Implementing a Nurse-Driven Protocol to Reduce Catheter-Associated Urinary Tract Infections In A Long-Term Acute Care Hospital Assignment
Implementing a Nurse-Driven Protocol to Reduce Catheter-Associated Urinary Tract Infections In A Long-Term Acute Care Hospital Assignment
| Article Title, Author, etc. (Current APA Format) | Study Purpose | Sample (Characteristics of the Sample: Demographics, etc.) Implementing a Nurse-Driven Protocol to Reduce Catheter-Associated Urinary Tract Infections In A Long-Term Acute Care Hospital Assignment
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Methods | Study Results | Level of Evidence (Use Melnyk Framework) | Study Limitations | Would Use as Evidence to Support a Change? (Yes or No) Provide Rationale. |
| Example, A. (2015) Title etc. per Current APA | To identify the need for technology to prevent falls | A convenience sample of 44 nurses in an acute care hospital | A non-experimental, descriptive survey | Findings indicate that fall rates decreased by 2% with the introduction of technology into the care setting | Level 6: descriptive design | Conducted in only one setting, small sample size | Does provide some good foundational information even though the level is a 6. |
| Parker et al., (2019).
Avoiding inappropriate urinary catheter use and catheter-associated urinary tract infection (CAUTI): a pre-post control intervention study |
To reduce IDC usage rates by reducing inappropriate urinary catheterization and duration of catheterization | Samples of 4 acute care hospitals in NSW, Australia are examined. | An experimental multifaceted design using a phased mixed method approach | Improved patient’s safety and reduced CAUTI infections by normalizing the implementation of best practices intervention. | Level 2: experimental design | Brief implementation and monitoring period. | Yes, provides effective information on improving CAUTI infections |
| Meddings et al., (2019)
Quantitative Results of a National Intervention to Prevent Hospital-Acquired Catheter-Associated Urinary Tract Infection: A Pre-Post Observational Study |
To evaluate the effect of a multimodal initiative on CAUTI in hospitals with high burden of health care-associated infection (HAI)Implementing a Nurse-Driven Protocol to Reduce Catheter-Associated Urinary Tract Infections In A Long-Term Acute Care Hospital Assignment. | 387 hospitals from Columbia district and 23 states. | An experimental survey. | Catheter utilization decreased from 21.46 to 19.83 catheter-days per 100 patient-days from the pre- to the post-intervention period. | Level 2: experimental design | Brief intervention period.
Failure to assess patients’ characteristics. |
Yes, provides critical insights on the impact of multimodal intervention in CAUTI or urinary catheter utilization |
| Zurmehly, J. (2018). Implementing a Nurse-Driven Protocol to Reduce Catheter-Associated Urinary Tract Infections in a Long-Term Acute Care Hospital | To reduce CAUTI infections in long term acute-care hospitals | Evidence-based CAUTI protocol was implemented across three units of long-term acute care hospitals. | An experimental quantitative design | CAUTI incidence rate decreased by 74% | Level 3; quasi experiment. | Brief implementation and assessment period. | Yes, justifies the effectiveness of EBP catheter protocol in reducing CAUTI infections |
| Ecker et al., (2020).
Reducing the Risk of Indwelling Catheter-Associated Urinary Tract Infection in Female Patients by Implementing an Alternative Female External Urinary Collection Device: A Quality Improvement Project |
Reducing the CAUTI infections risk for female patients by replacing indwelling catheter with female external urinary collection (FEUC) device. | 386 female acute care patients’ in Southern California Community hospital. | An experimental design | The CAUTI risk reduced by 31% in 2018 and 26% in 2019. | Level 2: experimental design. | Research conducted in only one hospital. | Yes, avails a tool for reducing CAUTI infection risks. |
| Article 5
Huis et al., (2020). Infection prevention practices in the Netherlands: results from a National Survey |
Examine the extent to which Netherlands Acute care hospitals have adopted effective CDI, CLABS, and CAUTI prevention practices. | 72 Acute care hospitals | Descriptive survey. | Most hospitals have adopted the CLABSI and CDI prevention practices while few have embraced CAUTI prevention practices. | Level 4: a case study | Brief monitoring period. | Yes, avails information on the extent of adoption of CAUTI, CLABSI, and CDI practices in Netherlands acute care hospitals. |
| Kaminski et al., (2021).
