Original article
The two-person catheter insertion procedure reduces catheter-associated urinary tract infections
Lutfiasih Rahmawatia, Josepha Mariana Tamaelaa, Lusi Anikaa, Anggi Lukman Wicaksanab,c,
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a Master of Nursing Program, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
b Department of Medical Surgical Nursing, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
c The Sleman Health and Demographic Surveillance System, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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"Lutfiasih" "apellidos" => "Rahmawati" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Josepha" "apellidos" => "Mariana Tamaela" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Lusi" "apellidos" => "Anika" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:4 [ "nombre" => "Anggi Lukman" "apellidos" => "Wicaksana" "email" => array:1 [ 0 => "anggi.l.wicaksana@ugm.ac.id" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Master of Nursing Program, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Medical Surgical Nursing, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "The Sleman Health and Demographic Surveillance System, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2563 "Ancho" => 2508 "Tamanyo" => 279697 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The PRISMA flowchart for review.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015"><span class="elsevierStyleBold">Introduction</span></span><p id="par0005" class="elsevierStylePara elsevierViewall">The urinary tract infection (UTI) is the major infection that caused by pathogens or microorganisms in the urinary system. The UTI could cause further complication such as kidney stones, obstructive problems in urinary tract, septic, and severe kidney diseases. This disease is mostly manifestated by current or positive findings of bactery in urine that could achieve more than 100,000/ml bacteries in urine analysis. The previous research had identified that <span class="elsevierStyleItalic">E. coli</span>, <span class="elsevierStyleItalic">Klebsiella sp</span>, <span class="elsevierStyleItalic">Proteus</span><span class="elsevierStyleItalic">sp</span>, <span class="elsevierStyleItalic">Providensiac</span>, <span class="elsevierStyleItalic">Citrobacter</span>, <span class="elsevierStyleItalic">P. aeruginosa</span>, <span class="elsevierStyleItalic">Acinetobacter</span>, <span class="elsevierStyleItalic">Enterococu faecali</span>, and <span class="elsevierStyleItalic">Staphylococcus saprophyticus</span> caused the UTI. About 90% of the UTI were caused by <span class="elsevierStyleItalic">E. coli</span>.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Recent research showed that the UTI is associated with multifactors, e.g. gender, individual health behaviors, and nosocomial infection while hospital admission.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> Women were known as a high risk group of the UTI due to shorter urethra among the women. Unhealthy behaviors and inappropriate genital hygiene were contributed to the UTI particularly for lower income households or vulnerable population. Medical procedures during hospitalization such as indwelling catheter insertion accounted numerous cases of the UTI, known as catheter-associated urinary tract infections (CAUTI). Patients receiving prolong duration of indwelling catheter was also known as a high risk group for the CAUTI because it stimulated bactery collonization in the urine.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> This mechanism was a reason for the CAUTI. The reported CAUTI were mostly occurred in the intensive care unit, about 30–40%. The occurrence of CAUTI is associated high morbidity, mortality, hospital costs, and prolong hospital admission.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The sterility during the catheter insertion procedure is crucial as prevention of the CAUTI. On the other hand, the incidence of the CAUTI may reflect on how catheter insertion procedure was well implemented.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> Maintaining all steps in a sterile condition could be a challenge and stressful, especially for the novice nurses. Then, nurses should have such a particular strategy to cope with this issue.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> To date, a two-person catheter insertion procedure (2CIP) is introduced as appropriate approach to minimize the CAUTI. This method involves two nurses during the catheter insertion; one as the person in charge for inserting the indwelling catheter while the rest as an observer. The observer has main role to keep watching and make sure that all procedures are based on the protocol and maintaining sterile.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> The observer can provide advice and reminder the nurse in charge for catheter insertion when needed. It potentially assists the nurses to keep sterile during the procedure and results in zero incidence of the CAUTI.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> The 2CIP is quite new, thus, limited research was conducted on this topic. Therefore, this study aim was to elaborate the effect of the 2CIP on the CAUTI.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">This was a literature review that performed in two databases, PubMed dan Science Direct. The search terms were used to do systematic search. We applied “patients with urinary catheters” OR “urinary catheter patients” OR “catheterized patients” AND “two-person catheter insertion procedure” OR “2-person catheter insertion procedure” AND “CAUTI” OR “catheter-associated urinary tract infection” OR “UTI” OR “Urinary Tract Infection”. We set inclusion criteria as articles published between 2010 and 2020, written in English, and explicitly provided data on the effect of the 2CIP on the CAUTI. All articles as editorial, news and conference abstract were excluded. The procedure of review in this study was followed the recommended guideline of PRISMA.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> Researchers applied the Joanna Briggs Institute (JBI) critical appraisal tools to evaluate the quality of the included studies. The process was independently conducted by two authors (LR and JMT). Discussion with the third author (LA) was conducted when there was different opinion.