Urinary tract infections, or UTIs, are the most encountered problem in urology (Jackson). Each year, more than 7 million women present with urinary tract infections (Ebell). A large number of women who think they have UTIs actually do, but there exists patients who present with UTI symptoms. In order to determine proper diagnosis and treatment, a systematic, evidence-based practice is necessary. Evidence-based practice exists at several levels, with the highest consisting of the highest sensitivity of diagnostic tests, systematic reviews, and randomized controlled trials (Jackson).
Diagnostic tests and systematic reviews allowed clinical decision rules to be made to help diagnose UTI. However, a positive urinalysis for UTI is seventy-five percent sensitive and eighty-two percent specific for UTI, which means that eighty-one percent of women with a positive urinalysis will actually have a UTI and seventy-seven percent of patients with a negative urinalysis will not (Ebell). Judging by this, UTI cannot be ruled out even if a patient has had a negative urinalysis.
In spite of the imperfect sensitivity and specificity of urinalysis to diagnose UTI, in an emergency department of a health care facility, patient history, physical examination, and urinalysis pinpointed five variables that impacted the diagnosis of UTI: previous UTI; back pain; more than fifteen WBC per HPF; more than a few bacteria in the urine; and more than 5 RBC per HPF (Ebell). In contrast, the “expert opinion” is the lowest EBP framework category (Jackson). In the absence of urinalysis and other diagnostic testing, algorithms are available for nurse use to evaluate possible instances of UTI (Ebell).
Once diagnosis is achieved, implementation of care can be achieved with different antibiotics. Factors such as patient age could add complications, and can result in contextual antibiotic treatment. In light of studies showing varying courses in antibiotic treatment of patients of varying ages, for healthy women aged 65 and older, physician judgment can be the deciding point between shorter or longer courses of antibiotic treatment (Ebell). Furthermore, UTIs deemed “complicated” occur in women who also have diabetes mellitus, chronic renal disease, immunosuppression, and other diseases, syndromes, or irritations.
Such patients are in need of longer, broader doses of antibiotics following urine culture and empiric therapy (Ebell). Urinary tract infections can also occur in urinary catheterization. Dangers include over usage or inappropriate use of catheterization, which prompted bacteremias and gram negative infections in patients; only such evidential indicators such as neurogenic bladder and urinary retention or obstruction may permit the use of urinary catheters (Angelo). In one pilot study at NDU, a project checklist was made using Sackett’s evidence-based practice definition, regarding proper urinary catheter management (Adams and Cooke).
Possible practice guidelines include daily assessment by the nurse, who would be using an approved, validated, and reliable auditing tool (Angelo). Practice change would occur after the auditing and evaluation of catheter management. Catheters orders not meeting evidence-based guidelines would be discontinued and anchoring devices for the catheters would be used to minimize mechanical damage or dislodgement and trauma from catheterization (Angelo). Evidence-based practice makes use of data in order to provide an amenable result of lowered hospital-acquired infections, cost savings, and efficiency.
For instance, such data would include percentage of catheters inserted in the emergency department and of those, the percentage of catheters inserted in light of evidence-based indicators, such as urinalysis. The number of catheter days, numbers of catheters discontinued, and the usage of anchoring device are also useful data to consider in practice change (Angelo). Future recommendation would be to circulate the knowledge gained from an evidence-based approach in which a decrease in catheter days and a decrease in infection rates is the end result.
In conclusion, UTIs are one of the most common urologic diagnoses regardless if the infection results from urinary catheterization or from other causes. The successful lowering of numbers of cases of UTIs and treatment of UTIs can be met with a systematic, evidence-based effort in which nurses can take a large part. By following guidelines and practice changes at the behest of evidence-based practice, future health care would benefit both in cost savings as well as patient health.
WORKS CITED
Adams, Freya, and Cooke, Mary. British Journal of Nursing. 10 December 1998, pp. 1393-1399. Angelo, Ellen J. “Evidence Based Practice Guidelines Related to Urinary Catheterization. ” Union Hospital. Ebell, Mark H. Point of Care Guides. 15 January 2006. “Treating Adult Women with Suspected UTI. ” American Academy of Family Physicians. 18 November 2008 [http://www. aafp. org/afp/20060115/poc. html] Jackson, Misti. “Evidence-Based Practice for Evaluation and Management of Female Urinary Tract Infection. ” 12 June 2007.