A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON THE KNOWLEDGE REGARDING RISK FACTORS AND PREVENTION OF URINARY TRACT INFECTION AMONG THE PATIENTS WITH INDWELLING URINARY CATHETER ADMITTED AT GOVERNMENT HEAD QUARTERS HOSPITAL, ERODE, TAMIL NADU
By 30095604
VIVEKANANDHA COLLEGE OF NURSING
(AFFILIATED TO THE TAMILNADU DR.M.G.R. MEDICAL UNIVERSITY, CHENNAI-32)
ELAYAMPALAYAM, TIRUCHENGODE, PIN -637205 TAMILNADU
APRIL 2011
A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON THE KNOWLEDGE REGARDING RISK FACTORS AND PREVENTION OF URINARY TRACT INFECTION AMONG THE PATIENTS WITH INDWELLING URINARY CATHETER ADMITTED AT GOVERNMENT HEAD QUARTERS HOSPITAL, ERODE, TAMIL NADU
RESEARCH GUIDE:______________________________________
Prof. Mrs. K.KANAGAVALLI, M.Sc(N)., (Ph.D.,) PRINCIPAL,
VIVEKANANDHA COLLEGE OF NURSING, ELAYAMPALAYAM,
T IRUCHENGODE – 637 205.
CLINICAL SPECIALITY GUIDE:____________________________
Prof. Mrs. M. GEETHA, M.Sc(N).,
DEPARTMENT OF MEDICAL SURGICAL NURSING, VIVEKANANDHA COLLEGE OF NURSING,
ELAYAMPALAYAM,
T IRUCHENGODE – 637 205.
VIVA VOCE
1. INTERNAL EXAMINER
2. EXTERNAL EXAMINER
Submitted in partial fulfillment of the requirements for the DEGREE OF MASTER OF SCIENCE (NURSING) The
Tamil Nadu Dr. M.G.R. Medical University, Chennai – 32 APRIL 2011
VIVEKANANDHA COLLEGE OF NURSING (Affiliated to the Tamilnadu Dr.M.G.R. Medical University)
Elayampalayam, Tiruchengode – 637 205, Tamilnadu Phone: 04288 – 234561
CERTIFICATE
This to certify that, this thesis, titled “A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON THE KNOWLEDGE REGARDING RISK FACTORS AND PREVENTION OF URINARY TRACT INFECTION AMONG THE PATIENTS WITH INDWELLING URINARY CATHETER ADMITTED AT GOVERNMENT HEAD QUARTERS HOSPITAL, ERODE, TAMIL NADU” submitted by Mrs.P. SHANMUGAVADIVU, M.Sc (Nursing) (2009 – 2011 Batch) Vivekanandha College of Nursing in partial fulfillment of the requirement of the Degree of Master of Science (Nursing) from the Tamilnadu Dr.M.G.R. Medical University is her original work carried out under our guidance.
This thesis or any part of it has not been previously submitted for any other Degree or Diploma.
Prof. Mrs. R.KANAGAVALLI, M.Sc (N), (Ph.D.,) PRINCIPAL
SPONSORED BY
ANGAMMAL EDUCATIONAL TRUST, ELAYAMPALAYAM
DECLARATION
I hereby declare that this thesis entitled “A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON THE KNOWLEDGE REGARDING RISK FACTORS AND PREVENTION OF URINARY TRACT INFECTION AMONG THE PATIENTS WITH INDWELLING URINARY CATHETER ADMITTED AT GOVERNMENT HEAD QUARTERS HOSPITAL, ERODE, TAMIL NADU” is the outcome of the original work undertaken and carried out by me under the guidance and direct supervision of Prof. Mrs. R.KANAGAVALLI, M.Sc (N), (Ph.D.,) and Speciality Guide Prof.Mrs. M.GEETHA, M.Sc(N)., Department of Medical Surgical Nursing, Vivekanandha College of Nursing, (Sponsored by Angammal Educational Trust), Elayampalayam, Tiruchengode, Namakkal District.
I also declare that the material of this thesis has not formed in any way the basis for award of any other Degree, Diploma or Associate fellowship previously of the Tamil Nadu Dr. M.G.R. Medical University.
30095604
Vivekanandha College of Nursing, Elayampalayam, Tiruchengode.
P lace: Elayampalayam, Date:
ACKNOWLEDGEMENT
“Our Chief want in life is, somebody Who will make us do, what we can”
Success is the companion of constant support, guidance and effort. There are several hands and hearts behind this work to bring it to this final shape for which I would like to express my gratitude.
First, I wish to acknowledge my heartful gratitude to Almighty God of all the wisdom and knowledge for his guidance, direction, strength, shield and support throughout this endeavor.
I extend my heart thanks to Vidya Rattan, Rashtriya Rattan, Hind Rattan Dr. M. Karunanithi, B.Pharm., M.S., Ph.D., The Chairman and Secretary of Vivekananda Group of Institutions to undertake this investigation in Vivekananda College of Nursing (Affiliated to the Tamilnadu Dr. M.G.R. Medical University, Chennai), Elayampalayam, Tiruchengode.
Nursing is a noble profession and the Teachers who teach are equally on the same pedestal. I am thankful for the initia tion and guidance of my teachers and well wishers who gave the strength in my career at all levels.
I wish to express my whole-hearted gratitude to Professor Mrs.R.Kanagavalli, M.Sc., (N), Principal, Vivekanandha College of Nursing for her Valuable suggestions, Precious advice and constant support.
I wish to express my deep sense of gratitude Mrs.K.Kamala,M.Sc(N)., (Ph.D.,), Principal, Rabindaranath Tagoore College of Nursing, for her valuable suggestions and guidance
It is my privilege to express my deep sense of gratitude to Mrs.M.Geetha, M.Sc., (N), Professor and Subject Guide in Medical Surgical Nursing, Vivekanandha College of Nursing, Elayampalayam, for her constant guidance, highly instructive suggestions, precious advice, inspiration and encourageme nt at each and every step of this study. Without her guidance, it would have been impossible for me to complete this work.
My sincere and special thanks to Miss, Arularasi, Lecturer in Biostatistics, Vivekanandha Institute of Medical Science and Research for his patience, support, expert guidance and valuable advice in statistical analysis and presentation of data.
I owe my special thanks to all the M.Sc (N) Faculty Members of Vivekanandha College of Nursing for their valuable suggestion and guidance.
I am highly thankful to the entire subject expert Mrs. Srividhya MSc (N) and Mrs. Devi MSc (N) for spending their valuable time for validating the tool.
I am thankful to the Librarians of Vivekanandha College of Nursing for extending library facilities through out the study.
My special thanks to the staff of Tamil and English Department for sharing their valuable time in translating the tool and editing the thesis.
A special note of thanks to Shri Krishna Computers, Five Roads, Salem for the skillful word processing and graphic presentation.
It would be a gracious lapse on my part if I do not thank the patients who enthusiastically participated in the study and without their co-operation the study would have remained as my dream.
I am grateful to the nursing staff and doctors of Govt. Head Quarters Hospital, Erode, for their Co-operation.
I am immensely grateful to my beloved parents and my family members for their support and help.
