Compliance With Guideline Statements for Urethral Catheterization in an Iranian Teaching Hospital

Abstract

Background: It is believed that healthcare staff play an important role in minimizing complications related to urethral catheterization. The purpose of this study was to determine whether or not healthcare staff complied with the standards for urethral catheterization. Methods: This study was conducted in Imam Reza teaching hospital, Tabriz, Iran, from July to September 2013. A total of 109 catheterized patients were selected randomly from surgical and medical wards and intensive care units (ICUs). A questionnaire was completed by healthcare staff for each patient to assess quality of care provided for catheter insertion, while catheter in situ, draining and changing catheter bags. Items of the questionnaire were obtained from guidelines for the prevention of infection. Data analysis was performed with SPSS 16. Results: The mean age of the patients was 50.54 ± 22.13. Of the 109 patients, 56.88% were admitted to ICUs. The mean duration of catheter use was 15.86 days. Among the 25 patients who had a urinalysis test documented in their hospital records, 11 were positive for urinary tract infection (UTI). The lowest rate of hand-washing was reported before bag drainage (49.52%). The closed drainage catheter system was not available at all. Among the cases who had a daily genital area cleansing, in 27.63% cases, the patients or their family members performed the washing. In 66.35% of cases, multiple-use lubricant gel was applied; single-use gel was not available. The rate of documentation for bag change was 79%. Conclusion: The majority of the guideline statements was adhered to; however, some essential issues, such as hand hygiene were neglected. And some patients were catheterized routinely without proper indication. Limiting catheter use to mandatory situations and encouraging compliance with guidelines are recommended. Implications for policy makers• The first step in improvement is to identify and address the deficits. There is a gap between evidence-based recommendations and the practice for urethral catheterization. • Routine and prolonged catheterization, without appropriate necessity is reported, which can lead to a high rate of catheter-associated urinary tract infection (CAUTI) and accompanying healthcare costs. • Adapting evidence-based guidelines and increasing patients' knowledge can be a solution for this apparently simple but indeed important problem. Implications for publicAppraising the quality of healthcare provided and identifying the gaps in the system are the main bases of further directions for health policies. Iatrogenic infections such as catheter-associated urinary tract infection (CAUTI) are among the most widespread complications and can lead to increased morbidity and length of hospitalization and to affect the costs of healthcare significantly. These problems can be prevented easily by appropriate practices. [1][2][3] This article revealed the gap between evidence-based recommendations and the practice for urethral catheterization. Filling these gaps by developing evidence-base...

Preventing Traumatic Urinary Catheter Insertion Through a Computerized Ordering System: Quasiexperimental Study From a Tertiary Academic Center

“…Efforts can also be made to ensure adherence to proper catheter insertion techniques and to minimize unnecessary urinary catheter insertion attempts. 14,15 In addition, the provider entering the order often was not the one who actually performed the catheterization. Even if the questions were answered correctly and risk factors were flagged in the computerized ordering system, it is uncertain whether the nurse, intern, or medical student took the positive action of ordering a Coudé-tip catheter.…”

Infecção do trato urinário associado ao cateter: Indicadores de Processo para análise das práticas de prevenção em pacientes críticos

“…A instituição de rotinas, protocolos e programas de melhoria, de forma sistematizada e com avaliação cíclica, também colaboram para resultados favoráveis para a adesão às boas práticas no cuidado ao paciente em uso de cateter vesical, o que vai ao encontro de diretrizes internacionais que zelam pela qualidade e segurança do paciente. [16][17][18][19][20][21] O Indicador 2 não obteve conformidade em nenhum dos setores, e ao analisarmos seus itens individuais (Tabela 2) concluímos que o determinante Páginas 07 de 08 não para fins de citação CVD, o que repercutiu negativamente na independência miccional após a alta. 18 O raciocínio mais frequentemente relatado neste estudo para uso inapropriado inicial do CVD foi "conveniência de cuidados" (49,6%).…”

“…Pontos específicos de manutenção do CVD como a fixação e fluxo desobstruído, devem ser discutidos entre os enfermeiros e sua equipe de enfermagem para a adequação, conforme protocolos institucionais do cuidado que vem sendo realizado no setor. [16][17][18][19][20][21][22][23] Além do exposto, consideramos essencial a instituição de programas de educação continuada às equipes de saúde que atuam no referido serviço e a educação permanente da equipe multiprofissional a fim de que sejam colocadas em prática as normativas elencadas nos protocolos institucionais, além da formação de uma cultura organizacional que preze pela qualidade do cuidado e na minimização de danos aos pacientes que ali são assistidos. desta insuficiência foi a não conformidade na fixação adequada (70,18%) e no fluxo de urina desobstruído (10,80%).…”

“…[16][17][18][19][20][21][22][23] Salienta-se que, apesar do tempo de permanência não ter sido quantificado em números de dias para análise do Indicador 1, durante as observações diárias constatamos a média de 8,80 dias de permanência do cateter vesical de demora nos setores analisados, valor alto quando comparado ao tempo de instabilidade hemodinâmica (maior justificativa para inserção) nestes pacientes. Segundo estudos, o tempo de permanência é fator crucial para colonização e ITU-RC pelo "crescimento bacteriano iniciar-se após a instalação do cateter, numa proporção de 5-10% ao dia, e estará presente em todos os pacientes ao final de quatro semanas".…”

Catheter-associated urinary tract infection: why do not we control this adverse event?

“…The risk of developing a catheter-associated UTI (CAUTI) increases with the duration of catheterization, and may reach 5% with each day of use. Thus, it is estimated that this risk rises to 100% after 28 days of catheterization, culminating in approximately 4% of patients with evolution from secondary sepsis to infection and an estimated mortality rate of up to 30% (3)(4) .…”