Trends in central-line-associated bloodstream infections and catheter-associated urinary tract infections in a large acute-care hospital system in New York City, 2016-2019 |
To examine Central-line bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) trends | Data from 11 acute care hospitals in New York were examined. | Exploratory survey | CLABSI and CAUTI cases reduced from 2016-2019. | Level 5: evidenced acquired from cohort studies. | The study cannot be used to establish cause and effect relationships. | Yes, provides insightful information on the impact of CAUTI and CLABSI on clinical outcomes and hospital reimbursement |
| Greene et al., 2021
Infection prevention practices in the United States, the Netherlands, Switzerland, and Japan: Results from national surveys |
Assess extent to which different countries use EBP in acute care hospitals Implementing a Nurse-Driven Protocol to Reduce Catheter-Associated Urinary Tract Infections In A Long-Term Acute Care Hospital Assignment. | Not clear: surveyed most acute care hospitals in USA, Japan and Switzerland. | Descriptive design | 59% of US hospitals, 77% of Switzerland hospitals and 65% of Japan hospitals have adopted certain infection prevention practices | Level 5: Evidence from qualitative studies. | Time constrain was an issue given that the assessment involved diverse acute care hospitals in US, Japan, Netherlands, and Switzerland. | Yes, avails clear strategies for reducing hospital infections in all 4 countries surveyed.
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| Ikeda-Sakai et al., 2021.
Effectiveness and safety of a program for appropriate urinary catheter use in stroke care: A multicenter prospective study |
Assess the safety and effectiveness of a program to promote Indwelling Urinary Catheter (IUC) use in stroke care. | Sample of 976 patients from three tertiary Japan care hospitals were examined. | Experimental design | The program improved the appropriate use of IUC and reduced CAUTI infections | Level 2: experimental design | Patients’ characteristics were not assessed due to time constraint. | Yes, insightful in improving the quality of IUC use to reduce CAUTI infections.
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| Saint et al., 2019
What acute care hospitals in the United States are currently doing to prevent common device-associated infections: results from a national survey |
Assess the use of novel and several established practices in preventing device-associated infections. | Random sample of 900 US acute care hospitals was selected. | Exploratory research | 59% of established and novel practices are used across 90% of the selected hospitals to prevent device associated infections, especially CAUTI. | Level 5: evidence from qualitative studies. | Failure to obtain triangulation. | Yes, provide very useful background information |
| Strassle et al., 2019.
Incidence and risk factors of non-device-associated urinary tract infections in an acute-care hospital |
To estimate the frequency and occurrence of non-device associated tract infections (ND-UTI) relative to CAUTI infections and identify ND-UTIs risk factors Implementing a Nurse-Driven Protocol to Reduce Catheter-Associated Urinary Tract Infections In A Long-Term Acute Care Hospital Assignment | 163,386 hospitalized patients in 2013-2017 in Academic teaching hospital were investigated | Experimental cohort study | Rate of ND-UTIs decreased slightly from 6.14 to 5.57 while CAUTI infections increased from 52% to 72%. | Level 4: Cohort studies | Study was limited to one hospital | Yes, provides statistics on the increased impact of device associated infections including CAUTI. |
Initiating the Literature Review Template
Information gleaned from evidence based articles is not only effective in improving patients’ outcome but also in making recommendations for change practice. Importantly, information acquired from relevant and credible research articles can be combined with real-time data and used to make well-founded decisions and change practice. Specifically, the results acquired from the gleaned articles above can be summarized and used to improve patients’ safety and reduce CAUTI related infections. As such, it would change practice where the use of non-device associated interventions would be preferred over device associated interventions in acute care settings. In cases where CAUTI is the only alternative, specific nursing interventions, novel practices, and safety programs will be practiced while using the instrument. Also, considering the study implications, the gleaned information identifies variations in nursing practice where most United States acute care hospitals have adopted effective practices to reduce CAUTI infections. It equally recommends the need for continuous use of novel practices and effective interventions to reduce device associated infections, especially CAUTI Implementing a Nurse-Driven Protocol to Reduce Catheter-Associated Urinary Tract Infections In A Long-Term Acute Care Hospital Assignment.