I extend my hearty gratitude to all my classmates for their timely help, support and co-operation.
There are still others, to whom I am indebted, words doesn’t seem to be enough, when I need to express my gratitude for the help they shared.
MRS. P. SHANMUGA VADIVU
ABSTRACT
A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON THE KNOWLEDGE REGARDING RISK FACTORS AND PREVENTION OF URINARY TRACT INFECTION AMONG THE PATIENTS WITH INDWELLING URINARY CATHETER ADMITTED AT GOVERNMENT HEAD QUARTERS HOSPITAL, ERODE, TAMIL NADU
OBJECTIVES
1. To assess the knowledge of the catheterized patients regarding risk factors and prevention of urinary tract infection associated with indwelling urinary catheter before administration of the structured teaching programme.
2. To develop the structured teaching programme on risk factors and prevention of urinary tract infection associated with including urinary catheter before administration of the structured teaching programme.
3. To administer the structured teaching programme to the patients regarding the risk factors and prevention of urinary tract infection.
4. To evaluate the effectiveness of the structured teaching programme in terms of improving the knowledge of the patients.
5. To compare the pretest and post-test knowledge.
6. To determine the association between pretest level of the knowledge and the sociodemographic characteristics of patients like age, sex, religion, educational status, occupation and previous exposure to information.
The conceptual frame work adopted for this study was based on Stuffle Beam’s Evaluatory theory.
The research approach adopted for this study was quasi- experimental approach. The research design selected for the study was one group pretest, posttest, which was used to measure the effectiveness of structured teaching programme.
The selection of the patient was done by simple random sampling technique and the samples consist of 40 patients with indwelling urinary catheter admitted at Government Head Quarters hospital, Erode.
The instrument developed and used for the present study was semistuctured interview schedule, which had two sections.
Section A: Comprised of 9 items relate to sociodemographic variables.
Section B: Comprised of 34 items related to knowledge regarding risk factors and prevention of urinary tract infection associated with indwelling urinary catheter.
The study was conducted in the month of November 2010, the collected data were analyzed by using descriptive and inferential statistics in terms of frequencies, percentages, mean, standard deviation (SD), Chi- square test.
SUMMARY OF THE MAJOR FINDINGS
In the present study, majority of the patients were above 40 years of age. Both male and female were included. Majority of the subjects were Hindus and both literates and illiterates were included in the study.
Majority of the patients were employee earning below RS.1000 and most of the subjects were married and were not having any previous information regarding urinary tract infection associated with indwelling urinary catheter.
The post mean test score percentage (82.73%) of knowledge on risk factors and prevention of urinary tract infection associated with indwelling urinary catheter were comparatively more than their pretest knowledge scores (26.4%). It conforms that there was increase in knowledge after administration of structured teaching programme.
The paired‘t’ test analysis of the pretest and post test knowledge t = 37.48 (P<0.05) was highly significant. This result evidently support the effectiveness of structured teaching programme in promoting the knowledge on the risk factors and prevention of urinary tract infection associated with indwelling urinary catheter.
The present study also reveals that, there is an association between pretest knowledge to education and exposure to previous information on the risk factors and prevention of urinary tract infection associated with indwelling urinary catheter. However, there was no association between knowledge and other sociodemographic variables such as age, sex, religion, occupation, income, and marital status.
RECOMMENDATIONS
? The study can be replicated on larger samples, there by, findings can be generalized to a larger population.
? A quasi-experimental study can be conducted with control group
? A comparative study can be conducted in two different hospitals with similar set up.
? This quasi experimental study can be conducted with caregivers of the patients
? A similar study can be done with the use of other teaching methods and teaching aids like video teaching programme.
? The same study can be conducted to caregivers of the other chronic bedridden patients.
TABLE OF CONTENTS CHAPTER
NO CONTENTS PAGE.
NO
I INTRODUCTION 1-17
? Need for the study 7
? Statement of the problem 9
? Objectives of the study 9
? Operational definitions 10
? Assumptions 12
? Limitations 12
? Conceptual framework 12
II REVIEW OF LITERATURE 18-42
III METHODOLOGY 43
? Research approach 44
? Research design 44
? Variables 47
? Setting of the study 48
? Target population 48
? Sample and sampling technique 48
? Selection criteria 49
? Selection and development of instrument 50
? Content validity 51
? Reliability 52
? Pilot study 53
? Procedure for Data collection 54
? Plan for data analysis 54
IV DATA ANALYSIS INTERPRETATION AND DISCUSSION
55-84 V SUMMARY, FINDINGS, CONCLUSIONS,
IMPLICATIONS AND RECOMMENDATIONS
85-93
? Summary 85
? Major findings of the study 87
? Conclusion 89
? Implications 90
? Recommendations 92
REFERENCES 94-102
LIST OF TABLES
S. NO TITLE PAGE NO
4.1.1 Distribution of patients with indwelling urinary catheters by age
59
4.1.2 Distribution of patients with indwelling urinary catheters by Sex
60
4.1.3 Distribution of patients with indwelling urinary catheters by Religion
61
4.1.4 Distribution of patients with indwelling urinary catheters by Educational Status
62
4.1.5 Distribution of patients with indwelling urinary catheters by Occupational Status
63
4.1.6 Distribution of patients with indwelling urinary catheters by their income
64
4.1.7 Distribution of patients with indwelling urinary catheters by Marital Status
65
4.1.8 Distribution of patients with indwelling urinary catheters by Source of Information
66
4.2.1 Pretest knowledge level of patients with indwelling catheter
67
4.2.2 Pretest knowledge means score of patients with indwelling catheter
68
4.2.3 Aspect wise pretests mean knowledge regarding risk factors and prevention of UTI associated with indwelling urinary catheter
69
4.3.1 Posttest knowledge score among patients with indwelling urinary catheter
70
4.3.2 Posttest knowledge score among patients with indwelling urinary catheter
71
4.3.3 Aspect wise Posttest mean knowledge regarding urinary tract infection associated with indwelling urinary catheter
72
4.4.1 Pre and post test knowledge level of patients 73 4.4.2 Pre and posttest knowledge score of patients 75 4.4.3 Pre – test and Post – test mean knowledge score
on different aspects of urinary tract infection associated with indwelling urinary catheter
77
4.5.1 Association between pretest knowledge and demographic variables of patients with indwelling urinary catheter
79
LIST OF FIGURES
S. NO TITLE PAGE NO
1.1 Conceptual frame work 16
3.1 Schematic representation of the research design 46 4.1.1 Distribution of patients with indwelling urinary
catheters by age
59
4.1.2 Distribution of patients with indwelling urinary catheters by Sex
60
4.1.3 Distribution of patients with indwelling urinary catheters by Religion
61
4.1.4 Distribution of patients with indwelling urinary catheters by Educational Status
62
4.1.5 Distribution of patients with indwelling urinary catheters by Occupational Status
63
4.1.6 Distribution of patients with indwelling urinary catheters by their income
64
4.1.7 Distribution of patients with indwelling urinary catheters by Marital Status
65
4.1.8 Distribution of patients with indwelling urinary catheters by Source of Information
66
4.4.1 Pre and post test knowledge level of patients 73 4.4.2 Pre and posttest knowledge score of patients 75 4.4.3 Pre – test and Post – test mean knowledge score
on different aspects of urinary tract infection associated with indwelling urinary catheter
77
LIST OF APPENDICES
S.NO TITLE PAGE NO
A Letter seeking permission to conduct the study 103 B Letter granting permission to conduct study 105
C Letter for validation of tool 106
D Letter seeking permission from the participants 108
E Semi-structured questionnaire 109
F Evaluation criteria check list for validation of tool
126
G Certificate of validation 127
H Structured Teaching Programme 128
CHAPTER I INTRODUCTION
“Staying healthy is not always easy; sometimes we have to take all the measures to keep our eyes on the prize.”