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="par0020" class="elsevierStylePara elsevierViewall">The searching step resulted in 24 articles, however, only 2 articles fitted the criteria (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Most articled were excluded because they did not provide data about the effect of 2CIP on the CAUTI and did not fit the research criteria. Two articles were assessed using the JBI critical appraisal tools for non-randomized experimental studies. The first paper<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> resulted in 6 points and 3 points for yes and unclear response, respectively. On the other hand, the second paper<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> indicated 6 points of yes, 2 points of unclear, and 1 point for no. The authors agreed to include both papers in analysis because the quality of paper and they provided information to respond the research aims. The included study presented the data on the implementation of the 2CIP with and without checklist. For both research, authors identified that there was no significant difference before and after the implementation of the 2CIP protocol. Although it did not show significant results, both research highlights that a reduction of the CAUTI rate after the protocol was implemented (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall">The sterile catheter insertion procedure is acknowledged to significantly reduce the CAUTI rate and prevent further harms for the patients.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> The CAUTI is known related to the lack of nurses’ skill to maintain sterile procedure. The 2CIP strategy could be a good choice for nurses to maintain sterile procedure which in turn decreasing the CAUTI.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> This strategy involves another nurse's observer while the insertion.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The findings showed that the 2CIP were able to reduce 39% of the CAUTI after the six months implementation.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> The results were similar with Fletcher-Gutowski and Cecil's findings, which identified the reduction of the CAUTI after 9 months implementation of the 2CIP with checklist.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> The procedure helped nurses to keep on mind and maintain a sterile procedure. Belizario found that the 2CIP made the inserting procedure of catheter easier and faster because the nurse's observer did not only inspect the operator nurse (who in charge in inserting an indwelling catheter), but also provide an assistance to adjust patient's position during the insertion.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> Moreover, the nurses who involved in the 2CIP protocol conducted a peer review through observing, criticizing, correcting, taking action when error happened, and accomplishing the examination.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">4,5</span></a> This method was useful as long life learning for nurses, especially for the novice nurses, and improved or enhanced nurses’ skill related to sterile procedure. Furthermore, the 2CIP training stimulated nurses to be more aware about the CAUTI and it helped them to keep on mind in maintaining sterile protocol.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> The 2CIP was implemented for inserting and withdrawing the indwelling catheter among adult males and females. Indwelling catheter kits contained dower catheters with closed system, personal protective equipment, and cleansers were used.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> Two nurses were available at the patient's bedside during the procedure. The protocols of 2CIP suggested to (1) utilize sterile techniques and equipment, and implement the guidelines for prevention of CAUTI. (2) When the nurse in charge cleaned periurethral area and inserted the indwelling catheter, the observer nurse inspected to make sure all were sterile procedure as the guideline. (3) Nurse observer had authority to puase or discontinue the procedure when the sterile technique was broken in any time s/he found. (4) Nurse observer could assist the nurse in charge for insertion to manage patient's position and clean the periurethral area. Because many patients had neurological deficit, unstable conscious level, and other fluctuated condition post surgery procedure, maintaining all procedure in sterile can be a challenge for nurses when they had to work alone without assistance of other nurses.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">There are no specific requirements for nurses to perform the protocol of 2CIP. However, several basic competences were required to make it possible such as skills to (1) assess the males’ and females’ bladder, (2) perform perennial care, (3) maintain sterile techniques during all procedures, (4) conduct indwelling catheter insertion, and (5) collaborate as teamwork.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The study has limitation related to study findings and number of included study. This finding suggested there was reduction on the CAUTI although it was not significant outcome. Further studies are required to compile the effect of the 2CIP on the CAUTI. In addition, only two studies met the criteria and included for analysis. Meta-analysis was only applicable when there were numerous available data. Further systematic review could be conducted in the future when available more study on the 2CIP.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035"><span class="elsevierStyleBold">Conclusion</span></span><p id="par0040" class="elsevierStylePara elsevierViewall">The strategy of the 2CIP requires another nurses as observer during the catheter insertion to evaluate and make sure that all procedure are running in sterile condition. The observer could take action to remind and keep all things under the protocol of catheter insertion. It stimulates the nurses’ awareness and helps them during the insertion of catheter that results in the decreasing incidence of the CAUTI. Nurses can take this approach as an alternative strategy to keep them more aware and on their mind during the procedure. The limited available evidence related to the 2CIP on CAUTI, suggests a further randomized control trial about this topic. A thorough meta-analysis is possible when abundant research available about the 2CIP on the CAUTI.