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Total Participant Numbers: Total numbers of participants in the study Prevention of Catheter Associated Urinary
Tract Infection (CAUTI)
Manu Acha Roy1, Nisha Philip2, Deepa Fulwadiya2, Shruti Dhabade3
1HOD Paediatric Nursing, Symbiosis College of Nursing, Symbiosis International University, Pune,
2MSc Nursing 2nd Year, Symbiosis College of Nursing, Pune, 3BSc Nursing 4th Year Symbiosis
College of Nursing, Pune
ABSTRACT
Urinary tract infections (UTIs) are a major public health problem in terms of morbidity and incur the highest
total health care cost among urological diseases, exceeding that of chronic renal failure even when renal
dialysis and renal transplantation are included. This study was conducted to assess the practice of staff
nurses regarding prevention of UTI in clients with indwelling catheter.
An evaluative approach was adopted for the study to determine the effectiveness of structured teaching
program on practice among staff nurses regarding prevention of urinary tract infection in patients with
indwelling catheter. Pre -experimental, one group pre-test post-test design was used for conducting the
study. The result shows that the mean practice score in the post-test (18.56+- 3.88) was higher than the
mean pre-test practice score(10.4+- 4.39),which is highly significant as p value <0.0001.This shows that the
structured teaching program was effective in improving the practice of staff nurses regarding prevention of
urinary tract infection in patients with indwelling catheter.
Keywords: Catheter associated Urinary Tract Infection (CAUTI), Effectiveness, Practice, Staff nurse
INTRODUCTION
Urinary tract infection represents one of the most
common diseases encountered worlwide in medical
practice today with more than 150 million UTIs per
annum. Although UTI occur in both men and women,
clinical studies suggest that the overall prevalence of
UTI is more in women. Uncomplicated urinary tract
infections in healthy women have an incidence of
50/1000/year. An estimated 50% of women experience
at least one episode of UTI at some point in their lifetime
and 20% - 40% of women have recurrent episodes.
Approximately 20% of all UTIs occur in men. Most
episodes of UTI are caused by E- coli (up to 85%) and
Staphylococcus saprophyticus(up to 10%)1. Catheter
associated urinary tract infection (CAUTI) are a major
problem in hospitals inspite considerable spending on
education and prevention. About 5,60,000 CAUTI are
reported by Centre of disease control and prevention
(CDC)every year2. It has been estimated that more than
7 million people visits to emergency units and 100,000
hospitalization annually and accounts for 35% of
nosocomial infection3.
Urinary catheterization is a known cause of
bacterial infections, which in the worst-case scenario
can be fatal. More than 5 million patients every year
is been catheterized. Up to 25 % of patients who are
catheterized for more than 7 days will develop catheter
associated urinary tract infection. It is the most common
nosocomial infection, comprising more than 40 percent
of all nosocomial infections 4.
To minimize the risk for introduction of
microorganisms into the bladder, urinary catheters
should only be inserted by well trained personnels.
Hand hygiene is the most important means
of preventing infection and should be performed
immediately before and after insertion of the catheter.
The Investigator also felt during her clinical experience
that many of the staff nurses posted in the medical
surgical unit, uro-ward, and post operative wards failed
to maintain proper aseptic technique while providing
catheter care5.
DOI Number: 10.5958/0976-5506.2018.00525.9
69 Indian Journal of Public Health Research & Development, June 2018, Vol. 9, No. 6
So the investigators felt that it is necessary to
assess the practice of staff nurses regarding prevention
of UTI in clients with indwelling catheter. Further
the investigator felt that the written material must be
supplied to staff nurses working in the medical surgical
wards which will help them in preventing urinary tract
infection in patients with indwelling catheter.
NEED FOR STUDY
A catheter is a tube placed in the bladder that excrete
urine from the urinary tract. Because this tube stays in
place for a long period of time, it is called an indwelling
catheter. Catheterization is commonly done in critically
ill and post opeartive patients .As the critically ill
patients have less immunity they are highly prone to get
nosocomial infections. Many hospitalized patients get
UTI due to catheterization. These infections are often
caused by E- coli and Proteus mirabilis. Individuals
needing an indwelling catheter are predisposed to
the development of CAUTIs due to the presence of
an indwelling catheter and more likely pathogenic
multidrug-resistant organisms in the hospital settings.