As per the saying “NO PAIN, NO GAIN”, in spite of all the aspects of care given by the health care personnel in the hospital, it is the responsibility of the individual to take all the measures to maintain their own health. The patients as well as the care givers have to follow the preventive measures as educated by the nurses to prevent further infections especially when they are hospitalized.
Hospital is the place where sick people go with expectation that they will get cure and relief. But there is no hospital however big or small is free from incidence of further infection. Hence unfortunately, there is a risk of hospitalalized patients to become infected, due to various diagnostic and therapeutic interventions carried out in the hospital.(Wikipedia Encyclopedia 2010)
Patients are admitted to the hospitals for various reasons, either for diagnostic purpose or for therapeutic purposes. Both in medical as we ll as in surgical conditions urinary catheterization is required, either for log term purpose or for short term purpose. An indwelling catheter is very common intervention frequently required many disease conditions among
the hospitalized patients. Unfortunately inappropriate and excessive catheter use still persists. One of the important reasons for inappropriate catheterization could be the lack of widely accepted guidelines regarding the indications for indwelling urinary catheterization placement in medical patients. Thus an indwelling urinary catheterization can also prolong the hospital stay and increases the cost of health care. (Pratt, et.al, 2001)
An indwelling urethral (Foley) catheter is an artificial, closed sterile drainage system that is inserted through the urethra into the bladder to allow for bladder drainage. It is used for acute care patients in order to drain the urine when their normal voiding pattern is affected . As well as it is associated with several complications and adverse effects that increases the mortality and morbidity rate of the patients. One of the most frequent adverse consequences of urinary catheter is catheter associated urinary tract infection as well as it increases the length of hospital stay.(Newman DK, 1998)
Cathete r associated urinary tract infection (CAUTI) is most frequent in US hospitals. It is estimated that 10 – 12 % of the hospital patients and 4% of the patients in the community were having indwelling urinary catheter at any given time. Catheter associated urinary tract infection accounts for more than 40% of hospital acquired infection and it is affecting an estimated 6, 00,000 patients per day. Nearly 15-25% of
patients in US government hospitals have a urinary catheter inserted during their hospital stay. Though there are definite indications for its use, it is often over used. As per the earlier studies most of the institutions indwelling urinary catheterization was found to be unjustified in 47% of cases studied in one of the US hospital. It is sure that the presence of urinary catheter predisposes to UTI. (Garibaldi, et.al., 1994).
Many hospitalized patients require the placement of indwelling urinary catheter for days or even weeks at a time, only minorities of patients develop urinary tract infections due the presence of urinary catheter. It depends upon number of factors, such as the host defense , the number of days the patients is catheterized and the reason for catheterization either appropriate or not, as well as the quality of catheter care and the patients knowledge regarding the self care of urinary catheter. Urinary tract infections accounts for up to 40%among the patients with urinary catheter. Urinary catheter use is common, approximately one in every 5 patients admitted to an acute care hospital receiving an indwelling urinary catheter. Infection frequently occurs after the placement of long term urinary catheter. (Saint Sanjay, 2000)
Patients are exposed to variety of micro-organisms during their hospitalization due to exposure to various inte rventions and diagnostic studies. Still, a contact between patient and organisms does not always results in the development of infection. The factors that influence the
nature and frequency of infections are age, immunity, length of hospital stay, exposure to invasive procedures etc.Organisms vary in resistance to antimicrobials and intrinsic virulence. The way of acquiring these organisms can be through, transfer from one patient to another. They can also be from patient’s own flora, or from inanimate object which is recently contaminated by other human sources. (Jonathans Colten, 2004)
Hospitalized patients with an indwelling urinary catheter are more prone to get catheter associated urinary tract infection. The indwelling urinary catheter is an important aspect of medical care for some of the patients admitted in hospital with certain diseases conditions such as urinary tract obstruction, urinary retention, patients undergoing major surgery, epidural catheter in place, frequent monitoring of urinary output as in case of trauma, burns, renal failure, deep sedation, paralysis, surgical repair of decubitus ulcer, and other terminal illness.(Ellern H.Elpern.)
Indwelling urinary catheterization is unavoidable in certain disease condition. In such conditions there is a chance for catheter to remain in place for long-term. Once when the Foley catheter is in place the risk for urinary tract infection is approximately 5% per day. As well as it accounts for 40% of CAUTI in the hospitalized patient. Thus through this information, the author insisted the hazards of indwelling urinary catheter and the incidence of CAUTI. (Ellen .H .Elpern)
The risk of developing CAUTI ranges from 3% - 7% on daily basis. Nearly 10 -12% of the hospitalized patients and 4% of patients in the community settings have indwelling urinary catheter. Hence, CAUTI, as estimated it can affect 6,00,000 patients per day. (Center for Disease Control –CDC)
In spite of increased awareness of the dangers of urethral catheterization, it is unavoidable in many disease conditions.
Unfortunately patients as well as their relatives are still unaware that they are prone to get urinary tract infection due to urinary catheterization. It is estimated that nearly 2% of hospital admissions acquire urinary tract infection. 5% of CAUTI leads to bactremia which in turn leads to septicemia which adds to the risk of death even. 15% of bactremia are attributable to urinary tract infection. (Nita Patwardhan, 2006)
The high incidence of urinary tract infection is mainly due to instrumentation of the urinary tract, either for diagnostic purpose or for therapeutic purpose. It is found out that 66 – 88% of the patients are still undergoing urinary instrumentation especially urinary catheterization.
Thus the author insisted that the more use of indwelling urinary catheter increases the risk of urinary tract infection due to urinary catheterization and it can be better reduced by reducing the use of urinary catheter or by following the guidelines for the appropriate use of urinary catheter. (Nita Patwardhan, 2006)
UTI in general medical practice accounts for 1 – 3% of bacterial infections. The prevelance of UTI in women is about 3% at the age of 20 years and it increases by about 1% for every decade . In male the incidence rate is less, but it is not uncommon in elderly male with benign prostate hypertrophy.(Boon.A.Nicholas, et.al.,2006)
Whenever the patients get admitted to the hospital the need for indwelling catheterization has to be evaluated, which is the only way to prevent CAUTI (Catheter associated urinary tract infection). The hospital policy has to include the guidelines that help the physician as well as the nurses in taking the decision regarding, the need for catheter insertion, catheter care protocol, and the duration of indwelling catheter in place.
