Knowledge, attitude and practice in relation to catheter-associated urinary tract infection (CAUTI) prevention: A cross-sectional study

Effectiveness of Nurse-Driven Protocols in Reducing Catheter-Associated Urinary Tract Infections: A Systematic Review and Meta-Analysis

BACKGROUND

Catheter-associated urinary tract infections (CAUTIs) are common health care-associated infections linked to indwelling urinary catheters. Nurse-driven protocols (NDPs) empower nurses to direct care without physician orders, potentially enhancing patient outcomes and reducing infection rates.

PURPOSE

This systematic review and meta-analysis aimed to evaluate the effectiveness of NDPs for preventing CAUTIs and reducing catheter utilization rates.

METHODS

Databases searched included Cochrane Library, PubMed, Embase, and others. Ten studies involving 27, 965 NDP-treated patients and 30, 230 controls were reviewed, examining catheter utilization rates and CAUTI incidence.

RESULTS

Use of NDPs significantly lowered catheter utilization rates (34.84% vs 49.40%) and CAUTI incidence (2.867% vs 6.503%). Risk ratio analysis revealed a 29.48% decrease in catheter utilization and a 55.91% reduced CAUTI risk with NDP implementation.

CONCLUSIONS

Using NDPs demonstrate superior efficacy in reducing catheter use and CAUTI occurrence compared to traditional methods. Further research is warranted to solidify evidence-based nursing practices in this area.

The Effect of Catheter-Related Infection Control Education on Surgical Nurses' Knowledge Levels and Attitudes: A Randomized Controlled Trial

BACKGROUND

Catheters are commonly used in health care. As nurses play an active role in the prevention of catheter-related infections, their knowledge and attitudes on this subject are important. The goal of this study was to determine the effect of an educational intervention about catheter-related infection control precautions on nurses' knowledge levels and attitudes.

METHOD

This study was a single-center randomized controlled trial. The intervention group (n = 35) received evidence-based face-to-face education. The control group (n = 35) received routine in-service training. The nurses' knowledge and attitudes were assessed before, immediately after, and 3 months after the education.

RESULTS

After the training, the intervention group had statistically higher total scores than the control group on both scales immediately after the training (p < .001 and p = .008, respectively) and 3 months after the training (p = .001 and p < .001, respectively).

CONCLUSION

The evidence-based structured educational intervention about catheter-related infection prevention practices positively affected the knowledge and attitudes of surgical nurses. [J Contin Educ Nurs. 2024;55(10):479-486.].

Impact of narrative nursing cognition, self-efficacy, and social support on the practices of registered nurses in China: a structural equation modeling analysis

BACKGROUND

Narrative nursing is a novel approach according with humanistic care, which has been shown to be effective in improving health outcomes for both patients and nurses. Nevertheless, few studies have investigated the status of narrative nursing practice among nurses, and a comprehensive understanding of factors influencing this practice remains elusive.

DESIGN

This was an observational, cross-sectional study using convenience sampling method.

METHODS

After obtaining the informed consent, a total of 931 registered nurses from three hospitals in China were investigated. Data were collected using the Social Support Rating Scale, the General Self-efficacy Scale, and the Knowledge-Attitude-Practice Survey of Clinical Nurses on Narrative Nursing. All the scales were validated in the Chinese population. The questionnaire results were verified by an independent investigator. Factors influencing narrative nursing practice were determined through a series of analyses, including independent sample t-tests, one-way ANOVA, and Pearson correlations. Subsequently, path analysis was performed and a structural equation model was established.

RESULTS

The score of narrative nursing practice in this study was 30.26 ± 5.32. The structural equation model showed a good fit, with a Root Mean Square Error of Approximation (RMSEA) of 0.007 (90%CI: 0.000, 0.047). Both social support and narrative nursing attitude could directly affect narrative nursing practice (βsocial support = 0.08, P < 0.001; βattitude = 0.54, P < 0.001) and indirectly influence it via self-efficacy (βsocial support = 0.04, P < 0.001; βattitude = 0.06, P < 0.001). In addition, narrative nursing knowledge (β = 0.08, P < 0.001) and the nurses' growth environment (β=-0.06, P < 0.001) also affected the practice of narrative nursing.

CONCLUSION

Narrative nursing in China is at a medium level and could be influenced by several personal and environmental factors. This study highlighted the critical role of nursing management in the advancement of narrative nursing practices. Nurse managers should prioritize specialized training and cultivate supportive environments for nurses to improve their narrative nursing practices.

