1Students’ Research Committee, Iranian Evidence-Based Medicine Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
2Iranian Evidence-Based Medicine Center of Excellence, Department of Urology, Tabriz University of Medical Sciences, Tabriz, Iran
Background It is believed that healthcare staff play an important role in minimizing complications related to urethral catheterization. The purpose of this study was to determine whether or not healthcare staff complied with the standards for urethral catheterization.
Methods This study was conducted in Imam Reza teaching hospital, Tabriz, Iran, from July to September 2013. A total of 109 catheterized patients were selected randomly from surgical and medical wards and intensive care units (ICUs). A questionnaire was completed by healthcare staff for each patient to assess quality of care provided for catheter insertion, while catheter in situ, draining and changing catheter bags. Items of the questionnaire were obtained from guidelines for the prevention of infection. Data analysis was performed with SPSS 16.
Results The mean age of the patients was 50.54 ± 22.13. Of the 109 patients, 56.88% were admitted to ICUs. The mean duration of catheter use was 15.86 days. Among the 25 patients who had a urinalysis test documented in their hospital records, 11 were positive for urinary tract infection (UTI). The lowest rate of hand-washing was reported before bag drainage (49.52%). The closed drainage catheter system was not available at all. Among the cases who had a daily genital area cleansing, in 27.63% cases, the patients or their family members performed the washing. In 66.35% of cases, multiple-use lubricant gel was applied; single-use gel was not available. The rate of documentation for bag change was 79%.
Conclusion The majority of the guideline statements was adhered to; however, some essential issues, such as hand hygiene were neglected. And some patients were catheterized routinely without proper indication. Limiting catheter use to mandatory situations and encouraging compliance with guidelines are recommended.
Bruminhent J, Keegan M, Lakhani A, Roberts IM, Passalacqua J. Effectiveness of a simple intervention for prevention of catheter-associated urinary tract infections in a community teaching hospital. Am J Infect Control. 2010;38(9):689-693. doi:10.1016/j.ajic.2010.05.028
Mody L, Saint S, Galecki A, Chen S, Krein SL. Knowledge of evidence‐based urinary catheter care practice recommendations among healthcare workers in nursing homes. J Am Geriatr Soc. 2010;58(8):1532-1537. doi:10.1111/j.1532-5415.2010.02964.x
Winter M, Helms B, Harrington L, Luquire R, McVay T, Rhodes N. Eliminating Eliminating catheter-associated urinary tract infections: part I. Avoid catheter use. J Healthc Qual. 2009;31(6):8-12. doi:10.1111/j.1945-1474.2009.00049.x
Rhodes N, McVay T, Harrington L, Luquire R, Winter M, Helms B. Eliminating catheter-associated urinary tract infections: part II. Limit duration of catheter use. J Healthc Qual. 2009;31(6):13-17. doi:10.1111/j.1945-1474.2009.00050.x
Saint S, Chenoweth CE. Biofilms and catheter-associated urinary tract infections. Infect Dis Clin North Am. 2003;17(2):411-432.
Allegranzi B, Pittet D. Role of hand hygiene in healthcare-associated infection prevention. J Hosp Infect. 2009;73(4):305-315. doi:10.1016/j.jhin.2009.04.019
Rebmann T, Greene LR. Preventing catheter-associated urinary tract infections: An executive summary of the Association for Professionals in Infection Control and Epidemiology, Inc, Elimination Guide. Am J infect control. 2010;38(8):644-646.
McNulty CA, Bowen J, Foy C, et al. Urinary catheterization in care homes for older people: self-reported questionnaire audit of catheter management by care home staff. J Hosp Infect. 2006;62(1):29-36. doi:10.1016/j.jhin.2005.03.008
Gokula RM, Smith MA, Hickner J. Emergency room staff education and use of a urinary catheter indication sheet improves appropriate use of foley catheters. Am J infect control. 2007;35(9):589-593.
Dailly S. Auditing urinary catheter care. Nurs Stand. 2012;26(20):35-40.
Conybeare A, Pathak S, Imam I. The quality of hospital records of urethral catheterisation. Ann R Coll Surg Engl. 2002;84(2):109.
Saint S, Wiese J, Amory JK, et al. Are physicians aware of which of their patients have indwelling urinary catheters? Am J Med. 2000;109(6):476-480.
Li L, Wen J, Wang L, Li YP, Li Y. Is routine indwelling catheterisation of the bladder for caesarean section necessary? A systematic review. BJOG. 2011;118(4):400-409. doi:10.1111/j.1471-0528.2010.02802.x
Harrod M, Kowalski CP, Saint S, Forman J, Krein SL. Variations in risk perceptions: a qualitative study of why unnecessary urinary catheter use continues to be problematic. BMC Health Serv Res. 2013;13:151. doi:10.1186/1472-6963-13-151
Tabrizi NT, Torabi Z, Bastani P, et al. Assessing the Perception of Pain and Distress of Female Patients Undergoing Routine Urethral Catheterization in Cesarean Delivery. International Journal of User-Driven Healthcare. 2013;3(2):78-84.
Chung C, Chu M, Paoloni R, O’Brien MJ, Demel T. Comparison of lignocaine and water‐based lubricating gels for female urethral catheterization: a randomized controlled trial. Emerg Med Australas. 2007;19(4):315-319. doi:10.1111/j.1742-6723.2007.00961.x
Beeson PB. The case against the catheter. Am J Med. 1958;24(1):1-3.