Following all these measures the risk of CAUTI can be reduced to some extent. In addition for the patients who require long-term catheterization, evidence based care should be provided . (LO, et.al., 2008)
The other way to avoid the CAUTI all the health care personnel and the caregiver of the patients have to go in hand together by means of following the protective measures and the appropriate guide lines for the catheter care to prevent the urinary tract infection. Whenever possible the use of catheter has to be reduced as well as the patients have to be encouraged for self voiding or instructed about the use of condom catheter. The other best way to reduce the incidence of CAUTI is to limit the number of catheter days. (Munasin ghe, et.al, 2001)
Recently the Health Care Associated Infection Task force from the society of America provided an evidence based practices made available, which focuses on the importance of maintaining an appropriate infrastructure for infection surveillance and prevention, education and training of health care personnel about catheter associated urinary tract infection, appropriate insertion of and maintenance of indwelling urinary catheter using reminders or stop orders. (Yoke DS, et.al,).
NEED FOR THE STUDY
Indwelling catheter associated urinary tract infection is the second most common cause of hospital acquired infection and it was identified that catheter associated urinary tract infection are associated with substantially increased institutional death rate, unrelated to the occurrence of urosepsis.
It is estimated that 12% of patients admitted to the hospital in the UK will be catheterized (Crow, et.al, 1988)
Indwelling urinary catheter also prolongs the hospital stay and increases the cost of health care. Up to 25% of hospitalized patients undergo urinary catheterization, and about 5% develop bacteriuria each day of catheterization. Catheter-related bacteriuria is associated with increased morbidity and mortality. (Saint Sanjay, 2000)
Nearly 80% of the urinary tract infection is associated with indwelling urinary catheter, and 12 – 16% of the patients admitted to acute care setting require indwelling catheterization. (Nita Patwardhan, 2006)
The overall incidence of CAUTI among these patients is 3% to 10% (average, 5%) per day. Urinary tract infections account for up to 40% of infections among the hospitalized patients. Even urinary catheterization may leads to bactremia and in turn leads to septicemia and finally death. (Saint Sanjay, 2000)
Though indwelling urinary catheter is an essential part of modern medical care unfortunately, when poorly managed, the indwelling catheter may present a hazard to the every patient.
Catheters drain the bladder, but they obstruct the urethra, producing other major problems such as urethral strictures and epididymitis.
The researcher identified the lack of knowledge among the patients as well their care givers regarding the consequences of urinary catheterization. A new approach to overcome CAUTI is clearly needed.
And even the patients and their care givers are still unaware about the care of indwelling urinary catheter to prevent the urinary tract infection.
The need for health education for the patient and their caregivers related
to the risk factors and the preve ntion of indwelling catheter related urinary tract infection is the key component in health care.
Hence the investigator felt that the patient as well as their care givers should have the knowledge regarding the risk factors and the prevention of urinary tact infection related to indwelling urinary catheter.
Thus the primary aim of this study is to reduce the risk of urinary tract infection among the catheterized patients and to analyze the effectiveness of a related structured teaching programme to the patient and the family members.
STATEMENT OF THE PROBLEM
“A study to assess the effectiveness of a structured teaching programme on the knowledge regarding the risk factors and prevention of urinary tract infection among the patients with indwelling urinary catheter admitted at Government Head Quarters Hospital, Erode, Tamil Nadu.”
OBJECTIVES
1. To assess the knowledge of the patients regarding the risk factors and prevention of urinary tract infection associated with indwelling urinary catheter, before administering the structured teaching programme.
2. To develop the structured teaching programme regarding risk factors and prevention of urinary tract infection associated with indwelling urinary catheter.
3. To administer the structured teaching programme to patients regarding the risk factors and the prevention of urinary tract infection related to indwelling urinary catheter.
4. To evaluate the effectiveness of the structured teaching programme in terms of improving the knowledge of the patients.
5. To compare the pretest and post test knowledge.
6. To determine the association between pretest level of the knowledge and the socio demographic characteristics of indwelling catheterized patients like age, sex, religion, educational status, occupation previous exposure to information.
OPERATIONAL DEFENITIONS Urinary Tract Infection
Urinary tract infection refers to entry and multiplication of micro organism into the urinary tract.
Indwelling Urinary Catheter
Indwelling urinary catheter refers to insertion and placement of Folley’s urinary catheter in the urinary tract for longer duration (at least more than seven days.)
Effectiveness
Statistical measurement of knowledge of the patients about the certain information, before and after administration of the structured
teaching programme regarding the risk factors and prevention of urinary tract infection associated with indwelling urinary catheter.
Knowledge
Knowledge refers to refers to the verbal responses of respondent’s to knowledge items on the risk factors and the prevention of urinary tract infection related to indwelling urinary catheter as measured by semi structured interview schedule.
Structured Teaching Programme
It refers to a systematically planned group of instructions designed to provide information to the urinary catheterized patients regarding the risk factors and the prevention urinary tract infection associated with indwelling urinary catheter.
Prevention
The process of serving to avert the occurrence of urinary tract infections among the patients with indwelling urinary catheter.
In this study the researcher uses the following abbreviations.
UTI for urinary tract infection.
CAUTI for catheter associated urinary tract infection.
IUC for indwelling urinary catheter.
IUCAUTI for indwelling urinary catheter associated urinary tract infection.
ASSUMPTIONS
1. Patients with indwelling urinary catheter have inadequate knowledge about the risk factors and prevention of urinary tact infection associated with indwelling urinary catheter.
2. The structured teaching programme regarding the risk factors and the prevention of urinary tract infection associated with indwelling urinary catheter will enhance the knowledge of the patients regarding the same.
HYPOTHESES
H1: There will be significant difference between the pretest knowledge level and the post test knowledge score.
H2: There will be significant difference in the pretest knowledge score socio-demographic variables of the selected samples.
LIMITATIONS
1. The study is limited to only 40 patients so the findings cannot be generalized.
2. The study is limited to patients with indwelling urinary catheters.
CONCEPTUAL FRAMEWORK
A conceptual framework is a precursor of a theory. It is a group of concepts and a set of prepositions that spells out the relationship between them. Conceptual framework plays several interrelated roles in the
progress of science. The overall purpose is to make a scientific finding meaningful and generalizable.
Polit and Beck, (2006) state that a conceptual framework is interrelated concepts on abstraction that are assembled together in some rational scheme by virtue of then relevance to a common theme. It is device that helps to stimulate research and the extensions of knowledge by providing both direction and impetus.
The conceptual framework of the study on the context, input process and output (CIPP) modeled by stufflebeam. This model consists of four steps of programme evaluation and obtaining information for making decisions. It provides comprehensive, systematic and continuous ongoing framework for programme evaluation.
Shufflebeam’s evaluation model consists of the following steps
? Context evaluation (Goals)
? Input evaluation (Plan)
? P rocess evaluation (action)
? P roduct evaluation (Outcomes)
Context Evaluation
Context evaluation describes the plan for identify ing the problem and developing the objective and its rationale. The present study is carried out to evaluate the effectiveness of a structured teaching
programme on the knowledge regarding the risk factors and prevention of urinary tract infection among the patients with indwelling urinary catheter Input Evaluation
It serves as a basis for studying decisions. It specifies resources, strategies and designs to meet programme goals and objectives. Here in the present study the input refers to,
? Development of structured teaching program on risk factors and
prevention of urinary tract infection among the patients with indwelling urinary catheter
? Development of Semi Structured interview schedule to assess the
knowledge of the catheterized patients regarding risk factors and prevention of urinary tract infection associated with indwelling urinary catheter
? Validation of the tool by expert’s opinion.