References
Eckert, L., Mattia, L., Patel, S., Okumura, R., Reynolds, P., & Stuiver, I. (2020). Reducing the Risk of Indwelling Catheter-Associated Urinary Tract Infection in Female Patients by Implementing an Alternative Female External Urinary Collection Device: A Quality Improvement Project. Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society, 47(1), 50–53. https://doi.org/10.1097/WON.0000000000000601
Greene, M. T., Krein, S. L., Huis, A., Hulscher, M., Sax, H., Sakamoto, F., Sakihama, T., Tokuda, Y., Fowler, K. E., & Saint, S. (2021). Infection prevention practices in the United States, the Netherlands, Switzerland, and Japan: Results from national surveys. Infection control and hospital epidemiology, 42(10), 1206–1214. https://doi.org/10.1017/ice.2020.1395
Huis, A., Schouten, J., Lescure, D., Krein, S., Ratz, D., Saint, S., Hulscher, M., & Greene, M. T. (2020). Infection prevention practices in the Netherlands: results from a National Survey. Antimicrobial resistance and infection control, 9(1), 7. https://doi.org/10.1186/s13756-019-0667-3
Ikeda-Sakai, Y., Kubo, K., Wada, M., Seki, R., Hijikata, Y., Yoshioka, T., Takahashi, Y., & Nakayama, T. (2021). Effectiveness and safety of a program for appropriate urinary catheter use in stroke care: A multicenter prospective study. Journal of evaluation in clinical practice, 10.1111/jep.13626. Advance online publication. https://doi.org/10.1111/jep.13626
Kaminski, M. A., Episcopia, B., Malik, S., Fornek, M., Landman, D., Xavier, G., & Quale, J. (2021). Trends in central-line-associated bloodstream infections and catheter-associated urinary tract infections in a large acute-care hospital system in New York City, 2016-2019. Infection control and hospital epidemiology, 42(7), 842–846. https://doi.org/10.1017/ice.2020.1293
Meddings, J., Manojlovich, M., Ameling, J. M., Olmsted, R. N., Rolle, A. J., Greene, M. T., Ratz, D., Snyder, A., & Saint, S. (2019). Quantitative Results of a National Intervention to Prevent Hospital-Acquired Catheter-Associated Urinary Tract Infection: A Pre-Post Observational Study. Annals of internal medicine, 171(7_Suppl), S38–S44. https://doi.org/10.7326/M18-3534
Parker, V., Giles, M., Graham, L., Suthers, B., Watts, W., O’Brien, T., & Searles, A. (2017). Avoiding inappropriate urinary catheter use and catheter-associated urinary tract infection (CAUTI): a pre-post control intervention study. BMC health services research, 17(1), 314. https://doi.org/10.1186/s12913-017-2268-2 Implementing a Nurse-Driven Protocol to Reduce Catheter-Associated Urinary Tract Infections In A Long-Term Acute Care Hospital Assignment
Saint, S., Greene, M. T., Fowler, K. E., Ratz, D., Patel, P. K., Meddings, J., & Krein, S. L. (2019). What US hospitals are currently doing to prevent common device-associated infections: results from a national survey. BMJ quality & safety, 28(9), 741–749. https://doi.org/10.1136/bmjqs-2018-009111
Strassle, P. D., Sickbert-Bennett, E. E., Klompas, M., Lund, J. L., Stewart, P. W., Marx, A. H., DiBiase, L. M., & Weber, D. J. (2019). Incidence and risk factors of non-device-associated urinary tract infections in an acute-care hospital. Infection control and hospital epidemiology, 40(11), 1242–1247. https://doi.org/10.1017/ice.2019.241
Zurmehly J. (2018). Implementing a Nurse-Driven Protocol to Reduce Catheter-Associated Urinary Tract Infections in a Long-Term Acute Care Hospital. Journal of continuing education in nursing, 49(8), 372–377. https://doi.org/10.3928/00220124-20180718-08
Clinical Question Development
Delivering evidence-based practice (EBP) healthcare services is an essential consideration by healthcare organizations. These healthcare organizations should teach their prelicensure nursing students and licensed nursing professionals how to apply EBP in all practices to improve the healthcare delivery model (Horntvedt et al., 2018). With EBP knowledge, the healthcare providers increase their chance of providing the target patient population with high-quality care based on the most appropriate evidence, thus minimizing medical errors and hospital stays. In our healthcare organization, patient numbers have been declining. Still, from the statistics, there is a high possibility that the main cause of such decline is associated with Hospital Acquired Infections (HAIs). The paper will focus on catheter-associated urinary tract infections (CAUTI), one of identified HAIs in our healthcare facility that have increased by 4 percent in the last six months. However, for the research to be more accurate, the Iowa Model of EBP.
