Knowledge and attitude of doctors and nurses regarding indication for catheterization and prevention of catheter-associated urinary tract infection in a tertiary care hospital

Decision-making around removal of indwelling urinary catheters after pituitary surgery

BACKGROUND

Diabetes insipidus (DI) is a common complication following pituitary surgery, causing significant health issues if left untreated. As part of the diagnostic process, accurate urinary output monitoring via indwelling urinary catheters (IDUCs) is essential, despite risks such as urinary tract infections and hindered recovery. Research on IDUC removal after pituitary surgery remains scarce.

AIM

To explore health professionals' perspectives on IDUC management following pituitary surgery.

METHODS

Employing a qualitative design, semistructured interviews were conducted with 15 professionals in the neurosurgical ward of a Dutch academic hospital.

FINDINGS

Four themes emerged: Concerns about missing identifying DI, patient-nurse dynamics, workload management, and lack of shared decision making.

CONCLUSION

The findings underscore the need to balance clinical needs with patient care efficiency. There is a need for evidence-based guidelines and a multidisciplinary approach to optimise IDUC management, given the importance of patient-centred care and shared decision-making.

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.

Catheter-Associated Urinary Tract Infection (CAUTI)

One of the most prevalent health-related illnesses globally is catheter-associated urinary tract infection (CAUTI). CAUTIs account for almost half of all hospital-acquired diseases. Most of the healthcare-acquired urinary tract infections result from catheter tubes implantation. These tubes connect a collecting system and the urinary bladder via the urethra. These are known as indwelling urinary catheters. The length of catheterization has a key role in starting bacteriuria since biofilm eventually forms on all of these devices. Despite the low percentage of people with bacteriuria who start showing symptoms, there is nevertheless a significant burden associated with these contamination due to the repeated use of indwelling urinary devices. Minimizing indwelling device usage and stopping the catheter as soon as medically possible are the two most crucial preventative measures for bacteriuria and infection when device use is required. Efforts to avoid catheter-acquired urinary infections must be implemented and monitored by infection control guidelines in healthcare institutions. These approaches include monitoring device use, the suitability of device justifications, and problems. Ultimately, technological advancements in device substances that inhibit colony generation will be necessary to avoid these infestations. There is still some way by which we can bring down the increased phenomenon of catheter-associated urinary tract contamination by maintaining hygiene while handling the catheter and patients and keeping the infected patients away or isolated from unaffected patients as a precaution. This article mainly focuses on an overview that helps with discussing prevention, risk factors, diagnosis, control and management of CAUTI.

Knowledge, Practice and Associated Factors of Health Care Workers on Prevention of Catheter-Associated Urinary Tract Infections in South Wollo Zone Public Hospitals, Northeast Ethiopia

Introduction

Health care providers are responsible for inserting and maintaining urinary catheters. Hence, it is very important that health care professionals need to be skillful and knowledgeable to prevent urinary tract infection for those patients undergoing indwelling catheter. Thus, this study aimed to assess knowledge, practice and associated factors of health care workers on prevention of catheter-associated urinary tract infections in South Wollo zone public hospitals, Northeast Ethiopia.

Methods

An institution-based cross-sectional study design was employed by using a simple random sampling technique among 413 health care workers. Data were entered into Epi-Data version 4.6 and were exported to SPSS version 26 for analysis. Bivariable logistic regression analyses were performed, and variables with P-value less than 0.25 were fitted to multivariable logistic regression. In multivariable regression analysis, variables having p-value <0.05 were declared as significant factors for outcome variable.

Results

Out of the total 413 health care workers, 298 (72.2%) had adequate knowledge and 233 (56.4%) had adequate level of practice towards catheter-associated urinary tract infection prevention. Received training [AOR = 2.33, 95% CI: 1.404–3.889] and being bachelor degree holder [AOR = 1.90, 95% CI: 1.084–3.359] were significantly associated with adequate knowledge. On the other hand, being master and doctor [AOR = 4.71, 95% CI: 1.768–12.56], adequate level of knowledge [AOR = 2.90, 95% CI: 1.785–4.723], received training [AOR = 2.09, 95% CI: 1.315–3.338] and work experience ≥20 years [AOR = 5.82, 95% CI: 1.497–22.69] were significantly associated with adequate level of practice.

Conclusion

A substantial proportion of health care workers had inadequate knowledge and practice towards catheter-associated urinary tract infection prevention. Therefore, health care workers should strictly follow infection prevention guidelines and should update their knowledge and practice by taking short and long term training.