? Establishment of reliability of tool by split half method.
? Selection of sample
? Frame a research design.
Process Evaluation
It describes about how the decisions implemented based on the limitations by means of establishing validity and reliability of the developed tool and relevant literature. In the present study, it refers to,
? P ilot Study
? Assessing the knowledge of the participants before administering structured teaching programme
? Administering structured teaching programme
? Assessing knowledge of the participants after administration of
structured teaching programme Product Evaluation
? The input and process enables to achieve the objectives of the
investigation which is identified with the product evaluation. It refers to the valid and reliable tool development. The structured teaching programme is implemented as per plan. The structured teaching programme regarding knowledge on risk factors and prevention of urinary tract infection associated with indwelling urinary catheter will show gain in knowledge by the participants in most of the areas which is identified with the statistical computation.
? The investigator found that this conceptual framework to be very
useful to evaluate the gain in knowledge of mothers as administration of structured teaching programme on risk factors and prevention of urinary tract infection associated with indwelling urinary catheter
FIG-1.1: CONCEPTUAL FRAMEWORK ADOPTED FROM STUFFLE BEAM MODEL
CONTEXTUAL EVALUATION
PRE-TEST Inadequate Knowledge regarding risk factors and prevention of UTI associated with indwelling urinary catheter.
INPUT EVALUATION Development of semi
structured interview schedule to assess the knowledge on risk factors and prevention of UTI associated with
indwelling urinary catheter.
Development of structured teaching programme on risk factors and prevention of UTI associated with indwelling urinary catheter.
PROCESS EVALUATION
? Pilot study
? Assessing knowledge before administration of structured teaching programme.
? Administration of structured teaching programme.
? Assessing knowledge after structured teaching programme.
PRODUCT EVALUATION POST-TEST
Posttest evaluate the
effectiveness of STP in terms of gain in score knowledge by comparing pretest and posttest scores.
SUMMARY
This chapter dealt with the introduction, need for the study, statement of the problem, objectives of the study, operational definitions, research hypothesis and limitations. The conceptual framework used for this study was based on the Shuffle beam’s content, input, process and product (CIPP) model of programme evaluation.
CHAPTER II
REVIEW OF LITERATURE
Review of literature is an important step in the development of a research project. Prior to start with any research study the researcher can get information related to the study topic, by means of reviewing the previous study and other book or journal literature related to the selected study in order to know about the study topic in depth. Thus, review of literature helps the investigator to develop the deeper insight into the problem, and gain information on the problem and helps to indentify what has been done before and also looks into the feasibility of the pre sent study, constraints of data collection, relates the findings from one study to another with a hope to establish a comprehensive body of scientific knowledge in the professional discipline from which, valid and pertinent theories may be developed.
A literature review is a written summary of the state of existing knowledge on a research problem. The task of reviewing research literature involves systematic identification, location scrutinizing and summary of written materials that contains information on research problem. (Polit and Beck, 2008)
The investigator carried out extensive review of literature relevant to the research topic to gain more previous information which adds up the existing knowledge of the researcher and helps the researcher to more collect information that strengthens the existing foundation of the study.
Literature relevant to the present study is organized under the following headings.
1. Literature related to urinary tract infection associated with indwelling urinary catheter.
2. Studies related to urinary tract infection associated with Literature related to urinary tract infection associated with indwelling urinary catheter.
LITERATURE RELATED TO URINARY TRACT INFECTION ASSOCIATED WITH INDWELLING URINARY CATHETER.
Urinary helps to main tain the body’s homeostasis in many ways.
Especially it helps in eliminating the metabolic wastes from our body.
Unfortunately the urinary tract can gets infected easily because of its anatomical location. Urinary tract infection when not treated promptly it may also leads to the very serious problem such as bactremia as well as septicemia which in turn leads to death even.
The urinary system is composed of two kidneys which are situated in the lower lumbar region, two ureter, a urinary bladder and a urethra.
The primary functions of the kidneys are to regulate the fluid and acid base balance of the body and to excrete waste products from the body.
The additional functions are to regulate the blood pH, blood pressure.
Thus the kidney is important to maintain the homeostasis of the body and hence it should be protected from all sorts of infections.(Tortora.J.Gerard, 2006)
The term urinary tract infection refers to an infection of a part of the urinary system by means of pathogenic micro organisms that enters the urinary tract. The urinary tract infection leads to the presence of bacteria in the urine. (Tortora.J.Gerard, 2006)
Normally the urinary tract is sterile, except, at the urethral meatus.
In a healthy person, the act of voiding flushes away the bacteria.
Infections occur when the microorganisms from the surrounding perineal skin or anal opening enters the urinary meatus and ascend the urethra.
One of the factor that increases the incidence of UTIs include, improper cleaning of the anal region after defecation, sexual intercourse, or any other procedure that involves introduction of an object (urinary catheter) into the urethra or bladder for diagnostic or therapeutic purpose. Hence the perineal region has to be cleansed thoroughly with soap and water to
prevent the spread of micro organism from the area surrounding the urethral meatus. (Sharon Fillingham, 2008)
An infection is an invasion and multiplication of micro organism into the body. Urinary tract infection refers to entry and multiplication of mic roorganism in the urinary tract. Urinary tract infection is usually caused by micro organisms that are found in the gastro intestinal tract.
The species that commonly cause UTI are E.coli, Klebsiella, and Proteus, which enters the urinary tract through, urethral meatus. The most common UTIs are infections of the urethra, bladder, both of which leads to lower UTIs. Infection of the ureter and the kidneys or tubule system is known as upper UTIs. (Nita Patwardhan, 2006)
Urinary tract infection is most often due to infection caused by the spread of organisms by way of the urethra, but may also be associated with certain drugs and radiation therapy of the lower abdomen.
Predisposing factors include indwelling urinary catheters instrumentation of the bladder by other means such as ultrasound scan, trauma of the tissues, stagnation of the urine, and compression of the bladder by neighboring enlarged organ. Clinical characteristics include urgency, frequency, dysuria and abdominal discomfort and cloudy urine. Thus the author emphasizes that UTI is mainly associated with the above mentioned risk factors. (Walsh Mike, 2007)
Urinary catheter is the major cause of urinary tract infection.
Indwelling urinary catheter (IUC) is a foreign body and hence it interferes with body’s immune responses and may cause chemically induced inflammation of the urethral and bladder mucosa as well as allows entry of micro organisms into the bladder, and offers a surface for the organisms to grow. Catheter also stretches the urethral orifice and injures the tissues. Obstruction of a catheter produces increased vesicular pressure, promoting the spread of organisms across the mucosa and up the ureter. (Walsh Mike, 2007)
Most commonly (75%) urinary tract infection is caused by the instrumentation of the urinary tract especially the urinary catheter.
