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Knowledge on Practice of Urinary Catheter Care and Compliance to Urinary

Catheter Care Guidelines-A Hospital based Study

Article  in  Indian Journal of Public Health Research and Development · November 2018

DOI: 10.5958/0976-5506.2018.01455.9

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 DOI Number: 10.5958/0976-5506.2018.01455.9

Knowledge on Practice of Urinary Catheter Care and

Compliance to Urinary Catheter Care Guidelines- A Hospital
based Study

Maryl Candida Cutinho1, Melita Sheilini2, Harish B3

Department of Medical Surgical Nursing, MSc (N), MCON, MAHE, Manipal, 2Assistant, Professor, Department of
1

Medical Surgical Nursing, Selection Grade, MCON, MAHE, Manipal, 3Lecturer, Department of Medical
Surgical Nursing, MSc (N), MCON, MAHE, Manipal

ABSTRACT

Background: Catheter associated urinary tract infections are the leading cause of secondary health care-
associated bacteremia. An infection that involves any of the organs or structures of urinary tract infection
including the kidneys, urethra, bladder and ureter is called as urinary tract infection. About 75% of urinary
tract infections acquired in the hospital are because of the urinary catheters. Prolonged use of indwelling
urinary catheter is one of the main risk of catheter associated urinary tract infection.

Objective: To assess the knowledge on practice of urinary catheter care and compliance to urinary catheter
care guidelines by the staff nurses.

Materials and Method: Quantitative approach with descriptive survey design was used for the study.
Staff nurses available during data collection and willing to participate were included. Purposive sampling
technique was used to recruit the participants to assess the knowledge. By concealed observation practices
of urinary catheter care were made to assess the compliance.

Results: Majority 89(82.4%) of the participants had average knowledge , 18(16.7%) had good knowledge
on prevention of catheter associated urinary tract infections .There was maximum noncompliance to the
procedural steps while performing urine specimen collection , removal of urinary catheter and maintenance
of urinary catheter.

Conclusion: Nurses have to be aware of hospital policies and CDC guidelines in carrying out procedures
like urinary catheter insertion, collection of urine specimens and maintenance of indwelling urinary catheter.
Compliance of staff nurses is vital in reducing and preventing the occurrence of health care associated
infection.

Keywords: knowledge on practice, urinary catheter care, compliance to urinary catheter care guidelines.