Efficacy and safety of preventing catheter-associated urinary tract infection by inhibiting catheter bacterial biofilm formation: a multicenter randomized controlled trial

BACKGROUND

Catheter-associated urinary tract infection (CAUTI) remains the most significant challenge among hospital-acquired infections (HAIs), yet still unresolved. The present study aims to evaluate the preventive effectiveness of JUC Spray Dressing (name of U.S. FDA and CE certifications, while the medical device name in China is Long-acting Antimicrobial Material) alone for CAUTI without combining with antibiotics and to evaluate the impact of bacterial biofilm formation on CAUTI results on the inserted catheters of patients.

METHODS

In this multicenter, randomized, double-blind study, we enrolled adults who suffered from acute urinary retention (AUR) and required catheterization in 6 hospitals in China. Participants were randomly allocated 1:1 according to a random number table to receive JUC Spray Dressing (JUC group) or normal saline (placebo group). The catheters were pretreated with JUC Spray Dressing or normal saline respectively before catheterization. Urine samples and catheter samples were collected after catheterization by trial staff for further investigation.

RESULTS

From April 2012 to April 2020, we enrolled 264 patients and randomly assigned them to the JUC group (n = 132) and the placebo group (n = 132). Clinical symptoms and urine bacterial cultures showed the incidence of CAUTI of the JUC group was significantly lower than the placebo group (P < 0.01). In addition, another 30 patients were enrolled to evaluate the biofilm formation on catheters after catheter insertion in the patients' urethra (10 groups, 3 each). The results of scanning electron microscopy (SEM) showed that bacterial biofilm formed on the 5th day in the placebo group, while no bacterial biofilm formed on the 5th day in the JUC group. In addition, no adverse reactions were reported using JUC Spray Dressing.

CONCLUSION

Continued indwelling urinary catheters for 5 days resulted in bacterial biofilm formation, and pretreatment of urethral catheters with JUC Spray Dressing can prevent bacterial biofilm formation by forming a physical antimicrobial film, and significantly reduce the incidence of CAUTI. This is the first report of a study on inhibiting bacterial biofilm formation on the catheters in CAUTI patients.

Torso hemorrhage: noncompressible? never say never

Since limb bleeding has been well managed by extremity tourniquets, the management of exsanguinating torso hemorrhage (TH) has become a hot issue both in military and civilian medicine. Conventional hemostatic techniques are ineffective for managing traumatic bleeding of organs and vessels within the torso due to the anatomical features. The designation of noncompressible torso hemorrhage (NCTH) marks a significant step in investigating the injury mechanisms and developing effective methods for bleeding control. Special tourniquets such as abdominal aortic and junctional tourniquet and SAM junctional tourniquet designed for NCTH have been approved by FDA for clinical use. Combat ready clamp and junctional emergency treatment tool also exhibit potential for external NCTH control. In addition, resuscitative endovascular balloon occlusion of the aorta (REBOA) further provides an endovascular solution to alleviate the challenges of NCTH treatment. Notably, NCTH cognitive surveys have revealed that medical staff have deficiencies in understanding relevant concepts and treatment abilities. The stereotypical interpretation of NCTH naming, particularly the term noncompressible, is the root cause of this issue. This review discusses the dynamic relationship between TH and NCTH by tracing the development of external NCTH control techniques. The authors propose to further subdivide the existing NCTH into compressible torso hemorrhage and NCTH' (noncompressible but REBOA controllable) based on whether hemostasis is available via external compression. Finally, due to the irreplaceability of special tourniquets during the prehospital stage, the authors emphasize the importance of a package program to improve the efficacy and safety of external NCTH control. This program includes the promotion of tourniquet redesign and hemostatic strategies, personnel reeducation, and complications prevention.

Knowledge, Attitude, Practice, and Associated Factors Toward the Prevention of Catheter-Associated Urinary Tract Infection Among Nurses in Ethiopia: Cross-Sectional Study

Introduction

Catheter-associated urinary tract infection (CAUTI) is one of the major device-associated hospital-acquired infections of the urinary tract. The nurse's knowledge, attitude, and practice (KAP) are the primary inputs for preventing the patient from developing CAUTI. Nevertheless, poor knowledge, a negative attitude, and poor practice toward the prevention of CAUTI among nurses remain an extensive problem.