Though the urinary catheter is used for the therapeutic purpose, it also leads to the serious hazard the urinary tract infection that is unavoidable when it is place in the urinary tract for the longer period. (Jean Douglas, 2008)
A urinary catheter is an artificial tube placed in the urinary tract to drain and collect urine from the bladder. Urinary catheters are used to drain the bladder, whenever the normal voiding is disturbed. Health care provider may recommend a catheter for short-term or long-term in case of urinary incontinence, urinary retention, surgery that made a catheter necessary, such as prostate or gynecological surgery, or any other major abdominal or orthopedic surgeries. As well as, it is used in other medical
conditions such as multiple sclerosis, spinal cord injury, or dementia.(Newman DK, 2007)
Incidence of Catheter associated urinary tract infection increases with increase in the use of indwelling urinary catheter and it accounts for atleast 5% per day of catheterization. Thus the duration of the indwelling urinary catheter increases the risk of CAUTI. The other factor that increases the risk of CAUTI is the means of drainage system. If the catheter is attached to the open drainage system the chance of occurrence of UTI is common. The urinary catheters are usually attached to a drainage bag to collect urine. A newer type of catheter has a valve that can be opened to allow urine to flow out, when needed which helps to prevent urinary tract infection from accidental entry of microorganism into the urinary tract. The closed drainage system helps to prevent the UTI. (Graves.N, et.al, 2007)
The indwelling Foley catheter presents the greatest risk of all urinary manipulations for the development of urinary tract infection. With the open drainage system virtually all patients are bactericuric within 4 days of introduction of the catheter. With the development of the closed system of urinary drainage the incidence of acquired bacteriuria has markedly diminished. The risk of infection is 97% with open drainage system and it decreases to 50% of patients with indwelling Foley’s catheter in which, it maintains sterile urine even after two weeks of
catheterization. Most of the patients who require short term Foley’s catheterization will never develop bacteriuria. (Sharon Fillingham, 2008)
The risk of acquiring a urinary tract infection depends on the method and duration of catheterization, quality of catheter care and the host’s susceptibility. Reported infection rates vary widely, ranging from 1%-5% after a single brief catheterization to virtually 100% for a patient indwelling catheter draining into an open system for longer than 4 days.
Adoption of closed method of urinary drainage has markedly reduced the risk of acquiring a CAUTI, but the risk is still substantial. (Nita Patwardhan, 2006)
Catheter associated urinary tract infection is generally assumed to be benign. There is greater risk for urinary tract infection with increased duration of catheterization. The prevalence of asymptomatic bacteriuria is 15% in patients catheterized less than thirty days and 90% for patients more than thirty days. Risk factors include can be classified as those that are modifiable which includes, unwanted, cathete rization, contamination during urinary catheter insertion, errors in catheter care and use of long term broad spectrum antibiotics. The risk factors that are non modifiable are female gender, post partum status, old age and severe underlying illness. (Nita Patwardhan, 2006)
A number of research studies have demonstrated the other associated risk factors for CAUTI that includes history of previous catheter use, the duration the catheter is in situ , the length of hospital stay prior to catheter insertion, the reason for and location of catheter insertion.(Leone, et.al, 2003; Stamm, 1991; Bryan and Reynolds, 1984 and Garibaldi, et.al, 1974)
Complication of long term catheter associated microburia falls into two categories. The first include symptomatic urinary tract infection such as those seen with short term catheterization, fever, acute pyelonephritis, blood stream infections. Some of these episodes such as urosepsis may end in death. The second group is more often associated with long term catheterization, urinary tract stones, chronic renal inflammation, and renal failure and over year's bladder cancer. Depending upon the severity of candiduria oral or intravenous Fluconazole or Amphotericin B may be used. Removal or replacement of urinary catheter or stent may be helpful.
The author emphasis that urinary catheterization leads to many complications especially CAUTI. (Reynolds’s. et.al, 2005)
The other hazards that result from indwelling urinary catheterization are trauma, bleeding, inflammation that may leads to stricture formation. These inflammatory reactions are due to chemical irritation or ischemia. (Burkett and Randall, 1987)
The major hazard of indwelling urinary catheter is bactremia that leads to even septicemia from urosepsis and the finally it leads to death also. (Nita Patwardhan, 2006)
The preventive aspect of catheter associated urinary tract infection follows the abbreviation ERASE
E - Evaluate the Indicators (the author insists about the importance of need assessment for indwelling urinary catheterization.)
R - Read Directions and Tips. (The author insists about the need for following the recommended guidelines by the physician and the nurses.)
A - Aseptic Technique (the author insists about the need for proper catheter care.)
S - Secure Catheter. (The author insists about the proper placement of urinary catheter, and to avoid accidental pulling of the urinary catheter.)
E - Educate The Patient. (The author insists about the need for patient education regarding the prevention of catheter care and the prevention of UTI). (Mundelein IL, 2009)
“This study also insists about the need for health education of the patient”.
As per the abbreviation ERASE, the first and foremost preventive measure is to avoid urinary catheterization when not required and it should be removed as early as possible. The most effective preventive strategy developed is the use of a closed drainage system, that was introduced almost a century ago and all the health care personnel should work in hand to follow the recommended guidelines as well as by following automated computer stop orders.
When ever possible either condom catheter or suprapubic catheter can be used. Aseptic catheter insertion and a properly maintained closed drainage system are essential to reduce the risk of CAUTI. (Saint S , et.al, 2006)
Antimicrobial agents should not be used to clean the urethral meatus. Urethral meatus can be cleansed with simple soap and water.
(Sanjay Saint, 2000)
An indwelling Foley catheter remains in place continuously. To prevent slipping of catheter, the balloon can be inflated with sterile water or the catheter that is connected to the drainage bag can be fixed to the thigh with the help of a plaster. (Mundelein IL, 2009)
Always wash the hands before and after handling the urine collection bag. Use soap and water to carefully wash around the drainage tube and to wash the perineal region after defecation. Do not apply powder or lotion to the catheter insertion site (Jean Douglas, 2008)
Check the area around the urethral meatus for signs of infection, irritation, redness, swelling burning sensation etc and promptly report to the health care personnel. Keep the urinary drainage bag below the level of the bladder. Instruct patient not to compress the tubing or not to pull it accidentally. (Carol Taylor 2006)
Drink plenty of fluids to increase the urine production. Drink atleast 8 glasses of water or other fluids each day.8 and 10 glasses of water, non caffeinated beverages, or fruit juice each day have to be taken.
Include fruits, vegetables, and fiber in the diet each day. (Christensen Kockrow, 2006)
Take care to avoid kinking of the drainage tubing. Do not pull or tug on the catheter. The urine collection bag has to be emptied at regular intervals, whenever it is half -full, and at bedtime. Wash your hands with soap and water before and after emptying urine from collection bag.
Drain the urine into a separate container then empty it into the toilet.