Aspects of Prevention of Urinary Tract Infections Associated with Urinary Bladder Catheterisation and Their Implementation in Nursing Practice

In the case of the prevention of catheter-associated urinary tract infections (CAUTI) related to healthcare provision, high-quality and comprehensively provided nursing care is essential. Implementation of preventive strategies is based on recommended procedures, and the introduction of whole sets of measures has been shown to be effective. The objective of this research is to find out whether the providers of acute bed care have implemented the steps of CAUTI prevention, and specifically which measures leading to improved quality of care in the area of urinary infections are already in place. To determine this, we carried out quantitative research. Data were collected using a questionnaire-based investigation; we used two non-standardised and one standardised questionnaire, and the respondents were general nurses in management positions (n = 186). The results revealed that result-related CAUTI indicators are monitored by only one-third of the respondents, and records of catheterisation indication are not kept by 17.3% of general nurses. The results of the research showed deficiencies in the monitoring of CAUTI outcome and process indicators, and a weakness of the implemented preventive measures is the maintenance of catheterisation documentation. Periodic CAUTI prevention training is not implemented as recommended. It is positive that there are well-working teams of HAI prevention experts in hospitals.

Diagnostic accuracy of electronic surveillance tool for catheter-associated urinary tract infections in tertiary care hospitals: A meta-analysis

BACKGROUND

Automated systems have been developed to reduce labor-intensive manual recordings during nosocomial infection surveillance. The diagnostic accuracies of these systems have differed in various settings.

METHODS

We designed this meta-analysis to evaluate the diagnostic accuracy of an electronic surveillance tool for catheter-associated urinary tract infections (CAUTIs) in tertiary care hospitals. We systematically searched databases such as Medline, Scopus, Cochrane library and Embase (from inception until November 2019) for relevant studies. We assessed the quality of trials using the diagnostic accuracy studies-2 tool, and performed a meta-analysis to obtain a pooled sensitivity and specificity for electronic surveillance. We included 6 studies with 16,492 patients in the analysis.

RESULTS

We found a pooled sensitivity of electronic diagnostic surveillance for CAUTIs of 97.5% (95% confidence interval [CI], 67.6-99.9%) and a pooled specificity of 92.6% (95% CI, 55.2-99.2%). The diagnostic odds ratio was 494 (95% CI, 89-2747). The positive likelihood ratio was 13.1 (95% CI, 1.63-105.8) and the negative likelihood ratio 0.02 (95% CI, 0.001-0.40). A bivariate box plot indicated the possibility of heterogeneity between the included studies.

CONCLUSION

Our review suggests that electronic surveillance is useful for diagnosing CAUTIs among hospitalized patients in tertiary care hospitals due to its high sensitivity and specificity.

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

BACKGROUND

Healthcare-associated infection (HAI) is one of the major threats to patients' safety besides being among the principal causes of patient morbidity and mortality. Catheter-associated urinary tract infection (CAUTI) is reported to be the most common HAI worldwide. CAUTI can be prevented with appropriate practice and care by healthcare personnel, especially nurses, who play the main role in urinary catheter care. Nurses' knowledge and attitude are considered to be important factors that influence their practice.

OBJECTIVES

To assess nurses' level of knowledge, attitude and perceived practice regarding CAUTI and its preventive measures.

METHODS

A cross-sectional design was adopted, and a self-administered questionnaire was used to collect data. Nurses from the medical and surgical inpatient wards of a tertiary teaching hospital in Malaysia were recruited in two stages using the stratified and simple random sampling methods. A total of 301 nurses participated. Descriptive analysis, an independent t test, ANOVA and hierarchical multiple regression were employed to analyse the data using SPSS software version 25. In addition, a STROBE checklist was used to report the results of this study.

RESULTS

Nurses were found to have good knowledge, a positive attitude and good perceived practice regarding CAUTI prevention. Nurses aged above 30 and who had more than ten years of experience reported higher knowledge levels. Knowledge was found to be positively correlated with attitude and perceived practice; however, attitude explained a higher variance in perceived practice of CAUTI prevention compared with knowledge.

CONCLUSION

Attitude was found to have a higher significant influence on perceived practice in this study. Educators need to emphasise the inculcation of a positive attitude among nurses rather than just knowledge for CAUTI prevention. Since this study assessed perceived practice, examining nurses' actual practice and its impact on patient outcomes is recommended in future studies.