Although the imminent threat of infection from these
potent opportunistic nosocomial multiresistant strains,
most cases of catheter-associated bacteria or the presence
of bacteria in the urine are asymptomatic. However, if an
episode of CAUTI becomes symptomatic, the resulting
array can range from mild (fever, urethritis, and cystitis)
to severe (acute pyelonephritis, renal scarring, calculus
formation, and bacteremia)6.
A study was carried by Danbury hospital, USA to
test a prevention bundle for catheter related urinary
tract infections. They concluded that there are around
560,000 cases of catheter associated urinary tract
infection per year. CAUTIs accounts for 23% of health
care-associated infections in adult critical care units
leading to complications such as cystitis, pyelonephriti,
bacteremia, sepsis and increased risk of death. National
rates for critical care have reached as high as 8.1
infections per 1000 catheters. Studies from around the
world has shown that CAUTIs increase the costs of
medical care morbidity and mortality.8
The Indian journal of critical care medicine carried
out a study to assess the knowledge and attitude of
health care providers regarding the indications for
catheterization and method of preventing CAUTI.
They concluded that there is a tremendous scope of
improvement in catheterization practices in the hospital
settings and education induced intervention would be the
most appropriate effort towards reducing the incidence
of CAUTI.7
A CAUTI occurs when a patient with an indwelling
urinary catheter develops 2 or more signs or symptoms
of UTI such as hematuria, fever, flank pain, change in
the character of urine and altered mental status.Most
hospitals do not have strict guidelines for the prevention
of CAUTI. Training the health care personnel and
introducing the prevention of CAUTI as a high priority in
hospitals is strongly associated with decreased incidence
of CAUTI. Many studies have shown that single most
important modifiable risk factor for decreasing the
incidence of CAUTI is reducing unnecessary catheter
use3.
Problem Statement:
A study to assess the effectiveness of structured
teaching program on the practices of staff nurses
regarding prevention of catheter associated urinary
tract infection (CAUTI) among hospitalized patients in
selected hospitals of Pune.
OBJECTIVES OF THE STUDY
To assess the practice of nurses regarding prevention
of urinary tract infection in patients with indwelling
catheter.
To assess the effectiveness of structured teaching
program on the practices of nurses regarding prevention
of urinary tract infection.
To find out the association of practice among nurses
with selected demographic variables.
OPERATIONAL DEFINITION
1) Practices
According to oxford dictionary practices refers to
the actual application or use of an idea, belief, or method,
as opposed to theories relating to it:the principles and
practice of teachingthe recommendations proved too
expensive to put into practice
In this study it refers to the method followed by the
staff nurse in urinary catheterization.
Indian Journal of Public Health Research & Development, June 2018, Vol. 9, No. 6 70
2) Staff nurses
According to oxford dictionary An experienced
nurse less senior than a sister or charge nurse which
helps the patient to restore to an healthy state
In this study it refers to the staff nurses working in
the medical surgical wards of the selected hospital in
Pune.
3) Catheter associated urinary tract
infection(CAUTI)
A catheter urinary tract infection (CAUTI) is
an infection involving any part of the urinary system,
including urethra, bladder, ureters, and kidney in a
patient associated with urinary catheter
METHODOLOGY
An evaluative approach was adopted for the study
to determine the effectiveness of structured teaching
program on practice among staff nurses regarding
prevention of urinary tract infection in patients with
indwelling catheter. The present study is aimed at
assessing the effectiveness of Structured Teaching
Program on practice among staff nurses regarding
prevention of urinary tract infection in patients with
indwelling catheter in selected hospitals.
The design selected for the present study was Pre
-experimental, one group pre-test post-test design.
The setting of the present study was medical surgical
wards of selected hospitals of Pune city. The population
for the study was staff nurses working in the medical
surgical wards of selected hospital.
