common among the elderly and occurs when a person cannot control when
urinating or leaking urine. Urinary retention is characterized by the inability to urinate or empty
the bladder when needed. Patients use foley catheters if they have benign prostatic hyperplasia,
lower body paralysis, Parkinson’s disease, multiple sclerosis, trauma, or pelvic organ prolapse
(Anggi et al., 2019).
There are various risk factors for patients using foley catheters. First is the prolonged use
of urinary catheters. Using foley catheters for more than the recommended use increases the
chance of bacteria traveling into the body and infecting the urinary system leading to CAUTI.
The recommended duration for catheter use should be three to eight days (Anggi et al., 2019).
The other risk factor for CAUTI is gender; over 60% of women using foley catheters have a risk
of having CAUTI; 12% of men using foley catheters are at risk of developing CAUTI (Medina &
Castillo-Pino, 2019). The other risk factors of CAUTI are the severity of illness, pregnancy, fecal
incontinence, and poor nutrition. The existence of underlying health conditions increases the use
of foley catheters. Since the CDC recommends using foley catheters in the short-term and
discontinuation when it is never needed, existing health condition hinders discontinuation,
increasing the risk of CAUTI (Anggi et al., 2019).
Review of Literature
The quasi-experiment conducted by Menegueti et al. (2019) investigated the impact of
implementing a daily checklist and a healthcare workers’ education program for indication of
indwelling catheters among patients using foley catheters on the incidence of CAUTI. The
identified gap is that the most effective approach to preventing CAUTI is the removal of foley
catheters as soon as it is no longer needed (Menegueti et al., 2019). However, compliance with
the measure in the clinical setting is very challenging. The study found that the mean rate of
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utilizing the catheter decreased significantly from phase one to phase four, from 73.1% to 74.1%
to 54.9% to 45.6%(Menegueti et al., 2019). Also, after using the two interventions, the incidence
density of CAUTI declined from phase one to phase four for every 1o00 catheter-utilization days
as follows; from 14.9 to 7.3 to 3.8 and then 1.1 (Menegueti et al., 2019). The researchers
concluded that healthcare workers’ education and use of a checklist for daily evaluation of
indwelling urinary catheter indications are highly effective strategies for reducing the long-term
use of foley catheter utilization and reducing the incidence density of CAUTIs.
Vascular and indwelling urinary catheters are important devices for patient care.
However, prolonged use of the devices increases non-infectious and infectious catheter risks.
Quinn et al. (2020) researched to understand the barriers hindering effective removal and
detection of unnecessary catheters. Major factors contributing to prolonged use of foley catheters
are a high number of unnoticed catheters/catheters hiding under the cloths, the high use of Do
Not Remove” orders from healthcare providers caring for the patient, and few discussions on
evidence-based practices for catheter use among healthcare providers (Quinn et al., 2020). The
data themes that emerged in the study responsible for the high prevalence of CAUTI among
patients using foley catheters are lack of standard protocol for using CAUTI; confusion that
catheter removal is not a priority among clinicians, and communication barriers (Quinn et al.,
2020). The evidence-based interventions for addressing the barriers to preventing CAUTI
include increasing access to catheter data, implementing standardized catheter removal protocols,
and streamlining communication to facilitate discussion among clinicians.
Source Evaluation
The first source by Menegueti et al. (2019) was published three years ago, which makes it
an important source of current evidence for supporting investigated variables. The study results
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are relevant to the proposal because the article was written to help experts, healthcare providers,
and learners learn evidence-based strategies that can be implemented in a clinical setting to
prevent CAUTI. The source is authoritative because it is written by experts in the nursing field.
The source provides a thorough analysis of how the research was conducted and why the
researcher chose to investigate the selected variables. All strategies used to reduce CAUTI are
explained, and how some of the strategies, such as reducing the duration of foley catheter
insertion, are difficult to implement in clinical settings. The source provides level III evidence
that daily evaluation of foley catheter indications and healthcare workers’ education effectively
reduces CAUTI. Lastly, the aim of the source aligned with the methodological approach and the
conclusion. The source is credible and reliable for supporting the proposal.
