Braidee Adams and Katreena Merrill, College of Nursing

Introduction

Catheter Associated Urinary Tract Infections (CAUTIs) are the most common healthcare acquired infection. One quarter of all hospitalized adults will have an indwelling catheter at some point during their stay and half of all catheterized patients test positive for bacteria in their urine within one week. A CAUTI can lead to further complications such as: fever, bloodstream infection, a longer hospital stay, and a need for more expensive antibiotics for treatment. In addition to these complications, hospitals do not receive reimbursement from insurance companies when a patient contracts a CAUTI. Nurses are the most influential team member when it comes to preventing CAUTIs. They are the ones performing catheter care and performing assessments throughout a patients’ stay. The purpose of this study was to measure nurses’ knowledge and attitudes of urinary catheter care.

Methodology

Registered Nurses across three Intensive Care Units from a local hospital and infection prevention nurses from a local infection control association chapter were surveyed. A modified version of the Knowledge and Attitudes of Urinary Catheter Care (KA-UCC) survey was used. Current national guidelines for preventing CAUTI were used to revise the questions. The instrument was then pilot tested in three Intensive Care Units. A link to a Survey Monkey questionnaire was distributed to 180 nurses. Results from the questionnaire were analyzed to assess nurses’ knowledge and attitudes of urinary catheter care and also to further revise and validate the instrument. Each response from the infection prevention nurses was reviewed and the instrument revised based upon their feedback. Descriptive statistics were completed for the results of the pilot test.

Results

To further validate the instrument, 8 infection prevention nurses reviewed the questions and provided feedback. A total of 64 Registered Nurses from 4 different departments completed the online questionnaire. All of the respondents reported being trained on catheter insertion (100%) but 85% of them reported they were trained more than 2 years previously. Most nurses (76%) reported being trained on catheter care but less than half were trained in the past year. The number of catheters placed in the last month was low, 80% of respondents reported placing 0-1 catheters in the last month. One-third (41%) of nurses reported changing gloves between peri-care and catheter care half of the time or less. A total of 28% of respondents agreed that patients get better care when they have urinary catheters placed.

Discussion

One of the most important aspects of patient care in hospitals is developing and following protocols for specific cares and procedures. These protocols ensure that patients don’t receive procedures they don’t need but they also help prevent complications for a patient in the hospital, such as acquiring an infection. Nursing Educators help provide evidence-based training for nurses on their units, however in the sample only half of the nurses had been trained on catheter care in the past year. It is essential to retrain and implement new evidence-based practice in nurses’ catheter care to improve infection rates in the hospital. By identifying areas that are in need of improvement, this instrument helps department managers and nurse educators know what they need to work on with their employees to help decrease CAUTI rates. Because of the complications associated with CAUTIs, it is very important that continual assessment, identification of problems, and strategy implementation continue in every patient care area that uses catheters.

Conclusion

CAUTI is the number one healthcare acquired infection. Nurses play a critical role in preventing CAUTIs but in order to do so they need to follow proper protocols and have the training to perform their responsibilities adequately. Previously there have been no valid and reliable instruments to measure nurses’ knowledge and attitudes of urinary catheter care. Department managers and heads of staff will be able to use our instrument to measure their staff’s knowledge and attitudes then use that data to develop a plan of improvement. Development of this instrument may result in additional information that will help infection prevention nurses succeed in quality improvement endeavors to decrease CAUTI rates in hospitals.