The impact of guidelines on sterility precautions during indwelling urethral catheterization at two acute-care hospitals in Sweden - a descriptive survey

Abstract

Background: To support a uniform and evidence-based practice for indwelling urinary catheterization in adults The European association of Urology Nurses (EAUN) published guidelines for this procedure in 2012. The Swedish national guidelines are based on the sterility precautions advocated by EAUN. 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.