The second source by Quinn et al. (2020) provided evidence-based findings that CAUTI
caused by improper use of foley catheters can be better managed by addressing the persistent
barriers hindering the timely removal of an indwelling catheter. The multimethod qualitative
approach used in the study facilitated data collection through observation and in-person
interviews. The course was published two years ago; thus, it provides current and reliable
findings for supporting the current issue. The qualitative content analysis facilitates the
generation of results based on evidence, making the article authoritative, accurate, and
purposeful. The investigated topic by the researchers aligns with the aim of the research
proposal. Therefore, it provides valid information for supporting the background of the study. All
the assertions made in the source are supported by prior evidence. The resource provides
evidence-based findings that increasing access to catheter data on time, implementing
standardized catheter removal protocols, and establishing delineated roles of clinicians in
removing foley catheters in patients prevents and reduces CAUTI (Quinn et al., 2020).
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Appropriate Health Promotion Conceptual Model
Strategies for preventing infections
Use a checklist for
daily evaluation of
indwelling urinary
catheter indications
Healthcare workers
education
Increasing access to
catheter data
Outcomes
•
Decline in CAUTI prevalence rate.
•
High compliance with CDC
guidelines for preventing CAUTI.
Implementation of
standardized catheter
removal protocols
•
Improved communication between
clinicians
Streamlining
communication to
facilitate discussion
among clinicians.
The framework above shows evidence-based strategies that can be effectively integrated
into clinical care to prevent the spread of infections in patients using foley catheters. The health
promotion model represents all best practices approved by other research that are effective in
reducing the spread of infection. There are no stand-alone strategies found for health promotion
proposals which necessitate the need to integrate all the strategies to maximize outcomes. Using
a checklist for daily evaluation of indwelling urinary catheter indications is important because it
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increases compliance. (Menegueti et al., 2019) It also helps determine individual performance in
complying with CAUTI prevention measures based on set metrics.
Training of healthcare providers improves their understanding of CAUTI and the most
practical approaches for preventing CAUTI over others (Menegueti et al., 2019). Increasing
access to catheter data lowers prolonged use. Implementation of standardized catheter removal
protocols increases compliance with the best care practice. Lastly, streamlining communication
improves clinician discussion when caring for a patient using a foley catheter (Quinn et al.,
2020). Also, it improves the handover process. The expected outcomes are; a decline in CAUTI
prevalence rate, high compliance with CDC guidelines for preventing CAUTI, and improved
communication between clinicians.
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References
Anggi, A., Wijaya, D. W., & Ramayani, O. R. (2019). Risk factors for catheter-associated
urinary tract infection and Uropathogen bacterial profile in the intensive care unit in
hospitals in Medan, Indonesia. Open Access Macedonian Journal of Medical
Sciences, 7(20), 3488-3492. https://doi.org/10.3889/oamjms.2019.684
Centres for Disease Control and Prevention. (2019, April 16). HAI
data. https://www.cdc.gov/hai/data/index.html
Medina, M., & Castillo-Pino, E. (2019). An introduction to the epidemiology and burden of
urinary tract infections. Therapeutic Advances in Urology, 11,
175628721983217. https://doi.org/10.1177/1756287219832172
Menegueti, M. G., Ciol, M. A., Bellissimo-Rodrigues, F., Auxiliadora-Martins, M.,
Gaspar, G. G., Canini, S. R., Basile-Filho, A., & Laus, A. M. (2019). Long-term
prevention of catheter-associated urinary tract infections among critically ill patients
through the implementation of an educational program and a daily checklist for
maintenance of indwelling urinary catheters. Medicine, 98(8),
e14417. https://doi.org/10.1097/md.0000000000014417
Quinn, M., Ameling, J. M., Forman, J., Krein, S. L., Manojlovich, M., Fowler, K. E.,
King, E. A., & Meddings, J. (2020). Persistent barriers to timely catheter removal
identified from clinical observations and interviews. The Joint Commission Journal on
Quality and Patient Safety, 46(2), 99-108. https://doi.org/10.1016/j.jcjq.2019.10.004

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