Avoid touching the tubing or drainage cap on the toilet, the collection container, or the floor. (Epic Project, 2001)
Be sure that the drainage tube is functioning properly and if no urine or very little urine is flowing into the collection bag and if the bladder is full and if there is pain in abdomen, pelvis, legs, or back inform the health care personnel. If the urine color is very cloudy, looks bloody, or has large blood clots inform immediately. Presence of fever of 100°F (37.8°C) or higher or back or flank pain, nausea, vomiting, or shaking chills are the signs and symptoms of urinary tract infections that are to be reported. (Carol Taylor, 2006)
Thus in a concise manner preventive measures includes, maintain proper hygiene, adequate fluid intake, regular emptying of the urinary collection bag, appropriate positioning of the catheter bag, maintaining proper urinary flow in the drainage tubing, patient education to report any signs and symptoms of urinary tract infection, catheter removal or catheter change according to hospital policy or blockage in the drainage tubing or bleeding and catheter associated urinary tract infection
STUDIES RELATED TO URINARY TRACT INFECION ASSOCIATED WITH INDWELLING URINARY CATHETER
Dixon L, et.al, (2010) conducted a study to compare the use of intermittent urethral catheterization with indwelling suprapubic catheterization in women undergoing surgery for urodynamic stress incontinence or uterovaginal prolapse. Total sample selected was 75 women who were randomized into two groups. 38 were randomized to
suprapubic catheterization; 37 to intermittent Three were deducted and hence each group was having 36 women .patients were not having their individual preferences for any type of catheter. During data collection and analysis the researcher found out that patients, who were using intermittent urinary catheterizatio n, regained their normal urinary pattern and voiding status as compared to that of the other group.
Katsumi HK, et.al, (2010) conducted a retrospective study at Long Beach Veterans Hospitals for choosing the best bladder management for male spinal cord injury patients. The purpose of this study was to compare the complications associated with indwelling catheters to that of complications associated with suprapubic tube (SPT)in patients with SCI.
Chart review identified morbidities including urinary tract infection (UTI), bladder stones, renal calculi, urethral complications, scrotal abscesses, epididymitis, gross hematuria and cancer. The total study participants were 179 patients. The researcher did not found out any significant difference between the two catheter groups. SCI patients with a chronic catheter have similar complication rates of UTIs, recurrent bladder/renal calculi and cancer. Urethral and scrotal complications may be higher with UC.
Hinrichsen SC, et.al, (2009) conducted a cohort study at Instituto de Medicina Integral Professor Fernando Figueira' from January to May of 2007 to identify the factors associated with bacteriuria after bladder
catheterization for the patients undergoing gynecologic surgery and to determine the frequency and risk factors associated with bacteriruria after urinary catheterization among women who were undergoing gynecological surgery. The total samples selected were 249 women. At 24 hours after catheter removal, urine was collected from all, out of which 23.6% of the urocultures were positive, while on days 7 to 10 this was reduced to 11.1%. Frequency of bacteriruria was 23.6% at 24 hours and 11.1% seven days after catheter removal. Thus the researcher concluded in his study that there was no association between bacteriuria at 7out of 10 days and any of the variables analyzed.
Kowal-Vem A, et.al, (2009) conducted an observational study at 12 US sites, to assess the economic impact of fecal contamination in bedridden patients using 2 different indwelling bladder catheters and to compare infection rates between groups. Total sample selected for the study was 146 bedridden patients (76 with catheter A, 70 with catheter B) who had similar Braden scores at enrollment. The rate of bedding and dressing changes per day differed significantly between groups (1.20 for catheter A vs 1.71 for catheter B; P = .004). According to a formula that accounted for personnel resources and laundry cycle costs, catheter A cost $13.94 less per patient per day to use as compared with catheter B.
Catheter A was less likely to cause UTI than catheter B to be removed during the observational period (P = .03).
Tsuchida T, et.al, (2008) conducted a prospective observational study to identify the relationship between catheter care and catheter- associated urinary tract infection at Japanese general hospitals. 555 adult patients who were catheterized for 3 days in five general hospitals in Japan were selected. The mean duration of catheterization was 25 days.
The overall incidence of CAUTIs was 3.9 cases per 1000-device days; the incidence of CAUTIs ranged from 0.6 to 7.2 cases per 1000 -device days among the five hospitals. Only fecal incontinent patients were analyzed since they accounted for 94% of the CAUTI cases. In the univariate analysis, the silver-alloy catheter emerged as a potential risk. In the final Cox model, two variables remained 'non-pre-connected closed system (standard system)' (RR 2.35, 95%CI 1.20 -4.60, p = 0.013) and 'no daily cleansing of the perineal area' (RR 2.49, 95%CI 1.32 -4.69, p = 0.005). the study suggested that the use of a 'pre-connected closed system' and 'daily cleansing of the perineal area' could reduce the incidence of CAUTIs by nearly 50%.Their investigation identified fecal incontinence as the major risk factor for CAUT Is in the study population and the hospital using silver-alloy catheters had the highest CAUTI rates, which is due to the antimicrobial propertyof the silver coated catheter.
Wald HL, et.al, (2008) conducted a retrospective cohort study at US hospitals, to describe the frequency and duration perioperative catheter use and to determine the relationship between catheter use and
postoperative outcomes. The sample was selected from 2965 acute care hospital in US hospitals. The total study samples were 35,904 undergoing major surgery.86% of patients undergoing major surgery had urinary catheter during the surgery. Out of the total samples 50% had IUC longer than 2 days after the surgery and they are more likely to develop UTI as compared with patients who had IUC for less than 2 days. Thus the researcher concluded that the use of long-term IUC has to be avoided and the number of catheterized days has to be reduced to decrease the incidence of urinary tract infections in the post operative period.
Ko Mu, et.al, (2008) conducted a study at Taipei , to identify the prevelance of uropathogens associated with CAUTI. The total sample was 2,997 and urine samples were sent for investigation at a regional hospital in Taipei, Taiwan 1,948 (65%) samples from hospitalized patients and 1,049 (35%) samples from outpatients. Patients with IUCs were accounted for 1,381 samples (46%). The patients with IUC had lower prevelance rate of Escherichia (E.) coli (23.4% versus 36.8%) and higher rates of resistant strains including Pseudomonas species (16.4%
versus 8.6%) and rare gram-negative bacilli (5.8% vs 4.5%). As well as IUCs significantly increased the antimicrobial resistance of E. coli (OR 2.41-3.07), other species of Enterobacteriaceae (OR 1.57-2.38), and rare gram-negative bacilli (OR 2.41 -5.21) to nearly all antibiotics tested, such as trimethoprim/sulfamethoxazole. Thus, the researcher concluded that
IUCs increased the prevalence of urinary tract infections caused by some highly resistant pathogens. And IUCs were associated with the increased risk of concurrent resistance of Enterobacteriaceae. Steps have to be taken to reduce the chance of CAUTI.