According to Aiken et al. (2011) Iowa model is the most effective model that helps nursing professionals support any EBP project in their healthcare organizations. The main reason for such assertions is based on the Iowa model providing a systematic guide on handling clinical problems to ensure that the intervention is effective. Hence, in addressing the increased rates of CAUTI in our healthcare organization, Iowa Model is the most effective model that will guide in addressing the problem and match it with the best intervention to prevent healthcare compromise that increases patient risks.
The Iowa model presents itself as an application-oriented guide within the EBP process. The first step involves evaluating the triggers that may have led to a clinical problem where these triggers may be knowledge-focused and problem-focused. The knowledge-focused triggers mainly involve when new guidelines or research findings are implemented. On the other hand, problem-focused triggers refer to healthcare issues arising from clinical problem identification and financial or risk management data (Green, 2020). Hence, CAUTI increase cases are a problem-focused trigger in our healthcare organization.
Iowa model’s second step is determining if the identified problem needs to be prioritized by the healthcare organization, unit, or department. Regarding the identified problem in the healthcare organization, CAUTI cases increase healthcare costs for patients and healthcare organizations due to patients overstaying in the hospital. Cudjoe and Heidelberg-Horton (2019) state that over 560,000 patients experience CAUTI each year in the US. Apart from contributing to hospital overstays and increased treatment costs, there is always an increase in mortality and morbidity rates. Considering the increase of CAUTI rate has been high over the last six months, the hospital needs to act fast since the situation risks its sustainability and competitiveness. That is because the patients will be more attracted to other healthcare organizations as they seek safe and quality healthcare services Implementing a Nurse-Driven Protocol to Reduce Catheter-Associated Urinary Tract Infections In A Long-Term Acute Care Hospital Assignment.
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The Iowa third step is to create a project team to help the healthcare organization develop, evaluate and implement an EBP change. The team will be essential to ensure that they implement the most appropriate change for CAUTI issues in our healthcare organization. The team will comprise of interprofessional EBP project team involving the nurses, physicians, infection preventionists, clinical educators, senior healthcare executives, and patient safety officers (McClusky, 2018). The reason for incorporating these representatives within and outside the nursing unit is to ensure that the team evaluates and implements the change effectively since they can consult and brainstorm to find the most appropriate implementation strategies.
The EBP project will also involve Iowa’s fourth step, gathering the necessary information and critically analyzing the evidence to inform the required practice change (Aiken et al., 2011). Also, this step is important since it helps create an appropriate PICO-related research question and search for related studies. Most studies have evaluated the most effective strategies that healthcare organizations can emulate to reduce CAUTI-related issues. From the research, hand hygiene has been discussed, but there are still gaps in how the hospitals can ensure that nurses and other healthcare providers comply with such implementation changes (Jones et al., 2021). Considering the implications of any hospital-acquired infection, American Nurse Association provides a streamlined, evidence-based, and innovative clinical tool that will enable nurses to reduce CAUTI implications through the American Nurse Association CAUTI prevention tool (ANA, n.d). Therefore, the PICO question will be, “For patients in acute care, is the application of the America Nurse Association CAUTI prevention tool compared to handwashing strategies more effective in reducing CAUTI infections?”
The fifth Iowa model step includes critiquing and synthesizing the discovered research (Aiken et al., 2011). Hence, the step will involve the evaluation of the effectiveness of the American Nurse Association CAUTI prevention Tool in preventing CAUTI in a hospital environment. Most researchers have embraced the incorporation of the proposed CAUTI prevention tool due to the dynamic nature in which it approaches the CAUTI issue. That is because it engages the nurses in three areas that help reduce CAUTI rates. These areas include inappropriate use of short-term catheters, the care necessary during urinary catheter placement, and the need for timely urinary catheter removal (Meddings et al., 2019). Our healthcare organization must embrace the proposed initiative due to its authenticity and reliability (Zurmehly, 2018). That is because American Nurse Association (ANA) collaborated with the Partnership for Patients (PfP), part of the Centers for Medicaid and Medicare Services. Both organizations worked towards reducing 30-day hospital readmission by 20 percent and hospital-acquired complications by 40 percent (Lawrence et al., 2018). The CAUTI prevention tool is also effective since it helps nurses evaluate the key components in completing bladder assessments. That is because the tool help in prioritizing and differentiating interventions depending on personalized assessment findings involving incontinence, urinary retention, and bladder emptying, which are essential factors when preventing CAUTIs.