Non probability purposive sampling technique was
used for the present study. The sample comprised of 60
staff nurses working in medical surgical wards of the
selected hospital.
The data collection method used for the study was
observational method to assess the practice related to
prevention of urinary tract infection in patients with
indwelling catheter. An observation checklist has been
prepared as a tool to assess the practice of staff nurses
regarding prevention of urinary tract infection in patients
with indwelling catheter.
The study was divided into 3 phases.
PHASE 1:Pre-test i.e. assessing the existing
practice of staff nurses regarding prevention of urinary
tract infection in patients with indwelling Catheter
through observational checklist.
PHASE 2: Structured Teaching program on
practice regarding prevention of urinary tract Infection
in patients with indwelling catheter.
PHASE 3: Post-test i.e. assessing the practice
of staff nurses regarding prevention of urinary tract
infection in patients with indwelling catheter.
Development of the tool
The tool for data collection had 2 sections Section
A and B
Section A: Demographic Proforma
This section consists of 5 items for the demographic
proforma of the staff nurses regarding their age, gender,
educational status , Years of experience and area of work.
Section B: Structured Observational Checklist:-
A structured observational checklist was used
collect information regarding the practice of staff nurses
on prevention of urinary tract infection in patients with
indwelling catheter. This consists of 30 items. Each item
was given a score of 1 and total score of the observational
checklist was 30.
Arbitrary scoring of prevention of urinary tract
infection practices
Good 20-30
Average 10-19
Poor 0-9
Reliability of the tool
The reliability of the tool was calculated to be 0.90
for practice aspects. The co-efficient of equivalence was
used to check the observational checklist by inter-rater
reliability. Thus the tool was found to be reliable.
Method of data collection:
The pilot study was conducted to assess the
feasibility of the study. The subjects of the pilot study
were from selected hospital. Sixty staff nurses were
selected using non-probability purposive sampling
technique.The purpose and nature of the study was
71 Indian Journal of Public Health Research & Development, June 2018, Vol. 9, No. 6
explained to the authority to gain cooperation. Then the
consent was taken from the willing staff nurses from
medical surgical wards.
After obtaining the informed consent for study, on
the first day, a pre-test was obtained using observational
checklist.On the same day itself, a structured teaching
practice was done.The practice of catheterization was
after the intervention on the 2nd day.
DATA ANALYSIS
The data obtained was analysed by descriptive
and inferential statistics on the basis of objectives of
the study.To compute the data a master data sheet was
prepared.
Section :1 Demographic proforma
Data on demographic proforma was analysed by
frequency and percentage and is presented in tables and
figures.
Section II: Practice on prevention of CAUTI
The practice of staff nurses regarding the practice
on prevention of CAUTI ,before and after administration
of intervention was analysed in terms of frequency,
percentage, mean, median, mean percentage and
standared deviation and is presented in the form of tables
and diagram.
The significant difference between mean pre-test
and post -test scores are found out by t -test.
Section III: Association between the practice
scores and selected demographic variables
Association of practice scores of staff nurses
regarding age, years of experience, and educational
status are tested using Chi-square test.
RESULTS AND INTERPRETATION
Section A: Description of the demographic
Variables of samples.
Table 1: Frequency and distribution of sample
according to demographic variable (n=60)
SNO
DEMOGRAPHIC
VARIABLES
FREQ-
UENCY
PERCEN-
TAGE
1 Age (in years )
20-30 15 25
31-40 25 41.6
41-50 15 25
51-60 5 8.4
2 Education
GNM 40 66.6
BSC Nursing 20 33.33
MSC Nursing nil 0
3 Years of experience
less than 5 20 33.3
05 to 10 years 10 16.6
10 to 20 years 20 33.3
20 to 30 years 10 16.6
Table 1: shows that maximum percentage(41.6)
of subjects were from the age group of 31-40 years
wherein (8.4%) of them were in the age group of 51-60
years. Majority (66.6%) of subjects had GNM education
, 33.33% had BSc/PBBSc Nursing and none of the
subjects had Msc Nursing education. 33.3 % of the
subjects had equal percentage of year of experience ie.
less than 5 ,and 10-20 years of experience respectively.