Assessment of Knowledge, Attitude and Practice on Prevention of Catheter-associated Urinary Tract Infection (CAUTI) among Health Care Professionals Working in a Tertiary Care Teaching Hospital

Catheter-associated Urinary Tract Infection (CAUTI) is a common healthcare-related infection occurring in patients admitted for various ailments. Approximately 80% of hospital acquired Urinary Tract Infections (UTIs) are catheter associated. The purpose of the current research was to find out the level of knowledge, attitude and practice on prevention of CAUTI among healthcare professionals working in tertiary care hospital. A descriptive study was done among 95 health care working in tertiary care hospital in Chennai. The researchers administered standard questionnaire and statistically explored the knowledge, attitude, and practice levels about prevention of CAUTI among the participants. Among 95 participants, 28.4% and 71.6% of the individuals had moderately adequate knowledge and adequate knowledge about CAUTI. About 4.2% of the participants had unfavourable, 88.4% had moderately favourable and 7.4% had favourable attitude towards prevention of CAUTI. About 4.2% of the individuals had moderately adequate and 95.8% had adequate practice towards the prevention of CAUTI. There was significant correlation between attitude and practice. The professional experience of the participants showed statistically significant association with the level of practice among the demographic variables. In our present study, we found out that health care professionals had adequate knowledge, attitude, and practice on prevention of CAUTI. Medical education programs, frequent auditing with a checklist about catheter care must be conducted to maintain the achieved knowledge and practice levels.

Examining instruments used to measure knowledge of catheter-associated urinary tract infection prevention in health care workers: A systematic review

BACKGROUND

Catheter-associated urinary tract infection (CAUTI) is the most frequently occurring health care-associated infection among hospitalized patients. Adequate knowledge of CAUTI in health care workers supports effective prevention and control of the infection. This systematic review assesses instruments used to assess knowledge of CAUTI prevention in health care workers to inform future research. The catheter lifecycle model was used to evaluate the conceptual framework upon which the measurement instruments were based. Finally, the psychometric quality of these instruments was evaluated.

METHODS

Five electronic databases were searched for published studies and instruments. The COnsensus-based Standards for the selection of health status Measurement INstruments checklist was used to assess the psychometric quality reporting of the instruments.

RESULTS

Fifteen studies met the review inclusion criteria and 13 instruments were available for review. Most of the instruments did not address all knowledge components essential for CAUTI prevention as defined by the catheter lifecycle model. The psychometric quality of the instruments was not sufficiently evaluated.

CONCLUSIONS

Few instruments are available for CAUTI prevention knowledge measurement. The instruments were not closely aligned with the catheter lifecycle model as a framework. If CAUTI knowledge cannot be measured accurately using an effective instrument, this has the potential to impact negatively on clinical care and the focus of interventions. There is a need for a standardized instrument for the evaluation of CAUTI prevention knowledge so that targeted interventions can address knowledge deficits.

AR, Sequera SK. Nurses’ Knowledge on Prevention of Catheter-Associated Urinary Tract Infection in a Selected Hospital of Mangaluru

Introduction Catheter-associated urinary tract infection (CAUTI) is one of the most common health care–acquired infections encountered in clinical practice. The most important predisposing factor for CAUTI is the insertion and prolonged use of indwelling urinary catheter, which has been performed by unsterile technique, and by not taking adequate measures to maintain cleanliness of the catheter. This study aimed to assess the knowledge on prevention of CAUTI among staff nurses in a selected hospital of Mangaluru.

Materials and Methods Staff nurses working in medical college hospital with National Accreditation Board of Hospitals and Healthcare Providers accreditation were included in this cross-sectional descriptive study. Structured knowledge questionnaire was used to assess nurses’ knowledge on CAUTI. Frequency, percentage, mean, standard deviation, and Chi-square test were used for association.

Results Majority of nurses (80.85%) had average knowledge on prevention of CAUTI, whereas 11.2% nurses had low knowledge and few (7.231%) nurses had high knowledge regarding CAUTI. Association was found between knowledge and age (0.013), educational qualification (0.018), and encounter with patients with CAUTI (0.00) is <0.05, at 0.05 level of significance

Conclusion Pooled results showed that majority of the nurses had average knowledge on prevention of CAUTI.

Change in staff perspectives on indwelling urinary catheter use after implementation of an intervention bundle in seven Swiss acute care hospitals: results of a before/after survey study

OBJECTIVE

To evaluate changes in staff perspectives towards indwelling urinary catheter (IUC) use after implementation of a 1-year quality improvement project.