Ikuerowo. SO, et.al, (2008) conducted a study which was aimed at identifying the health, financial and quality of life, implications of prolonged use of indwelling catheter among the urinary catheterized patients with acute urinary retention who were awaiting for surgery. The total study participants were 62.The mean age of the patients was 57.5 years and the mean catheter use time was 23 months. The cause of acute urinary retention was BPH in 40 cases (64%) and urethral trauma in 16 (28.4%) patients. The common side effects of prolonged catheterization included urethral or suprapubic pain, bleeding per urethra , loss of dignity, loss of job or being out of school, lack of sexual intercourse, pericatheter leakage of urine and recurrent urinary tract infection. The average cost of catheter change was 789.67 Naira. The total annual cost for the change of indwelling catheter after acute urinary retention in the catheter clinic was estimated to be 58,800 US dollars 535 three (85.5%) patients were unhappy. Thus there was a significant correlation between
quality of living and the presence of pain (p = 0.015) and bleeding (p = 0.042) associated with the presence of an indwelling catheter.
Saint.S, et.al, (2008) conducted a nation wide study to examine the current practices followed in the hospitals to prevent hospital acquired urinary tract infection. The study was conducted among 600 randomly selected nonfederal US hospitals and to all 119 Veterans Affairs hospitals .During the study the hospitals were questioned about the practices to prevent hospital acquired UTI. The response rate was 72%.The researcher analyzed that on the whole 56% of hospitals did not monitor for the patients with IUC, and 74% of the hospitals did not monitor for catheter duration. 30% of hospitals reported about regular use of antimicrobial urinary catheters and portable bladder scanners; 14% of the hospitals used condom catheters, and 9% of the hospitals used catheter reminders. VA hospitals mostly use portable bladder scanners (49% vs. 29%; P=.001) as compared with non-VA hospitals. Condom catheters (46% vs. 12%;
P=.001), and suprapubic catheters (22% vs. 9%; P=.001); non-VA hospitals mostly use antimicrobial urinary catheters (30% vs. 14%;
P=.001). Thus the researcher through his study insisted that most of the Veteran Affairs hospital practice almost all the preventive aspects of hospital acquired infection especially urinary catheter associated urinary tract infection.
Hazelett.SE, et.al, (2006) conducted a study to find out association between IUC use and UTI .The total study sample was 277 patients out of which 73% of patients who received an IUC in the ED were elderly (> or
=65 years old). Of these, 77 (28%) were diagnosed with UTI during their hospitalization. Fifty three (69%) of those diagnosed with a UTI by discharge either had the UTI diagnosed in the ED or had bacteriuria > or
=105 organisms/ml prior to IUC placement. Among 24 elderly patients who developed a catheter-associated UTI (i.e., 9% of the elderly population who received an IUC) 11 had inappropriate catheter placement. Thus the study indicates that the strong association between IUC use and UTI may be partly explained by the high prevalence of preexisting UTI prior to IUC placement. The researcher recommended for further prospective studies to clarify the true risk versus benefit ratio for IUC use in acutely ill elderly patients.
Saint S, et.al, (2006) conducted a randomized controlled trial study to compare the condom and indwelling catheter in terms of infection risk and patient satisfaction. The study was conducted at academically affiliated Veterans Affairs medical center .Totally 75 subjects were selected randomly and grouped into 41 receiving indwelling urinary catheter and 34 receiving condom catheter. The incidence of adverse outcome was 131 for 1000 patient-days in patients with IUC when compared with 70 for 1000 patient-days in patients with condom catheter (p=.07). The adverse effect occurs within 7 days in patients with IUC but it takes about 11 days in patients with condom catheter. Thus the researcher found out that the use of condom catheter reduces the risk of
developing bacteriuria, symptomatic UTI, or death as compared to the use of IUC.
Zacharias S, et.al, (2006) conducted a randomized controlled study at All India Institute Of Medical Sciences between the period of June and December 2006. 60 selected samples were selected randomly in the neurosurgical intensive care unit, in order to study the effect of amikacin sulfate bladder wash on CAUTI in neurosurgical patients and to study the various organisms causing CAUTI and their antibiotic sensitivity and resistance pattern. The samples were randomly divided into control and study groups. The researcher concluded that 40% of the subjects in the control group developed CAUTI, while none of the subjects in study group developed CAUTI. (Fisher's exact test, P value < 0.001) Pseudomonas aeruginosa (51%) was the commonest pathogen.
Su FH, et.al, (2005) conducted a study regarding Purple urine-bag syndrome (PUBS) .The purpose of the study is to identify the prevalence and possible causes of PUBS for a group of elderly patients. Tota l sample were 157 with urinary catheterization out of the which, the researcher found 13 subjects with PUBS. Urine samples were collected for culture from all the PUBS patients participating. 69.2% of the patients with PUBS, as compared to 43.1% of the non-PUBS patients, lived in nursing homes, and 84.6% of the PUBS -affected patients were constipated, and in total, 72.7% of PUBS patients were using a laxative suppository,
compared with 41% of the non-PUBS group, whereas 92.3% of PUBS patients were catheterized using a plastic (PVC) Foley, as compared to 70.8% of the non-PUBS patients. The pH for 12 out of 13 PUBS patients' urine was > or = 7. Escherichia coli, Provendicia var. spp., Proteus mirabilis, Klebsiella pneumonae were the common pathogens isolated from the urine samples provided by PUBS patients. The study indicates that PUBS was more likely associated with the female gender, alkaline urine, constipation, institutionalization, the use of a plastic (PVC) urinary catheter, and certain bacteria such as Provendicia var. spp., Escherichia coli, Proteus mirabilis, and Klebsiella, pneumonae.
Safdar.N, et.al, (2005) conducted a nested case control study to evaluate the epidemiology of candiduria in renal transplant recipients at the University of Wisconsin over period of 8 years.. The total study sample was 192 having 276 episodes of candiduria. Out of 192 cases, Candida glabrata was the most common pathogen identified among 98 patients. Mostly the risk factors were female sex of about 12.5 ;95%, hospitalized patients in ICUs 8.8;95%, patients who were treated with antibiotics 3.8;95%, patients with indwelling urinary catheter 4.4;95% , patients with DM 2.2; 95% patients with neurogenic bladder 7.6; 95%
and who were malnourished 2.4; 95% .Patients were treated with following regimen. For 119 patients (62%) IUCs were removed.
Candiduria was recovered in 148 case patients thus the researcher
analyzed that catheter removal reduces the risk of candiduria and recommended for early removal of urinary catheter.
Dalen DM, et.al, (2005) conducted a prospective observational study over a period of 26 consecutive days at The Ottawa Hospital the University of Ottawa Heart Institute, Ottawa, Ontario, to assess the current management of patients with CAUTIs with respect to antimicrobial therapy followed at the study setting. Total study sample were 119 subjects out of which, 15 (52%) were prescribed with antimicrobials and were therefore considered to be inappropriately managed. Differences were identified between the appropriate and inappropriate management groups in terms of duration of stay to positive urine culture and whether yeast or bacteria were isolated from the culture.
And it was concluded that antimicrobial agents were prescribed in over one-half of CAUTI cases, contrary to recommendations from the literature. Education is required to bring this strongly supported recommendation into clinical practice.
Gokula.RR, et.al, (2004) conducted a chart review study to assess the prevalence and appropriate use of indwelling urinary catheter (IUC) at a community teaching hospital in the medical wards. The study samples were in the age group of 65 years and older who were having IUC. The researcher collected about 285 charts of the patients with IUC at the first 24 hours of admission. Only 46% of the patient’s charts were found to