McNulty C, Bowen J, Foy C, et al. Urinary catheterization in care homes for older people: self-reported questionnaire audit of catheter management by care home staff. J Hosp Infect. 2006;62(1):29-36. doi:10.1016/j.jhin.2005.03.008
Pratt RJ, Pellowe C, Wilson J, et al. epic2: National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect. 2007;65:S1-S59. doi:10.1016/s0195-6701(07)60002-4
National Clinical Guideline Centre. Infection: Prevention and Control of Healthcare-Associated Infections in Primary and Community Care: Partial Update of NICE Clinical Guideline 2. London: Royal College of Physicians (UK), National Clinical Guideline Centre; 2012.
Health Protection Surveillance Centre (HPSC). Guidelines for the prevention of catheter-associated urinary tract infection. Published on behalf of SARI by HSE Health Protection Surveillance Centre. 2011.
Andreessen L, Wilde MH, Herendeen P. Preventing catheter-associated urinary tract infections in acute care: the bundle approach. J Nurs Care Qual. 2012;27(3):209-217. doi:10.1097/NCQ.0b013e318248b0b1
Lee JH, Kim SW, Yoon BI, Ha US, Sohn DW, Cho YH. Factors that affect nosocomial catheter-associated urinary tract infection in intensive care units: 2-year experience at a single center. Korean J Urol. 2013;54(1):59-65. doi:10.4111/kju.2013.54.1.59
Greer SF, Sethi AK, Hecker MT, McKinney BL, Dumford DM 3rd, Donskey CJ. Survey of patients' knowledge and opinions regarding the use of indwelling urinary catheters. Infect Control Hosp Epidemiol. 2011;32(2):174-176. doi:10.1086/657935
Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA. Guideline for prevention of catheter‐associated urinary tract infections 2009. Infect Control Hosp Epidemiol. 2010;31(4):319-326. doi:10.1086/651091
Koskeroglu N, Durmaz G, Bahar M, Kural M, Yelken B. The role of meatal disinfection in preventing catheter-related bacteriuria in an intensive care unit: a pilot study in turkey. J Hosp Infect. 2004;56(3):236-238. doi:10.1016/j.jhin.2003.12.017
Godfrey H, Fraczyk L. Preventing and managing catheter-associated urinary tract infections. Br J Community Nurs. 2005;10(5):205-212. doi:10.12968/bjcn.2005.10.5.18048
Siderias J, Guadio F, Singer AJ. Comparison of topical anesthetics and lubricants prior to urethral catheterization in males: a randomized controlled trial. Acad Emerg Med 2004;11(6):703-706.
Tanabe P, Steinmann R, Anderson J, Johnson D, Metcalf S, Ring‐Hurn E. Factors affecting pain scores during female urethral catheterization. Acad Emerg Med. 2004;11(6):699-702.
Vaughan M, Paton EA, Bush A, Pershad J. Does lidocaine gel alleviate the pain of bladder catheterization in young children? A randomized, controlled trial. Pediatrics. 2005;116(4):917-920. doi:10.1542/peds.2005-0103
Smith SL. Effect of an Educational Intervention on Hospital Acquired Urinary Tract Infection Rates [PhD Thesis]. Jacksonville: Brooks College of Health; 2009.
Conway LJ, Larson EL. Guidelines to prevent catheter-associated urinary tract infection: 1980 to 2010. Heart Lung. 2012;41(3):271-283. doi:10.1016/j.hrtlng.2011.08.001
Tijani KH, Lawal AO, Ojewola RW, Badmus TA. Quality of documentation of urethral catheterization in a Nigerian teaching hospital. Nig Q J Hosp Med. 2010;20(4):177-180.
Conybeare A, Pathak S, Imam I. The quality of hospital records of urethral catheterisation. Ann R Coll Surg Engl. 2002;84(2):109-110.
Fink R, Gilmartin H, Richard A, Capezuti E, Boltz M, Wald H. Indwelling urinary catheter management and catheter-associated urinary tract infection prevention practices in Nurses Improving Care for Healthsystem Elders hospitals. Am J Infect Control. 2012;40(8):715-720. doi:10.1016/j.ajic.2011.09.017
National Collaborating Centre for Nursing and Supportive Care.. Infection Control: Prevention of Healthcare-associated Infections in Primary and Community Care. National Institute for Health and Clinical Excellence: Guidance. London (UK): Thames Valley University; 2003.
Elpern EH, Killeen K, Ketchem A, Wiley A, Patel G, Lateef O. Reducing use of indwelling urinary catheters and associated urinary tract infections. Ame J Crit Care. 2009;18(6):535-541. doi:10.4037/ajcc2009938
Huang WC, Wann SR, Lin SL, et al. Catheter-associated urinary tract infections in intensive care units can be reduced by prompting physicians to remove unnecessary catheters. Infect Control Hosp Epidemiol. 2004;25(11):974-978. doi:10.1086/502329
Saint S, Kaufman SR, Thompson M, Rogers MA, Chenoweth CE. A reminder reduces urinary catheterization in hospitalized patients. Jt Comm J Qual Patient Saf. 2005;31(8):455-462.
Meddings J, Rogers MA, Macy M, Saint S. Systematic review and meta-analysis: reminder systems to reduce catheter-associated urinary tract infections and urinary catheter use in hospitalized patients. Clin Infect Dis. 2010;51(5):550-560. doi:10.1086/655133
Cornia PB, Amory JK, Fraser S, Saint S, Lipsky BA. Computer-based order entry decreases duration of indwelling urinary catheterization in hospitalized patients. Am J Med. 2003;114(5):404-407. doi:10.1016/s0002-9343(02)01568-1