DESIGN

Repeated cross-sectional survey at baseline (October 2016) and 12-month follow-up (October 2017).

SETTING

Seven acute care hospitals in Switzerland.

PARTICIPANTS

The survey was targeted at all nursing and medical staff members working at the participating hospitals at the time of survey distribution. A total of 1579 staff members participated in the baseline survey (T₀) (49% response rate) and 1527 participated in the follow-up survey (T₁) (47% response rate).

INTERVENTION

A multimodal intervention bundle, consisting of an evidence-based indication list, daily re-evaluation of ongoing catheter need and staff training, was implemented over the course of 9 months.

MAIN OUTCOME MEASURES

Staff knowledge (15 items), perception of current practices and culture (scale 1-7), self-reported responsibilities (multiple-response question) and determinants of behaviour (scale 1-7) before and after implementation of the intervention bundle.

RESULTS

The mean number of correctly answered knowledge questions increased significantly between the two survey periods (T₀: 10.4, T₁: 11.0; p<0.001). Self-reported responsibilities with regard to IUC management by nurses and physicians changed only slightly over time. Perception of current practices and culture in regard to safe urinary catheter use increased significantly (T₀: 5.3, T₁: 5.5; p<0.001). Significant changes were also observed for determinants of behaviour (T₀: 5.3, T₁: 5.6; p<0.001).

CONCLUSION

We found small but significant changes in staff perceptions after implementation of an evidence-based intervention bundle. Efforts now need to be targeted at sustaining and reinforcing these changes, so that restrictive use of IUCs becomes an integral part of the hospital culture.

Therapeutic perceptions in management of transplant athletes at transplant games

OBJECTIVE

To investigate manual therapist's knowledge and beliefs of working with Transplantee Athletes (TxA) at Transplant Games.

DESIGN

On-line questionnaire.

PARTICIPANTS

Thirty present and previous members of Transplant Sport 'therapy team' (age; 35 ± 14 years, 24 female).

MAIN OUTCOME MEASURES

Questions concerned demographics and general information on the background of the therapists. Closed questions with rating statements concerning beliefs when treating TxA and open questions asking for advice the participants would give to colleagues and further information they would like to have available to them.

RESULTS

TxA were thought to be a vulnerable group of athletes requiring special precautions and considerations. Two areas of information evolved: "general advice for TxA management" and "specific advice for therapists". General advice was to understand TxAs and be vigilant with hygiene. Specific therapy advice was to avoid grade V manipulations and care with taping and massage, because of complications resulting from side effects of long-term medication.

CONCLUSION

There appears to be a lack of research-based evidence to guide practitioners in their management of TxAs. Generic, good advice is now available from experienced practitioners however there is a paucity of research evidence to support this. Thus, there is a potential danger of being overcautious in approaches to treatment which ultimately may impact on athletic performance. .

Nurses' knowledge and attitudes regarding major immobility complications among bedridden patients: A prospective multicentre study

AIMS AND OBJECTIVES

To gain insight into nurses' knowledge and attitudes regarding major immobility complications (pressure ulcers, pneumonia, deep vein thrombosis and urinary tract infections) and explore the correlation of nurses' knowledge and attitudes with the incidence of these complications.

BACKGROUND

Immobility complications have adverse consequences, and effective management requires appropriate knowledge, attitudes and skills. Evidence about nurses' knowledge and attitudes regarding immobility complications is lacking.

DESIGN

Cross-sectional study.

METHODS

A total of 3,903 nurses and 21,333 bedridden patients from 25 hospitals in China were surveyed. Nurses' knowledge and attitudes regarding major immobility complications were assessed using researcher-developed questionnaires. The content validity, reliability and internal consistency of the questionnaires were validated through expert review and a pilot study. The incidence of major immobility complications among bedridden patients from selected wards was surveyed by trained investigators. Correlations between knowledge, attitudes and the incidence of major immobility complications were evaluated with multilevel regression models.

RESULTS

Mean knowledge scores were 64.07% for pressure ulcers, 72.92% for deep vein thrombosis, 76.54% for pneumonia and 83.30% for urinary tract infections. Mean attitude scores for these complications were 86.25%, 84.31%, 85.00% and 84.53%, respectively. Knowledge and attitude scores were significantly higher among nurses with older age, longer employment duration, higher education level, previous training experience and those working in tertiary hospitals or critical care units. Nurses' knowledge about pressure ulcers was negatively related to the incidence of pressure ulcers, and attitude towards pneumonia was negatively correlated with the incidence of pneumonia.

