Table 1. Demographic Variables of Study Participants
Urinary catheterization, a procedure in which a tube is placed into the urinary bladder through urethra for draining out urine is the major cause of catheter associated infections that causes 70% to 80% of catheter associated infections globally, along with 17.5% infections in European hospitals, 23.6% in US hospitals and 52% in the hospitals of Pakistan. Objectives of the study were, to asses nurse's knowledge regarding urethral catheter related infections. This study was channelized in public tertiary care hospitals of Peshawar, Pakistan. A descriptive cross-sectional design was used for this study, and conveniently ninety nurses were selected for the study. The entire period of study was from September 2017 to December 2017. A self-developed questionnaire was used to assess knowledge. Out of 90 participants, GNM were 65 (72.2%) & BSc(N) 25 (27.8%). 61.1% of the participants had low level of average knowledge and 38.9% of them had high level of average knowledge. Nurses' knowledge was low, therefore the administration & Human Resource Department of the hospitals provide periodic in-service education, up-to-date guidelines to nurses which are evidence-based for catheter use, insertion, maintenance and extraction.
Urinary catheterization, a procedure in which a tube is placed into the urinary bladder through urethra for draining out Urine is the major cause of Catheter associated infections that account for 70% to 80% infections associated with catheter globally, along with 17.5% infections in European hospitals and 23.6% in US hospitals (Prasanna & Radhika, 2015). In Pakistan, the percentage of CAUTI is 52% of all infections in which E.coli, the crucial abortifacient microorganism accounts for 20.43% (Khan et al., 2010; Mahboob et al., 2011). According to the report of National Health Care Safety Network, 75% infections are caused due to urinary catheter; among these infections UTIs are the enormous ordinary infections (Edwards et al., 2009). UTI is an infection in which parts of the urinary system i.e. urethra, ureters, urinary bladder and kidneys might be infected. Indications of urethral catheterization are large in number; it is primarily indicated for urinary output monitoring of chronic patients, for comfortableness of critically sick patients, management of impaired skin induce by urinary incontinence, and use of maintaining on ongoing gefflux of urine for clients who go through preoperative procedures. For preoperative patients, maintaining ongoing draining of urine in clients with problem in urination due to neural illness that causes loss of sensation which affects micturition and prompts treatment for acute urinary retention (Shehab, 2017).
Contra indications of urethral catheterization are, urethral injury either suspected or confirmed, current urinary tract surgery, urethral stricture, and aggressive patients (Rawal et al., 2017).
The most common complications of urethral catheterization are UTIs which develop in 3 to 10% of patients after per day of Urethral catheterization, although some infections are limited to asymptomatic bacteriuria, but sometimes pyelonephritis, bacteremia, urosepsis, paraphimosis and urethral trauma develop (Saint & Lipsky, 1999).
The different potential risk factors of CAUTI are continuation of indwelling urinary catheter, insertion of catheter without use of aseptic techniques, repeated break/disconnection of closed drainage system and accumulation of pathogens in urethral meatus (Thomas & Setnik, 2006). Preventive strategies for urinary catheter related infections are, placement of catheter for appropriate indications and leaving in place as long as needed, reduced urethral catheter usage and its duration, usage of urinary catheter in operative patients when necessary and removal of catheter from post-operative patients as soon as possible unless the patient needs catheter for appropriate indication. For continuous use of the catheter, perform hand hygiene suddenly before and after insertion or touching the device and catheter site. Insertion of catheter to be performed only by trained health personnel, usage of sterile gloves, drapes, sponges, and suitable antiseptic or sterile solution for cleaning of catheter sit and securing of urethral catheter after placement to preclude urethral movement and traction to be enforced (Fasugba et al., 2015). Drekonja et al. carried out an internet survey in 2010 on Minnesota nurses regarding Foley catheter practice and knowledge, for which nurses were selected for the survey through random sampling technique. The Survey was pertaining to indications of Foley catheter insertion and effectiveness of different interventions for preventing urethral catheter related infection. The nurses observed that early dragging of catheter was the highest effective intervention to prevent urethral catheter related infections. Investigators inferred that the Minnesota nurses illustrated high level of knowledge of the utility of early dragging of indwelling catheter for averting urethral catheter related infections. The nurses are responsible for the care and maintenance of indwelling catheters. They can prevent the patients from catheter associated infections through best practices for indwelling catheters care (Drekonja et al., 2010).
The objective was for nurses' knowledge regarding urethral catheter related infections.
What do nurses know regarding urethral catheter related infections?
To execute objectives of the study, descriptive and cross sectional design was applied for data collection and analysis.
Self-developed questionnaire was used after a thorough research literature review (Drekonja et al., 2010; Rawal et al., 2017).
The study was conducted in public tertiary care hospitals of Peshawar, Pakistan, and the study population were registered nursing staff.
A convenient Sampling Technique was used. Samples were selected from registered nursing staff working in all departments of each tertiary care hospitals.