Objective

This study aimed to assess KAP and associated factors toward the prevention of CAUTI among nurses in public hospitals in Addis Ababa, Ethiopia, in 2021.

Methods

An institution-based cross-sectional study was conducted among nurses from March 1 to April 30, 2021, in five public hospitals in Addis Ababa, Ethiopia. A total of 344 nurses were chosen for the study using a systematic random sampling technique. Data were collected using knowledge, attitude, and practice toward the prevention of CAUTI questionnaires. Data were entered into Epi Data 4.2 and exported into SPSS 25 for analysis. Binary and multivariate logistic regression were performed, and the statistical significance of associations between the variables was determined using odds ratios with a 95% confidence interval and p < .05.

Results

The study included 344 nurses, with a 97.7% response rate. Of the total nurses, 42.7% had good knowledge, 48.0% had a positive attitude, and 54.9% had good practice toward the prevention of CAUTI. Being married, having guidelines, and having a positive attitude were associated with good knowledge, whereas being married, having good knowledge, and having good practice were associated with a positive attitude toward the prevention of CAUTI. Having a high monthly income, having guidelines, having good knowledge, and having a positive attitude were associated with good practices toward the prevention of CAUTI.

Conclusion

The findings of this study show that nurses have a low level of knowledge, a negative attitude, and poor practice toward the prevention of CAUTI. Factors such as marital status, monthly income, and having guidelines in the working unit were associated with KAP toward the prevention of CAUTI. Therefore, the Ministry of Health and Hospital Interventions focused on these findings are required to improve KAP toward the prevention of CAUTI among nurses.

Healthcare workers' compliance with the catheter associated urinary tract infection prevention guidelines: an observational study in Yemen

BACKGROUND

Catheter-associated urinary tract infection is a global problem but it can be prevented with the appropriate implementation of evidence-based guidelines. This study was conducted to assess the level of compliance of healthcare workers with the catheter-associated urinary tract infection prevention guidelines during the insertion of a urinary catheter.

METHODS

An observational study using a descriptive cross-sectional design was conducted at Sana'a City hospitals, Yemen. All the nurses and physicians from the governmental, teaching, and private hospitals were eligible to participate in the study. The data collection was performed through convenience sampling from March 2020 to December 2020, using a structured observational checklist prepared specifically for this study.

RESULTS

The majority of the urinary catheter insertions were performed by nurses. There were no written policy or procedures for an urinary catheter insertion and no in-service education or training departments in the majority of the hospitals. The overall mean score of compliance was 7.31 of 10. About 71% of the healthcare workers had a high or acceptable level of compliance and 29% had an unsafe level of compliance. Compliance was low for maintaining aseptic technique throughout the insertion procedure, using a single use packet of lubricant jelly, performing hand hygiene immediately before insertion, and securing the urinary catheter once inserted. Factors affecting the healthcare workers compliance were gender, the working ward/unit of the healthcare workers, the availability of a written policy/procedure and a department or unit for in-service education.

CONCLUSION

Yemeni healthcare workers' overall compliance was acceptable but it was unsafe in several critical measures. There is an urgent need for developing, implementing, and monitoring national guidelines and institutional policy and procedures for catheter-associated urinary tract infection prevention. Periodical in-service education and training programs and adequate access to the necessary materials and supplies are paramount.

Knowledge, attitude, and practice regarding postoperative delirium among cardiac surgery nurses: A cross-sectional multi-centre study

AIMS AND OBJECTIVES

To examine knowledge, attitude, and practice regarding postoperative delirium and the relationships among cardiac surgery nurses in China.

BACKGROUND

Postoperative delirium is a prevalent and devastating complication following cardiac surgery. Nurses play a part in multi-disciplinary collaboration for preventing and managing postoperative delirium, of whom knowledge, attitude, and practice are essential.

DESIGN

A cross-sectional multi-centre study.

METHODS

Nurses from cardiac surgery wards and intensive care units of five tertiary hospitals in Wuhan, Hubei Province, China were enrolled. Data were gathered online using a self-administered questionnaire. Student's t-test, or analysis of variance, or non-parametric tests were performed to compare differences across groups. Bootstrapping mediation analysis was conducted to examine the relationship between knowledge, attitude, and practice. The STROBE checklist was used for the reporting of this study.