CONCLUSION

Clinical nurses have relatively positive attitudes but inadequate knowledge regarding major immobility complications. Improved knowledge and attitudes regarding major immobility complications may contribute to reducing these complications.

RELEVANCE TO CLINICAL PRACTICE

Nursing managers should implement measures to improve nurses' knowledge and attitudes regarding major immobility complications to reduce the incidence of these complications in bedridden patients.

Trauma and Intensive Care Nursing Knowledge and Attitude of Foley Catheter Insertion and Maintenance

In the acute care setting, the majority of urinary tract infections are associated with indwelling urinary catheters. Despite guidelines for proper use, catheter-associated urinary tract infections (CAUTIs) continue to occur in critically ill/injured patients. There is a paucity of data on the translation between CAUTI prevention education and behavioral change. This project evaluated nurse's clinical knowledge and attitude toward Foley catheter insertion and maintenance to determine the benefits of addressing gaps in knowledge and inconsistencies in attitude through education.A prospective cohort study was conducted with registered nurses from the emergency room, trauma/surgical, and medical intensive care units. Participant's clinical knowledge and attitude toward Foley catheter usage and CAUTIs were evaluated using a 20-question survey tool before and after a CAUTI education program.Forty-eight nurses completed the presurvey, educational training, and postsurvey. The mean postsurvey score was significantly higher (86.9 ± 8.3%) than the presurvey score (76.0 ± 12.3%) for the knowledge section of the survey. There was no marked difference in participant attitude following the educational training, with mean presurvey and postsurvey scores of 91.3 ± 7.0% and 89.8 ± 5.3%, respectively. After the course, participants were more confident in their clinical knowledge; however, perception regarding CAUTI prevention did not improve. A series of unannounced rounding observations before and after the intervention showed an improvement in proper Foley catheter maintenance.Catheter-associated urinary tract infection prevention education was an effective countermeasure to address gaps in clinical knowledge, but modifying attitudes was difficult to achieve. In the short term, the training appeared to improve proper maintenance in clinical practice.

Determinants of urinary catheter removal practices in the pediatric intensive care unit: A survey

BACKGROUND

Prolonged use of indwelling catheters is associated with hospital-acquired urinary tract infections (UTIs). Literature is scarce about the factors influencing urinary catheter removal and maintenance in children. This study aims to describe the determinants of urinary catheter removal in pediatric intensive care unit (PICU) patients.

METHODS

Cross-sectional survey of 171 physicians and nurses working at 2 tertiary PICUs in Montreal, Canada. We used focus groups and literature review to design the survey questions and 3 clinical scenarios. We analyzed our results using descriptive statistics and multivariate multinomial regression.

RESULTS

There were 131 (77%) participants who answered the survey. Factors prompting urinary catheter removal (P < .01) included recent extubation, superficial sedation level, fever, and history of previous UTI. Presence of shock (P < .01) and fluid overload (P < .05) were associated with maintenance of catheters. Physicians were more likely to remove urinary catheters than nurses in all scenarios.

CONCLUSIONS

We identified a consistent set of variables that drive the removal of indwelling catheters in PICUs. Studies are needed to determine whether incorporating these determinants into infection control interventions will reduce urinary catheter use and catheter-associated UTIs in critically ill children.

Rehabilitation Nurses' Knowledge, Attitudes, and Behaviors for Preventing Urinary Tract Infections From Intermittent Catheterization

PURPOSE

The aim of this study was to develop and examine the reliability of a survey to assess knowledge, attitudes, and behaviors (KAB) of rehabilitation nurses for preventing urinary tract infections in persons requiring intermittent catheterization.

DESIGN

Cross-sectional survey with principal component analysis.

METHODS

Survey development and administration based on national guidelines.

FINDINGS

Principal component analysis produced three reliable components of KAB explaining 54.5% of response variance. Results indicate that nurses report adequate knowledge and training. Although the facility had an evidence-based online catheterization procedure, staff reported that the procedure was not helpful nor useable. Twenty-eight percent incorrectly identified the root cause of urinary tract infection, and 45% reported that other nurses always washed their hands. Barriers to using standard intermittent catheterization technique were staff, time, and patient variables.

CONCLUSION

The modified survey is a reliable measure of KAB.

CLINICAL RELEVANCE

The survey assists with identifying knowledge gaps, customizing education, and changing practice.