Nursing Practices toward Prevention of Indwelling Catheter Associated Urinary Tract Infection: An Interventional Study for nursing staff

Nursing Practices toward Prevention of Indwelling Catheter Associated Urinary Tract Infection: An Interventional Study for nursing staff

Ahmed Barid Kayem ¹, Hakima Shakir Hassan ² *

1. Academic Nurse, Ministry of Health/ Al-Diwaniya Health Directorate, Iraq.  
2. Assist. Prof, Adult Nursing/ College of Nursing University of Baghdad, Iraq.

Corresponding author: Ahmed Barid Kayem

Email: ahmedbread999@gmail.com

ORCID

Received: 14 April 2022, Accepted: 08 June 2022, Available online: 28 August 2022.

INTRODUCTION

Urinary catheters are frequently used to manage such things as perfecting urine output in intensive conditions, improving the rest of severely ill patients, and catheterization also helps to control skin breakdown caused by urinary incontinence, while other methods and uses for keeping the constant voiding of urine for surgical patients are ineffective (Shehab, 2017).

The single most important predisposing factor for (CAUTI) is the installation of a urinary catheter, which produces severe morbidity in hospitalized patients, including discomfort, fever, and malaise (Coleman, 2017). Every day that an indwelling urinary catheter is in place, it increases the risk of infection by 3% to 7%. CAUTIs are common, dangerous, and costly; around a quarter of all hospitalized patients are catheterized at least once a year, and 10% develop urinary tract infections (Lo et al., 2017). On a yearly basis, CAUTI is associated with more than 75% of these UTIs all over the world. Over 1.7 million patients are affected by UTIs, which account for 32 to 40% of all hospital-acquired infections (Clarke et al., 2013).                                         

Each year, over 13,000 people die as a result of UTIs. HCAIs kill more people than breast cancer, AIDS, and car accidents put together. On the other hand, most HCAIs may be prevented. CAUTI is the most common kind of HCAI. CAUTI complications result in a longer hospital stay, more patient suffering, greater health-care costs, and mortality (Chant et al., 2011). As a result, understanding CAUTI risk factors, such as catheterization length, advanced age, male sex, and weakened immunity, is crucial in order to propose CAUTI prevention strategies (Verma et al., 2017). Approximately half of all adult guys get at least one UTI. UTIs are the second most common ailment after respiratory infections, accounting for around 5% of general practice appointments (Fashafsheh et al., 2015).

In Iraq, many male patients suffer from UTIs that result from IUC due to poor nursing performance which depends on their practices. This has an impact on patients' health outcome, and period of hospital staying. Therefore, thus study concerns the effectiveness of nursing interventional program through assessing of nursing staffs' practices through the utilization of practice checklist in Al-Diwaniya Province/ Iraq.

METHOD

The pre-experimental design had been applied with the use of one group pre-test/post-test was approach 45 nurses to examine the effectiveness of the nursing interventional program through assessing of nursing staffs' practices through the utilization of practice checklist

Study instrument: The questionnaire is one of the means to help collect data that contribute to achieving the results expected by the study, so the researcher designed this questionnaire, which aims to clarify the study objectives and significance to evaluate nursing staffs'' practices toward prevention of indwelling catheter associated urinary tract infection. This questionnaire consists of two for parts which includes the following:

Part I: This section composed of socio-demographic information which includes age, gender, educational level, social status, and years of experience in nursing and training courses

Part II: This part was constructed to assess the nurses' practices were observed during the morning, and night shifts. The observational checklist for nurses' practices was composed of (15) items distributed on two domains, these items were rated based on the Likert scale; (3) always; (2) sometimes; (1) never.

Content validity was determined by the study tools, which include the interventional program, the knowledge form, and the observational checklist, was determined by (12) experts, who have more than 10 years of experience in their fields, to verify the interventional program contents, nurses' practices checklist toward prevention of indwelling catheter-associated urinary tract infection. Reliability of the questionnaire (tools) was determined through the use of test and re-test approach obtained through evaluating 5 nurses selected from Al-Diwaniya Teaching Hospital and the interval period was four weeks. Reliability Coefficient revealed that (0.95) respectively of the knowledge test and (0.91) respectively of the practice test.

The data were analyzed using (SPSS) version 21 application of statistical analysis system. The information was evenly distributed. Frequencies, Percentages, Mean and Standard Deviation, Pearson's Correlation Coefficients, T-test (paired sample t-test) to determine the mean difference between the nurses' practices at two levels of measurements (pre-test and post-test), and Analysis of variance (One Way-ANOVA) to determine the association between the nurses' practices and some demographic characteristics. Statistical significance was defined as a p 0.05.

RESULTS

Table 1 revealed that age of nurses (45) for a quasi-experimental design study at most 66.7% was from twenty to twenty nine years with Mean ± SD 30.68 ± 7.351. According to gender, the all participants were male. A high percentage (n=28; 62.2%) of nurses are graduating from a nursing institute. Regarding the years of experience in nursing were with Mean ± SD 7.17 ± 7.043. A more than fifty percent (n=26; 57.8%) of nurses were married. According to the training course the most nurses attended a training course with percentage (n=18; 40%) respectively just one time inside the Iraq, and form them 24.4% for one week and 15.6% more than one week.

Findings demonstrated in table 2 the evaluation of Nurse’s practices preventing Indwelling Catheter-Associated with Urinary Tract Infections in Preprogram were poor practices while in Post program were high practices. Also the results showed there were highly significant statistical differences between pre and post program at p< 0.001for nurse’s practices about preventing Indwelling Catheter-Associated with Urinary Tract Infections in Pre and Post Program for the Study Group in Al-Diwaniyah Teaching Hospital.

Findings demonstrated in table 3 there in no significant statistical differences between practices with nurse's education level at p- value ˃ 0.05. And the results showed there in no significant statistical correlation between practices with nurse's age and years of experience at p- value ˃ 0.05.

Table 1. Participants Demographics Characteristics

f.: Frequency, No.: Number, %Percentage, M= mean, SD= stander deviation

Table 2. Evaluation and comparison between Pre and Post Tests for the Study Group According to Main Domains of the Nursing staffs' practices in preventing CAUTI.

M = Mean of score, S.D=Standard Deviation, Eva=evaluation level, P = poor (1 – 1.66), IN= Intermediate (1.67 - 2.32), H = High (2.33 - 3). Sig.= Significance,  N.S=Non-Significant at p>0.05, S= Significant at p<0.05, H.S: High Significant at p<0.001

Table 3. Association between nurses' demographics with their practices in post program about prevention of CAUTI.

P=probability value, NS: Non-Significant at P ˃ 0.05, S: Significant at P < 0.05, HS: Highly Significant at P < 0.01.