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflict of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1605805" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1437172" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 4 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 5 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusion" ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interest" ] 8 => array:2 [ "identificador" => "xack565911" "titulo" => "Acknowledgement" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-10-08" "fechaAceptado" => "2020-10-13" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1437172" "palabras" => array:4 [ 0 => "CAUTI" 1 => "Catheter insertion" 2 => "Indwelling catheter" 3 => "Urinary infection" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">This study aimed to identify the effect of two-person catheter insertion procedure (2CIP) on catheter-associated urinary tract infections (CAUTI). The literature review was performed on PubMed and Science Direct databases. Only original articles which provided data the effect of the 2CIP on the CAUTI and published articles within last ten year were included for the review. The preferred reporting item for systematic review and meta-analysis was implemented. The search term used “patients with urinary catheters” OR “urinary catheter patients” OR “catheterized patients” AND “two-person catheter insertion procedure” OR “2-person catheter insertion procedure” AND “CAUTI” OR “catheter-associated urinary tract infection” OR “UTI” OR “Urinary Tract Infection”. Joanna Briggs Institute critical appraisal tools were used to assess the quality of study. We identified there were 24 articles at the beginning of searching but only 2 articles fitted the criteria and were included in the analysis. From the limited included articles, we found that the 2CIP indicated that there was no significant difference was found before and after the implementation of the 2CIP. However, the reduction of CAUTI rate was occurred after implementing the intervention.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:1 [ "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Peer-review under responsibility of the scientific committee of the 3rd International Joint Conference on Nursing Science (IJCNS). Full-text and the content of it is under responsibility of authors of the article.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2563 "Ancho" => 2508 "Tamanyo" => 279697 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The PRISMA flowchart for review.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Author(s)/country \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Aim \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Title \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Methods \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Intervention \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Results \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Belizario/USA<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">To reduce the level of CAUTI on the post surgery units using 2 persons technique of catheter insertion. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Preventing urinary tract infections with a two-person catheter insertion procedure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Design was unclearly stated.All hospitalized patients received a 2 persons technique of catheter insertion.Total sample of patients inserted catheter were not reported. However, the author reported an incidence of CAUTI before and after the implementation of procedure. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The 2 persons catheter insertion procedure protocol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Six months before implementation of the protocol, the CAUTI rate was 5/746 days (6.70). Six months after implementation, the CAUTI rate was 3/729 days (4.11). Two-third of the CAUTI were associated with the indwelling catheter insertion, due to diarrhea. Six months after the completed project, the CAUTI rate was 1/625 days (1.6).There was no significant difference between the number of the CAUTI before and after the protocol implementation, but the CAUTI was reduced by 39% for six months after the initiation of the protocol implementation using 2CIP. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fletcher-Gutowski & Cecil/USA<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">To minimize the level of CAUTI on the progressive and pulmonary care units using checklist of the 2 persons urinary catheter insertion protocol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Is 2-person urinary catheter insertion effective in reducing CAUTI? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Design was unclearly stated.All hospitalized patients in the pulmonary and progressive care units.No report about the total of hospitalized patients in the article, the author reported the CAUTI rates during the research. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The 2-person urinary catheter insertion protocol (UCIP) with a checklist was implemented for 9 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Although there was no statistically significant difference in levels of Q1 and Q2 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleInf">unit</span><span class="elsevierStyleInf">a</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.503; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleInf">unit</span><span class="elsevierStyleInf">b</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.514; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleInf">unit</span><span class="elsevierStyleInf">c</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.747), the researchers noted that the application of the 2CIP with checklist reduced the risk of contamination during the insertion. Training on the 2CIP with checklist among nurses raised their awareness about the association between indwelling catheter insertion and the incidence of CAUTI rate.Eventually, this initiative was able to minimize harms and patients’ disadvantages. \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2739135.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Extracted data of the included articles.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Center for Diseases Control and Prevention. Catheter-associated urinary tract infection (CAUTI). 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Belizario" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.NURSE.0000460736.74021.69" "Revista" => array:6 [ "tituloSerie" => "Nursing" "fecha" => "2015" "volumen" => "45" "paginaInicial" => "67" "paginaFinal" => "69" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25689714" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0060" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Is 2-person urinary catheter insertion effective in reducing CAUTI?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. Fletcher-Gutowski" 1 => "J. 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