RESULTS

Of 429 nurses, a moderate level of knowledge and high levels of attitude and practice regarding postoperative delirium were revealed. Nurses with higher education, higher academic title, 5-10 years of practice in nursing and cardiac surgery nursing exhibited increased knowledge. With advanced age, practice in a specialised hospital, and training experience, nurses reported a better degree of practice. Attitude played a full mediating effect in the relationship between knowledge and practice, accounting for 81.82% of the total effects.

CONCLUSIONS

Knowledge, attitude, and practice regarding postoperative delirium are promising among Chinese cardiac surgery nurses, with knowledge of screening tools and perioperative nonpharmacological interventions and practice of screening in need of enhancement. Attitudes act as an intermediary between knowledge and practice regarding postoperative delirium.

RELEVANCE TO CLINICAL PRACTICE

Innovative and stratified in-service education is warranted to address knowledge enhancement. Meanwhile, organisations are suggested to make efforts to foster nurses' positive attitudes, particularly in creating a favourable culture and developing institutional protocols for postoperative delirium management to improve practice.

NO PATIENT OR PUBLIC CONTRIBUTION

This study is focused on cardiac surgery nurses' knowledge, attitude, and practice regarding postoperative delirium, and the research questions and design are from clinical nursing practice, literature review, and expert panel review, in which the patient or public is temporarily not involved.

Variation of diagnosis and treatment of catheter-associated urinary tract infections: an online survey among caretakers involved

Background

The diagnosis of a clinically significant catheter-associated urinary tract infection (CAUTI) in patients performing clean intermittent catheterization (CIC) or with an indwelling catheter (IC) can be challenging.

Objective

To get an insight into the variation of the used definition, diagnosis and management of CAUTIs by relevant healthcare workers in the Netherlands.

Design

An online clinical scenario-based survey.

Methods

The survey was built in Limesurvey and distributed to healthcare workers from randomly selected urology departments, rehabilitation departments/centres and general practice offices between January and May 2022. Questions regarding their field of experience, management strategies, used guidelines and two hypothetical cases with clinical scenarios of a possible CAUTI were included.

Results

A total of 172 individuals participated, of which 112 completed the survey. In all, 32 individuals who completed the survey partially were also included. Participants consisted of 68 [44 urologists, 22 rehabilitation doctors (RDs) and 2 general practitioners (GPs)] doctors, 60 nurses (46 from the urology department and 14 from rehabilitation centres/departments) and 16 medical assistants (13 from urology department and 3 from GP offices). The majority consulted patients with an IC or on CIC on a daily/weekly or monthly basis. In all, 35 urologists (79.5%), 9 RDs (40.9%), 21 (45.7%) nurses in the urology department and 6 (42.9%) nurses from a rehabilitation department/centre indicated bladder irrigation as a treatment option for prevention/treatment of CAUTIs, treatment of symptoms or treatment of blockage of the catheter. In the clinical scenarios presented, treatment discrepancies were seen between subspecialties and healthcare workers. Various guidelines were named for the definition of CAUTIs.

Conclusion

A considerable variation in diagnoses and management of CAUTIs between the healthcare workers involved was seen. Uniformity in diagnosing and managing CAUTIs, to prevent overtreatment and possible resistance to antibiotics, is advised. Suitable multidisciplinary guidelines are preferred.

Knowledge, attitudes and practices concerning catheter-associated urinary tract infection amongst healthcare workers: a mixed methods systematic review

AIM

To evaluate healthcare workers' knowledge, attitudes and practices level of prevention and management of catheter-associated urinary tract infection.

DESIGN

A mixed-methods systematic review.

METHODS

Searches were conducted in CINAHL, Cochrane Library, EMBASE, Medline, PubMed and Web of Science databases. Limited literatures published in English before 20 June 2021. Data were analysed and synthesized using thematic analysis by two authors.

RESULTS

Thirty-four articles were included. Healthcare workers' unbalanced varied knowledge level, positive attitudes, undesirable practices of catheter-associated urinary tract infection's prevention and control were identified. Barriers of healthcare workers' knowledge, attitudes and practices level of infection prevention included heavy workload, understaffing, physician variability in indwelling urinary catheter (IUC) practice by diagnosis, nursing variability in IUC placement technique, poor relationship and nurse's poor documentation. Leadership, better education, teamwork, technique training and information technology support, advocacy for nurse-driven protocol and IUC removal reminder were considered as facilitators.