Remaining 16.6% of the subjects had 20-30 years of
total experience.
Section B: Level of practice of staff nurses on
prevention of CAUTI
Practice of 60 staff nurses was assessed by using
observational checklist and analysed by descriptive
statistics as presented in table 2.
Table 2: Frequency and percentage Distribution of sample based on level of practice
Level of practice Range of score Pre-test Post-test
Frequency Percentage Frequency Percentage
Poor 0-9 27 45 0 0
Average 10-19 29 48.33 42 70
Good 20-30 4 6.6 18 30
Indian Journal of Public Health Research & Development, June 2018, Vol. 9, No. 6 72
The data presented in table 2 shows that in pre-test majority (48.33%)of the the staff nurses had average practice,
45% of staff nurses had poor practice and 6.6 % had good practice on prevention of CAUTI .
In post-test (70%) of staff nurses had average practice and 30% had good practice whereas none of the staff
nurses had poor practice on prevention of CAUTI.
Table 3: Mean, Median, standard Deviation and mean percentage and t- value of pre-test and post-test
practice scores
Mean
Standard Devi-
ation
Mean percent-
age
Mean difference of pre-test and post
test
t test value
Pre-test 10.4 4.39 34.66
8.16 12.76
Post-test 18.56 3.88 61.86
Data in the table 3 shows that the mean practice
score in the post-test was (18.56+- 3.88) was higher that
the mean pre-test practice score(10.4+- 4.39), which is
highly significant as p value <0.0001.This shows that the
structured teaching program was effective in improving
the practice of staff nurses regarding prevention of
urinary tract infection in patients with indwelling
catheter.
Section C: Association between pre-test practice
score and demographic proforma
There were no significant difference in the pre-test
knowledge score with selected demographic variables
such as age, and year of experience, educational status
DISCUSSIONS
In this study the seriousness of CAUTIs in the
hospitalised patients, decreasing the CAUTI rate by
50% was a tremendous leap forward in the study and
this effort helped to minimize the CAUTI rate and
increased the practice of staff nurses. This study also
provided standardization in nursing practice when
caring for patients with urinary catheters. The bedside
checklist and interventions provided further consistency
in care as a reminder to staff to perform all aspects of
CAUTI prevention. Limitations in this study included
lack of randomization for group assignments. For
ethical reasons, standard catheter care could not be
withheld in the patients, thus eliminating the possibility
of a true control group for this study. Further, it would
not be feasible from a nursing work-flow perspective
to effectively sort the patient assignments based on
bundled versus non-bundled catheter care to form a
control group. Finally, results were collected on adult
patients in medical surgical units and as such, results
are not generalizable to pediatric patients. During the
pre-intervention time period, patients with indwelling
cathters were cleansed daily with chlorhexidine wipes.
This may have also had a positive impact in reducing
CAUTIs, although the chlorhexidine wipes were never
used on mucosal areas such as the perineum/meatus.
CONCLUSION
The findings of the study show that there is a highly
significant difference between the pre-test and post-test
practice scores of the group. The Structured Teaching
program significantly brought out an improvement in
the practice aspect among nurses working in medical
surgical wards regarding prevention of urinary tract
infection in patients with indwelling catheters. There is
no significant association between practice scores with
the selected demographic variables like age, educational
status, years of experience and as p value >0.05. The
study could help in increasing the practice among staff
nurses regarding prevention of urinary tract infection in
patients with indwelling catheters.
Ethical Clearance: It is been taken from Research
Advisory Committee(RAC), Symbiosis College of
Nursing.
Source of Funding:- Self
Conflict of Interest: Nil
REFERENCES
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Brentlinger, Kristy Dixon Stinger, Carol Polito. A
quasi-experimental study to test a prevention bundle
for catheter associated urinary tract infections.
Journal of Hospital Administration. March 27, 2014.
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