Aysel Kulbay1, Eva Joelsson-Alm2, Ann Tammelin3. 1. Department of Medicine Solna, Karolinska Institutet, Unit of Infectious diseases, Solna, Stockholm, Sweden. aysel.kulbay@ki.se. 2. Department of Clinical Science and Education, Karolinska Institutet, Unit of Anaesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden. 3. Department of Medicine Solna, Karolinska Institutet, Unit of Infectious diseases, Solna, Stockholm, Sweden.
Abstract
BACKGROUND: To support a uniform and evidence-based practice for indwelling urinary catheterization in adults The European association of Urology Nurses (EAUN) published guidelines for this procedure in 2012. The Swedish national guidelines are based on the sterility precautions advocated by EAUN. Some hospitals have local guidelines with other requirements concerning sterility and leave to staff to decide how to perform the catheterization. The aim of this descriptive survey was to investigate the nurses´ self-reported sterility precautions during indwelling urethral catheterization at two acute-care hospitals, where the local guidelines differ in their sterility requirements. The study also aimed to analyze factors affecting conformity with sterility precautions in the EAUN-guidelines. METHODS: A structured questionnaire with questions concerning the participant, working conditions and performance of indwelling urethral catheterization was left to 931 nurses in two acute care hospitals. Chi-square test, Fisher's exact test and Mann-Whitney U-test were used for descriptive statistics. Logistic regression was used to analyze variables associated with practicing the sterility precautions in the EAUN-guidelines. RESULTS: Answers were obtained from 852 persons (91.5%). Most of the participants called their insertion technique "non-sterile". Regardless of designation of the technique the participants said that the indwelling urinary catheter (IUC) should be kept sterile during procedure. Despite that not everyone used sterile equipment to maintain sterility of the catheter. The nurses´ conformity with all the sterility precautions in the EAUN-guidelines were associated with working at departments for surgery and cardiology (OR 2.35, 95% CI 1.69-3.27), use of sterile set for catheterization (OR 2.06, 95% CI 1.42-2.97), use of sterile drapes for dressing on insertion area (OR 1.91, 95% CI 1.24-2.96) and using the term "sterile technique" for indwelling urethral catheterization (OR 1.64, 95% CI 1.11-2.43). CONCLUSIONS: Only 55-74% of the nurses practiced one or more precautions that secured sterility of the IUC thus demonstrating a gap between the EAUN-guidelines and the actual performance. Adherence to the guidelines was associated with factors that facilitated an aseptic performance such as using a sterile set and sterile drapes. Healthcare-settings should ensure education and skill training including measures to ensure that the IUC is kept sterile during insertion.
BACKGROUND: To support a uniform and evidence-based practice for indwelling urinary catheterization in adults The European association of Urology Nurses (EAUN) published guidelines for this procedure in 2012. The Swedish national guidelines are based on the sterility precautions advocated by EAUN. Some hospitals have local guidelines with other requirements concerning sterility and leave to staff to decide how to perform the catheterization. The aim of this descriptive survey was to investigate the nurses´ self-reported sterility precautions during indwelling urethral catheterization at two acute-care hospitals, where the local guidelines differ in their sterility requirements. The study also aimed to analyze factors affecting conformity with sterility precautions in the EAUN-guidelines. METHODS: A structured questionnaire with questions concerning the participant, working conditions and performance of indwelling urethral catheterization was left to 931 nurses in two acute care hospitals. Chi-square test, Fisher's exact test and Mann-Whitney U-test were used for descriptive statistics. Logistic regression was used to analyze variables associated with practicing the sterility precautions in the EAUN-guidelines. RESULTS: Answers were obtained from 852 persons (91.5%). Most of the participants called their insertion technique "non-sterile". Regardless of designation of the technique the participants said that the indwelling urinary catheter (IUC) should be kept sterile during procedure. Despite that not everyone used sterile equipment to maintain sterility of the catheter. The nurses´ conformity with all the sterility precautions in the EAUN-guidelines were associated with working at departments for surgery and cardiology (OR 2.35, 95% CI 1.69-3.27), use of sterile set for catheterization (OR 2.06, 95% CI 1.42-2.97), use of sterile drapes for dressing on insertion area (OR 1.91, 95% CI 1.24-2.96) and using the term "sterile technique" for indwelling urethral catheterization (OR 1.64, 95% CI 1.11-2.43). CONCLUSIONS: Only 55-74% of the nurses practiced one or more precautions that secured sterility of the IUC thus demonstrating a gap between the EAUN-guidelines and the actual performance. Adherence to the guidelines was associated with factors that facilitated an aseptic performance such as using a sterile set and sterile drapes. Healthcare-settings should ensure education and skill training including measures to ensure that the IUC is kept sterile during insertion.
Authors: Milisa Manojlovich; Sanjay Saint; Jennifer Meddings; David Ratz; Renee Havey; Jonathan Bickmann; Caitlin Couture; Karen E Fowler; Sarah L Krein Journal: Infect Control Hosp Epidemiol Date: 2015-10-05 Impact factor: 3.254
Authors: Carolyn V Gould; Craig A Umscheid; Rajender K Agarwal; Gretchen Kuntz; David A Pegues Journal: Infect Control Hosp Epidemiol Date: 2010-04 Impact factor: 3.254
Authors: F M E Wagenlehner; Mete Cek; Kurt G Naber; Hiroshi Kiyota; Truls E Bjerklund-Johansen Journal: World J Urol Date: 2011-09-07 Impact factor: 4.226
Authors: Evelyn Lo; Lindsay E Nicolle; Susan E Coffin; Carolyn Gould; Lisa L Maragakis; Jennifer Meddings; David A Pegues; Ann Marie Pettis; Sanjay Saint; Deborah S Yokoe Journal: Infect Control Hosp Epidemiol Date: 2014-05 Impact factor: 3.254
Authors: H P Loveday; J A Wilson; R J Pratt; M Golsorkhi; A Tingle; A Bak; J Browne; J Prieto; M Wilcox Journal: J Hosp Infect Date: 2014-01 Impact factor: 3.926
Authors: Regina Fink; Heather Gilmartin; Angela Richard; Elizabeth Capezuti; Marie Boltz; Heidi Wald Journal: Am J Infect Control Date: 2012-01-31 Impact factor: 2.918
Authors: Thomas M Hooton; Suzanne F Bradley; Diana D Cardenas; Richard Colgan; Suzanne E Geerlings; James C Rice; Sanjay Saint; Anthony J Schaeffer; Paul A Tambayh; Peter Tenke; Lindsay E Nicolle Journal: Clin Infect Dis Date: 2010-03-01 Impact factor: 9.079
Authors: Jennifer Meddings; Mary A M Rogers; Sarah L Krein; Mohamad G Fakih; Russell N Olmsted; Sanjay Saint Journal: BMJ Qual Saf Date: 2013-09-27 Impact factor: 7.035