INTRODUCTION that which is occurring in patient during the process of

Health care-associated infection(HCAI), also
referred to as “ nosocomial” or “hospital” infection, is
Correspondent author:
Dr. Melita Sheilini
Department of Medical Surgical Nursing,
Manipal College of Nursing Manipal,
MAHE, Manipal-576104. Telephone no: 8095976561.
email: shyli.mel@manipal.edu,
Fax: 0091-08202922572
care in the hospital or health care facility which was not
present or incubating at the time of admission1.
Catheter associated urinary tract infections
(CAUTI) are the leading cause of secondary health
care-associated bacteremia. An infection that involves
any of the organs or structures of urinary tract infection
including the kidneys, urethra, bladder and ureter is
called as urinary tract infection. About 75% of urinary
tract infections acquired in the hospital are because
of the urinary catheters. Prolonged use of indwelling
 Indian Journal of Public Health Research & Development, November 2018, Vol. 9, No. 11
urinary catheter is one of the main risk of catheter
associated urinary tract infection .Catheter associated
urinary tract infection is caused by many organisms.
The frequent pathogens associated are E.Coli(21.4%),
Candida spp (21%),Enterococcus(14.9%), Pseudomonas
Aeruginosa(10%), Klebsiella Pneumoniae( 7.75) and
Enterobacterspp(4.15).2,8,11
Urinary tract infections are the 4 most common type
th
of hospital acquired infection with an estimated 93,300
urinary tract infections (UTI) in acute care hospitals in
the year 20112. UTIs are accounting for more than 12%
of infections reported by acute care hospitals. Research
studies shows that when health care facilities, doctors,
nurses and care teams are aware of infection problems, it
is possible to take specific steps to prevent them. CAUTI
can causes a number of complications like cystitis,
prostatitis, endocarditis, pyelonephritis, orchitis, septic
arthritis, endopthalmitis, meningitis in patients. Yearly
13,000 deaths occur due to urinary tract infection related
to urethral catheters2, 9, 10, 16. The present study aimed at
assessing the knowledge on practice of urinary catheter
care and compliance to urinary catheter care guidelines
by the staff nurses working at a tertiary care hospital.
MATERIALS AND METHOD
The study was conducted in a tertiary care multi-
specialty hospital in southern India among 108 staff
nurses. Staff nurses working in the intensive care units
were included in the study. The data was collected
between 2nd January 2017 and 5th February 2017.
After obtaining administrative permission and from
Institutional Ethics Committee (IEC No. 748/2016)
concealed observation of events such as urinary
catheter insertion, urinary catheter removal, urine
specimen collection and maintenance of urinary catheter
were made. After this the staff nurses in the units
were explained about the concealed observation and
consent was sort and participant information sheet was
given to them. The knowledge was assessed by using
structured knowledge questionnaire which consisted
of 30 items with domains such as hospital infection
control committee guidelines, Centre for disease control
guidelines, pathogenesis of catheter associated urinary
tract infection. Each item consisted of four options from
which participants were asked to choose the right one.
Compliance to different procedural steps of urinary
catheter care practices was assessed by concealed
219
observation. Procedures like insertion of urinary catheter,
removal of urinary catheter, urine specimen collection,
maintenance of urinary catheter were observed using
checklist. All the events available during data collection
were observed. Confidentiality of study participants was
maintained throughout the study.
Non probability Purposive sampling technique was
used to assess the knowledge of staff nurses (n=108) on
prevention of catheter associated urinary tract infection
and for practices maximum number of observations
were made by concealed observation.
Data was collected using structured knowledge
questionnaire to assess knowledge and practices
of urinary catheter care were made observed using
observation checklist.
RESULTS AND DISCUSSION
Data was analysed using descriptive statistics. The
findings of the study showed that out of 108 participants
majority 95 (88%) were between the age group of 20
to 30. Majority 92 (85.2%) were females, 64(59.3%)
were GNM qualified and majority 67(62%) were having
experience of 1 to 5years.Out of 16 (14.8%) who had
attended the training program on CAUTI; 14(13%)
expressed having awareness on Evidence Based
Guidelines of CAUTI preventive practices (Table 1).
Out of 108 participants, 89(82.4%) had average
knowledge and only 1(0.9%) had poor knowledge on
practice of urinary catheter care (Figure 1). The results
of the study conducted by Prasanna at Nellore,India in
2015 on Knowledge regarding catheter care among 30
staff nurses showed that 46.7% had adequate knowledge
and 20% had inadequate knowledge.3 The findings of
the study done by Opina & Oducado at Iliolo city in
2014 reported that out of 30 staff nurses 70% had low
level of knowledge and 30% had average knowledge.4
Study conducted by Purbia, Vyas, Sharma & Rathore
among staff nurses working at Geetanajli Hospital
Udaipur, Rajasthan India showed that 58.88% belonged
to inadequate knowledge and 12.22% belonged to
moderate knowledge.5
With regard to practices of urinary catheter insertion,
out of 19 events observed there was noncompliance to
procedural steps in the areas of hand hygiene before
catheter insertion with soap and water though few of them
used hand rub. Perineal hygiene with antiseptics was
 220 Indian Journal of Public Health Research & Development, November 2018, Vol. 9, No. 11
observed in all the events but a single swab was used for
multiple strokes 17(89.5%).Compliance was observed in
securing the urinary catheter and hanging the urine bag
below bladder level (Table2). This finding is supported
by a descriptive study which was conducted by Mark
Lister & Ryan Michael in 2014 to assess the knowledge
and practices of staff nurses regarding infection control
practices for indwelling urinary catheters. The findings
of the study reported that 40% of staff nurses did not
perform hand washing before catheter insertion. It was
identified that 66.7 % had poor practices on infection
control. Out of 30 staff nurses who were observed for 30
days; handling of sterile equipments was 80%, wearing
sterile glove before insertion is 83.3%, perineal care is
3.3%, placement of drainage bag was 100%4.
Out of 21 observations done; there was
noncompliance in the areas of handhygiene, cleaning
of port with disinfectant and aspiration of urine with
sterile syringe, which was not performed in all the 21
observations. It was observed that urine specimen were
collected either by disconnecting continuous drainage
system for cultures or directly from urine collecting bag
for routine tests (Table. 3). The findings of this study
contradicts the findings of the study done in 2016 to assess
the knowledge and practice on appropriate reasons in
obtaining proper urine cultures and identifying catheter
associated urinary tract infection .The results showed
that out of 394 staff nurses 78.9% of them reported of
collecting urine specimen from port by aspirating while
3.3% reported that urine specimen was collected from the
drainage bag or by disconnecting the closed drainage6.
The findings also showed that with regard to practices
of urinary catheter removal there was compliance
observed in all events except in the area of routine
perineal care 11(91.7%) after the catheter removal (Table
4).With regard to practices of maintenance of urinary
catheter, out of 170 observations done noncompliance
Table 1: Description of sample characteristics. N=108
Frequency(f)
Sample characteristics
Age in years
20-30 95
>30 13
Gender
Male
16
Female
92
was observed in the areas of handhygiene before
procedure 50(29.41%), cleaning of perineal area with
soap and water 20(11.76%),handhygiene after procedure
152(89.41%), securing the catheter 161(94.70%) and
maintaining closed drainage system 161(94.70%)
(Table. 5). A prospective observational study conducted
in 5 general hospitals of Kansai area of Japan reported
that the perineal care was given by only 56% of the
nurses for the patients with urinary catheter.7
CONCLUSION
Healthcare associated infections are a threat to
patient’s safety. Nurses have a vital role in preventing
healthcare associated infections. With developing
technologies nurses need to update themselves to face
the challenges of dealing with and preventing healthcare
associated infections. Nurses have to be aware of
hospital policies and CDC guidelines in carrying out
procedures like urinary catheter insertion, collection of
urine specimens and maintenance of indwelling urinary
catheter. Compliance of staff nurses can reduce and also
prevent the healthcare associated infection.12, 14, 17 In
the present study majority (82.4%) of the staff nurses
had adequate knowledge but there was noncompliance
to procedural steps of urinary catheter insertion, urine
specimen collection, maintenance of urinary catheter.
The study findings has provided a base in finding out
the compliance of staff nurses towards practices of
prevention of urinary tract infection associated with
indwelling urinary catheter. Though the staff nurses
had adequate knowledge on prevention of catheter
associated urinary tract infection there was maximum
noncompliance observed in practices regarding
catheter care. The study recommends that nurses need
to enhance their knowledge on the hospital as well as
CDC guidelines for prevention of urinary catheter care
infections so as to be compliant to the procedures.
Percentage(%)
88
12
14.8
85.2
 Indian Journal of Public Health Research & Development, November 2018, Vol. 9, No. 11 221

