The Effect of Nurse Driven Protocol Implementation on the Incidents of Catheter Acquired Urinary Tract Infection in Geriatric Patients
Abstract
The aging process affects the immune system, making the elderly more vulnerable to bacterial and viral infections. Urinary tract infection (UTI) is the second most common infection among geriatric patients. UTIs caused by urinary catheter use, known as Catheter Acquired Urinary Tract Infections (CAUTI), are the leading cause of nosocomial infections, with 80% linked to catheter use. Preventing catheter use beyond 72 hours can reduce CAUTI incidence. The use of Nurse Driven Protocols (NDP) is one of the interventions recommended by the CDC to reduce catheter-related risk factors. This articles aiming to discuss the impact of NDP implementation on the incidence of CAUTI in geriatric patients. This study was conducted using the PRISMA checklist. Literature searches were conducted through several databases, including ProQuest. Science Direct, Scopus, and ClinicalKey Nursing, within the last five years (2020–2024). From 110 identified articles, five met the inclusion criteria, and two were analyzed in depth. The implementation of Nurse Driven Protocols (NDP) significantly reduced the incidence of CAUTI by ensuring catheters are only used when absolutely necessary and removed as soon as no longer indicated. Routine 24-hour assessments enable nurse to independently evaluate catheter use based on clear clinical criteri , such as the HOUDINI system. NDP empowers nurse to conduct independent evaluations and make decisions regarding catheter use, effectively preventing CAUTI and improving the quality of patient care.
References
Alamri, H., Alnamlah, S., Altulayqi, W., Owaydhah, E., Almohammadi, A., Allam, A., Alotaibi, A., Alsayed, R., & Albejawi, A. (2022). Urinary Tract Infections Among Geriatric Patients: A Systematic Review. Journal of Healthcare Sciences, 02 (08), 170–181. https://doi.org/10.52533/johs.2022.2806
Ana, KD, Riwayati, NY, & Jayanti, SF (2020). Relationship between Length of Catheter Installation and the Incidence of Urinary Tract Infections in Patients in the Internal Medicine Room of the Hospital Tk II Dr. Soepraoen Malang. Care: Scientific Journal of Health Sciences, 8 (2), 138. https://doi.org/10.33366/jc.v8i2.1213
Anggreiny. (2019). Relationship of Risk Factors with Catheter Incidents Associated Urinary Tract Infection in Intensive Care Installation Patients at H. Adam Malik Central General Hospital and the University of North Sumatra Hospital from July to August 2018. In Thesis, University of North Sumatra.
Atkins, L., Sallis, A., Chadborn, T., Shaw, K., Schneider, A., Hopkins, S., Bunten, A., Michie, S., & Lorencatto, F. (2020). Reducing catheter-associated urinary tract infections: A systematic review of barriers and facilitators and strategic behavioral analysis of interventions. Implementation Science, 15 (1), 1–23. https://doi.org/10.1186/s13012-020-01001-2
Dutta, C., Pasha, K., Paul, S., Abbas, MS, Nassar, ST, Tasha, T., Desai, A., Bajgain, A., Ali, A., & Mohammed, L. (2022). Urinary Tract Infection Induced Delirium in Elderly Patients: A Systematic Reviews. Cureus, 14 (12). https://doi.org/10.7759/cureus.32321
Gandaria Purba, AS, & Ginting, S. (2018). Relationship between Duration of Urethral Catheter Use and Urinary Tract Infection In Patients With Urethral Catheters at Deli Serdang Lubuk Pakam Regional General Hospital. Journal of Medical Nursing Research, 1 (1), 7–14. https://doi.org/10.36656/jpkm.v1i1.96
Hariati, D. (2019). RISK FACTORS FOR URINARY TRACT INFECTION DUE TO THE USE OF 180 Articles that have been identified by searching using electronic bases such as CINAHL, Proquest, Google Scholar, and Science Direct Screening Abstract Identification: (N = 26 issued. Permas Scientific Journal: Kendal STIKES Scientific Journal, 9 (4), 1–10.
Implementation of a Care Prevention Bundle for Catheter-Associated Urinary Tract Infections Submitted by Karen Ann Peterson A Direct Practice Improvement Project Presented in Partial Fulfilment of the Requirements for the Degree Doctor of Nursing Practice Grand Canyon University Phoenix Arizona. (2020).
Improving Patient Outcomes through Implementation of a Nurse-Directed Protocol for Urinary Catheter Removal Submitted by Barbara Jean Campbell A Direct Practice Improvement Project Presented in Partial Fulfilment of the Requirements for the Degree Doctor. (2019).
Irawan, E., & Mulyana, H. (2018). Factors Causing Urinary Tract Infection (UTI). Proceedings of the National Seminar and Dissemination of Health Research, April, 1–12.
Joseph- Armstrong, T.M. (2023). Walden University Publishing. Thesis Walden University.
Meddings, J., Rogers, M.A.M., Macy, M., & Saint, S. (2010). Systematic review and meta- analysis: Reminder systems to reduce catheter-associated urinary tract infection and urinary catheter use in hospitalized patients. Clinical Infectious Diseases, 51 (5), 550–560. https://doi.org/10.1086/655133
Menegueti, M.G., Ciol, M.A., Bellissimo-rodrigues, F., Auxiliadora-martins, M., Gaspar, G.G., Rita, S., Canini, S., Basile-filho, A., & Laus, A.M. (2019). A quasi-experimental study. 0 ( December 2018), 4–9.
Milsom, I., & Gyhagen, M. (2019). The prevalence of urinary incontinence. Climacteric, 22 (3), 217–222. https://doi.org/10.1080/13697137.2018.1543263
Mrziglod, L., Saydan, S., Schwab, F., Zohlnhöfer-Momm, D., Gastmeier, P., & Hansen, S. (2023). Reducing urinary catheter use in geriatric patients - results of a single center champion-led intervention. BMC Infectious Diseases, 23 (1), 1–8. https://doi.org/10.1186/s12879-023-08064-8
Nuwa, MS, Arsa, SAW, Nisa, K., & Erniawati, Y. (2018). Nursing Interventions for CAUTI Prevention in Adult Patients with Indwelling Catheters. Airlangga University, August.
Rosenthal, V.D., Memish, Z.A., Nicastri, E., Leone, S., & Bearman, G. (2025). Preventing catheter-associated urinary tract infections: A position paper of the International Society for Infectious Diseases, 2024 update. International Journal of Infectious Diseases, 151, 107304. https://doi.org/10.1016/j.ijid.2024.107304
Sleziak, J., Błażejewska, M., & Duszyńska, W. (2025). Catheter-associated urinary tract infections in the intensive care unit during and after the COVID-19 pandemic. BMC Infectious Diseases, 25 (1), 595. https://doi.org/10.1186/s12879-025-10996-2
Su, L. (2025). Effectiveness of Nurse Driven Protocols in Reducing Catheter-Associated Urinary Tract Infections. Journal of Nursing Care Quality, 40 (1), 39–45. https://doi.org/10.1097/NCQ.0000000000000811
Suparyanto and Rosad (2015. (2020).済無No Title No Title No Title. Suparyanto and Rosad (2015, 5 (3), 248–253.
Suryarinilsih, Y., -, D., & Aulia, M. (2018). Duration of Catheter Use with Urinary Tract Infection Incidents in Catheterized Patients. Journal of the Indonesian National Nurses Association (JPPNI), 2 (3), 152. https://doi.org/10.32419/jppni.v2i3.92
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