As the sixth Iowa model suggests, there is a need to evaluate if there is enough research on practice change implementation. The different scholarly databases present various research concerning CAUTI prevention tools by ANA. For instance, PubMed has 14 studies evaluating the CAUTI prevention tool by ANA, with Google Scholar having over 291 studies and data from reliable healthcare websites filtered within the last five years. Hence, such research will aid in implementing the change in our healthcare organizations.
The seventh and the eighth step of the Iowa model depends on the feasibility of the proposed change practice. Hence, the as a researcher, there will be a need to carry out a pilot program that will emphasize the need for nurses and other healthcare providers to avoid inappropriate use of short-term catheters, involve the care necessary during urinary catheter placement, and the need for timely urinary catheters removal for utmost three months to assess if there will be any change in CAUTI numbers. After realizing that the change practice is efficient, the healthcare organization will need to fully implement the CAUTI prevention tool by American Nurse Association to improve acute care patient safety and health quality.
In conclusion, the paper has evaluated ways that our healthcare organization can reduce instances of CAUTI, which has been one factor that led to the decline of patients in the organization. The need to address the CAUTI issue is mainly inclined towards ensuring that the healthcare organization maintains its competitiveness and sustainability by following the Iowa model for evidence-based practices in nursing. Also, since healthcare organizations’ main aim is to improve patients’ well-being, incorporating the America Nurse Association CAUTI prevention tool is essential since it proves its effectiveness in reducing CAUTIs compared to other interventions such as handwashing.
INITIATING THE LITERATURE REVIEW ASSIGNMENT INSTRUCTIONS OVERVIEW After a clinical question (PICO) has been developed, following the Iowa Model as a conceptual framework, a review of the literature is initiated. The literature will provide the necessary information to direct the evidence-based project. Based on what is found in the literature, the PICO question may be edited as needed. It is important to identify the strength of the literature by reviewing the methodology used in a study and assigning a level of evidence. This is accomplished by using Melnyk’s framework located within the course. Once the literature is reviewed the common ideas and themes are synthesized providing the user with the essential findings/outcomes of the literature under review and thus determining if the literature is sufficient to make a practice change. INSTRUCTIONS For this assignment, you will be building on the work started in Developing a Clinical Question Assignment. In that assignment, you developed a clinical question, using the PICO format as a guide. Key terms were also developed to serve as a guide to secure peer reviewed journals. In this assignment, you will be using the key terms to start the literature review. You will: 1. Secure a minimum of 10 peer-reviewed journals, no older than 3–5 years. 2. Select articles that will support the clinical question developed in the PICO Development Assignment. 4. Use the Initiating the Literature Review Template to evaluate the articles and determine the level of evidence for each article. Use the Melnyk Pyramid found as an Explore item in this module. 5. Develop a narrative (approximately 150–200 words) discussing how the information, gleaned from the articles, would be used to make recommendations for change practice or not to change practice. This may be placed below the matrix in the same document. 6. Be sure to synthesize the article outcomes into a robust narrative (as stated above) and not merely report out on each individual article. 7. Discuss implications of practice. 8. Include a title page and reference page as a part of the assignment. Note: Your assignment will be checked via the Turnitin plagiarism tool Implementing a Nurse-Driven Protocol to Reduce Catheter-Associated Urinary Tract Infections In A Long-Term Acute Care Hospital Assignment.