Cont... Table1: Description of sample characteristics. N=108

Educational qualification
GNM
64 59.3
B.SC
44 40.7
M.SC
0 0

Total Years of experience

<1 9.3
10
1-5 62
67
>5 28.7
31

Attended training programs on catheter associated

urinary tract infection
Yes 14.8
16
No 85.2
92

Awareness of EBP on CAUTI

Yes 14 13
No 94 87

N= 108

Figure1. Knowledge scores of nurses on prevention of catheter associated urinary tract infections.
 222 Indian Journal of Public Health Research & Development, November 2018, Vol. 9, No. 11

Table 2: Frequency and percentage description of infection control practices while inserting urinary
catheter N=19

Sl. Practices Yes No No

Frequency
Frequency (f) Percentage (%) Percentage (%)
(f)

1. Arrange sterile equipments 19 100 0 0

2. Position patient supine with knee flexed 19 100 0 0

3. Performs hand hygiene 0 0 19 100
4. Don sterile gloves 19 100 0 0

5. Perform perineal hygiene with antiseptics 2 10.5 17 89.5

6. Select appropriate catheter(smaller bore) 19 100 0 0

7. Lubrication 19 100 0 0

8. Exposes meatus with non dominant hand. 19 100 0 0

Sterile hand to pick up the catheter with the distal

9. 19 100 0 0
end on the sterile field

Insert catheter into urethra until urine begins to

10. 19 100 0 0
drain.

11. Inflate the retention ballon with 15ml of water  19 100 0 0

12. Pull the tube gently to ensure placement 19 100 0 0

13. Connect the distal end to urine collecting bag 19 100 0 0

14. Secure catheter tubing on thigh 19 100 0 0

15. Attach drainage bag below the bladder level 19 100 0 0

16. Remove gloves and perform hand hygiene 19 100 0 0

Table 3: Frequency and percenatge description of infection control practices during urinary specimen
collection. N=21

Sl Practices Yes No No

Frequency(f) Percentage (%) Frequency (f) Percentage (%)

1. Performs hand hygiene 0 0 21 100

2. Don gloves 21 100 0 0

3. Clean the port of the tube with disinfectant 0 0 21 100

Aspirate the urine from the port with

4. 0 0 21 100
sterile syringe
Open the sterile urine container and drop
5. 21 100 0 0
the urine in and recap

6. Discard gloves and perform hand hygiene 21 100 0 0

 Indian Journal of Public Health Research & Development, November 2018, Vol. 9, No. 11 223

Table 4. Frequency and percenatge description of infection control practices during urinary catheter
removal N= 12

Sl. Practices Yes No No

Frequency(f) Percentage (%) Frequency (f) Percentage (%)

1. Perform hand hygiene 0 0 12 100

2. Don clean gloves 12 100 0 0

Aspirate the water to deflate the

3. 12 100 0 0
balloon

4. Slowly pull the tube out 12 100 0 0

5. Routine care of perineal area 1 8.3 11 91.7

Discard gloves and perform hand

6. 12 100 0 0
hygiene

Table 5. Description of infection control practices during urinary catheter maintenance N=170

Sl. Practices Yes No No

Frequency(f) Percentage (%) Frequency (f) Percentage (%)

1. Perform hand hygiene 50 29.41 120 70.59

2. Wear clean gloves 170 100 0 0

Cleans the perineal area with soap

3. 20 11.76 150 88.24
and water

Performs hand hygiene after

4. 152 89.41 18 10.59
procedure

5. Catheter secured appropriately 161 94.70 9 5.3

6. Maintain closed drainage system 161 94.70 9 5.3

Ethical Clearance: Ethical clearance was sought 2016

from institutional ethical committee (IEC No.748/2016),
permission from Medical superintendent was sort
and registered in CTRI. Informed consent from the
participants was obtained after explaining the purpose
of the study and assuring confidentiality of information.
Source of Funding: Self
Conflict of Interest: Nil
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