WHO calculator was used for sample size calculation. Population size was 1150. Confidence level was kept at 95%, and confidence Interval was 9.93 %. Calculated sample size was 90.
Instruments utilized in this study consisted of the following sections.
Section-I contained sociodemographic data such as age, work place, sex, designation and experience.
Section-II consisted of 13 multiple choice questions Every correct answer got one-mark, false answer got zero mark, and unattempted was considered as zero.
The pilot study was channelized. Ten registered nursing staff from each tertiary care hospital were selected for study. Ten minutes were given for answering the questionnaire.
Aims of the study were described to the nursing directors of each tertiary care hospital after getting their permission. Written consent was given to the study subjects after discussing with them the nature and aims of the study. They were assured that their information would be confidential and utilized only for research purpose.
Statistical Package for Social Sciences version 22 was used for statistical analysis. In descriptive statistic for data analysis, frequencies and percentages were calculated for ordinal and nominal data, while mean and standard deviation were calculated for scale data.
In this study, most of the nurses 94.5% were under the age of 40 years. However,4.4% of the participants were between 41 to 50 years and 1.1% were aged above 50 years. GNM were 72.2% and Generic BSc(N) were 27.8%. Samples with clinical experience between 1-6 years were 64.5%, 27.7% samples with clinical experience between 7- 12 years, samples with clinical experience ranging from 13- 18 were 3.3%; similarly samples with clinical experience more than 25 years were 2.2%. In this study 90 (100%) were charge nurses of each tertiary care hospital of Peshawar (Table 1).
Table 1. Demographic Variables of Study Participants
The knowledge test consists of 13 questions on CAUTI with the highest score of eleven. Overall score of knowledge achieved above 7, marked as high and below 7, marked as low with a mean of 1.61, with standard deviation 0.49, mode 2.00, and median 2.00. Most of the nurses had low knowledge which is below average knowledge regarding CAUT.
Table 2. Samples Dispersion According to Knowledge Score
Data given in Table 3 displays the percentage of knowledge score achieved in every question regarding CAUTI. Areas of low knowledge <50% were, most common urinary catheter associated infections in males 18.88%, Cystitis is common with 45.55%. Pyelonephritis is an infection of 45.55%, most common complication caused due to use of catheter for long time 20%, and steps necessary to prevent CAUTI 45.55%. Nursing intervention which helps to reduce CAUTI 46.66% and purpose of urinary catheterization 50.00%. Nurses scored less than 50% in seven out of thirteen questions which displays low knowledge regarding CAUTI.
Table 3. Percentage of Knowledge Regarding CAUTI in Every Question of Knowledge Test among Nurses
Many studies have been conducted regarding catheter related infections in different countries. This study is accentuated to assess nurses' knowledge regarding urethral catheter related infections. Study conducted by Gopalakrishnan A in 2009 shows that most of the nurses have low knowledge and only 2.63% had high knowledge (Gopalakrishnan, 2009). Similarly, the current study displayed that many of the nurses had low level of average knowledge and 38.9% had high level of average knowledge. In Nellore, India, study was conducted which dispersed that most of the nurses (46.7%) had adequate (High) knowledge and 20% nurses had inadequate (low) knowledge, while the current study revealed that 61.1% had high (adequate) knowledge and 38.9% had low (inadequate) knowledge (Opina & Oducado, 2014). A study conducted on 150 nurses in Peshawar, Pakistan indicated that 25.3% had adequate (High) knowledge and 34% had inadequate (Low) knowledge, while the current study resulted that 38.9% had high knowledge and 61.1% had low knowledge (Shah et al., 2017).
This study was limited to the registered nursing staffs who were working in all departments of each tertiary care hospitals of Peshawar, Pakistan.
Administration and Human Resource Department of the hospitals should provide to nurses up-to-date and evidence based guidelines, about direct urethral catheter usage, insertion, maintenance and extraction. They should be provided in-service education, proper training for urethral catheter insertion, maintenance, as will as extraction. Nurses should be given chance to attend national and International seminars regarding urethral catheter related infections.
The study was carried out in public tertiary care hospitals of Peshawar, Pakistan. The current study was centered on nurses’ knowledge regarding catheter associated urinary tract infections. In this study, 90 participants were charge nurses of each tertiary care hospital of Peshawar. Most of the nurses (94.5%) were under the age of 40 years. However, 4.4% of the participants were of 41 to 50 years and 1.1% were aged above 50 years. GNM were 72.2% and Generic B.sc(N) were 27.8%. Samples with clinical experience between 1-6 years were 64.5%, samples with clinical experience between 7-12 years were 27.7%, samples with clinical experience ranging from 13-18 were 3.3%; similarly samples with clinical experience greater than 25 years were 2.2%. A test was conducted to asses the knowledge of nurses regarding urethral catheter related infections. The result of the test was that 38.9% had high knowledge & 61.1% had low knowledge. The results were unsatisfactory to know that nurses’ knowledge regarding urethral catheter related infection was low.