References
Aiken, L. H., Cimiotti, J. P., Sloane, D. M., Smith, H. L., Flynn, L., & Neff, D. F. (2011). Effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments. Medical care, 49(12), 1047–1053. https://doi.org/10.1097/MLR.0b013e3182330b6e
ANA (n.d) ANA CAUTI Prevention Tool. https://www.nursingworld.org/practice-policy/work-environment/health-safety/infection-prevention/ana-cauti-prevention-tool/
Cudjoe, K. G., & Heidelberg-Horton, D. V. (2019). Proper indwelling catheter use to prevent CAUTIs. Nursing made Incredibly Easy, 17(6), 16-19. doi: 10.1097/01.NME.0000585108.94257.45
Green, C. (2020). Application of the Iowa Model, an Evidence-Based Practice Model, When Initiating Clinical Project Pilots to Evaluate How Self-Care Techniques Affect Simulated Nursing Performance. SAGE Publications Ltd.
Horntvedt, M. E. T., Nordsteien, A., Fermann, T., & Severinsson, E. (2018). Strategies for teaching evidence-based practice in nursing education: a thematic literature review. BMC medical education, 18(1), 1-11. https://doi.org/10.1186/s12909-018-1278-z
Jones, K. M., Mantey, J., & Mody, L. (2021). Current Practices in Infection Prevention: A 3-year Survey of Michigan Nursing Homes’ Urinary Tract Infection Prevention Strategies. American Journal of Infection Control, 49(6), S7. https://doi.org/10.1016/j.ajic.2021.04.028
Lawrence, K. G., Bliss, D. Z., Dailey, M., Trevellini, C., & Pontieri-Lewis, V. (2019). The CAUTI Prevention Tool Kit: A Professional Practice and Collaborative Project of the Wound, Ostomy and Continence Nurses Society. Journal of Wound Ostomy & Continence Nursing, 46(2), 154-157. doi: 10.1097/WON.0000000000000505
McClusky, J. L. (2018). One Year CAUTI Free: A Multi-Disciplinary Team Approach to Reducing CAUTI in a Pediatric Intensive Care Unit. American Journal of Infection Control, 46(6), S76. DOI:https://doi.org/10.1016/j.ajic.2018.04.143
Meddings, J., Manojlovich, M., Fowler, K. E., Ameling, J. M., Greene, L., Collier, S., … & Saint, S. (2019). A tiered approach for preventing catheter-associated urinary tract infection. Annals of internal medicine, 171(7_Supplement), S30-S37. https://doi.org/10.7326/M18-3471
Zurmehly, J. (2018). Implementing a nurse-driven protocol to reduce catheter-associated urinary tract infections in a long-term acute care hospital. The Journal of Continuing Education in Nursing, 49(8), 372-377. https://doi.org/10.3928/00220124-20180718-08
Initiating the Literature Review Assignment Instructions
Overview
After a clinical question (PICO) has been developed, following the Iowa Model as a conceptual framework, a review of the literature is initiated. The literature will provide the necessary information to direct the evidence-based project. Based on what is found in the literature, the PICO question may be edited as needed. It is important to identify the strength of the literature by reviewing the methodology used in a study and assigning a level of evidence. This is accomplished by using Melnyk’s framework located within the course. Once the literature is reviewed the common ideas and themes are synthesized providing the user with the essential findings/outcomes of the literature under review and thus determining if the literature is sufficient to make a practice change.
Instructions
For this assignment, you will be building on the work started in Developing a Clinical Question Assignment. In that assignment, you developed a clinical question, using the PICO format as a guide. Key terms were also developed to serve as a guide to secure peer reviewed journals.
In this assignment, you will be using the key terms to start the literature review. You will:
- Secure a minimum of 10 peer-reviewed journals, no older than 3–5 years.
- Select articles that will support the clinical question developed in the PICO Development Assignment.
- Access the assistance of the Liberty University School of Nursing Librarian to assist you as needed. Contact information is available at the Jerry Falwell Library (JFL) web site.
- Use the Initiating the Literature Review Template to evaluate the articles and determine the level of evidence for each article. Use the Melnyk Pyramid found as an Explore item in this module.
- Develop a narrative (approximately 150–200 words) discussing how the information, gleaned from the articles, would be used to make recommendations for change practice or not to change practice. This may be placed below the matrix in the same document.
- Be sure to synthesize the article outcomes into a robust narrative (as stated above) and not merely report out on each individual article.
- Discuss implications of practice.
- Include a title page and reference page as a part of the assignment.
Note: Your assignment will be checked via the Turnitin plagiarism tool Implementing a Nurse-Driven Protocol to Reduce Catheter-Associated Urinary Tract Infections In A Long-Term Acute Care Hospital Assignment.