Insertion of indwelling urinary catheters should be performed in a way that minimizes the risk of introducing bacteria to the urinary bladder. Nurses and assistant nurses from three departments at an acute-care hospital in Sweden answered a questionnaire about their insertion of urinary catheterization. Of the 563 nurses, 92% answered the questionnaire. Among the 492 who performed catheterization, 58% ( n = 287) said that they followed the hospital guideline. Two-thirds of those following the hospital guideline said that they used clean technique and one-third sterile technique. In all, 82% considered the catheter should be kept sterile while inserted but only 16% described all the prerequisites to achieve this. Over 90% of the respondents performed catheterization less than once a week. Our conclusion is that a guideline should describe every step of catheterization in detail and that an evidence-based process for implementation of the guideline is necessary to achieve uniformity in performance.

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. Nevertheless, 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 analyse factors affecting the participants´ 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 analyse variables associated with practicing the sterility precautions in the EAUN-guidelines.Results: Answers were obtained from 852 persons (91.5%). A majority 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. In spite of that not everyone used sterile equipment to maintain the 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 1.69-3.26), use of sterile set for catheterization (OR 2.08, 95% CI 1.44-3.00), use of sterile drapes for dressing on insertion area (OR 1.87, 95% CI 1.21-2.89) and using the term “sterile technique” for indwelling urethral catheterization (OR 1.70, CI 1.15-2.51). Conclusions: The study showed that only 55-74% of the nurses practised one or more precautions that secured sterility of the IUC thus demonstrating a gap between the EAUN-guidelines and the actual performance. Compliance to disinfection of hands prior to the procedure was however around 90%. Healthcare-settings should ensure education and skill training to achieve sterile IUC-insertion according to the requirements in the EAUN-guidelines.

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. Nevertheless, some hospitals have local guidelines with other requirements concerning sterility and leave to staff to decide what equipment to use and how to perform the catheterization. The aim of this study 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 analyse factors affecting the participants´ conformity with sterility precautions recommended 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 analyse variables associated with practicing the sterility precautions as recommended in the EAUN-guidelines.Results: Answers were obtained from 852 persons (91.5 %). A majority of the participants called their insertion technique “non-sterile”. Regardless of what the insertion technique was called, the participants said that the IUC should be kept sterile during procedure. In spite of that not everyone used necessary sterile equipment to maintain the sterility of the catheter. The nurses´ conformity with all the sterility precautions as advocated in the EAUN-guidelines were associated with working at departments for surgery and cardiology (OR 2.50, CI 1.78-3.49) and years in profession (OR 1.54, CI 1.03-2.30). It was also associated with use of sterile set for catheterization (OR 2.03, CI 1.40-2.94), use of sterile drapes for dressing of the insertion area (OR 1.94, CI 1.25-3.00) and using the term “sterile technique” for indwelling urethral catheterization (OR 1.67, CI 1.13-2.47). Conclusions: To achieve a uniform practice in aseptic urethral catheterization national and local hospital guidelines should advocate same sterility precautions. Evidence-based guidelines should describe how sterility precautions are accomplished and should be implemented in healthcare-settings.