الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 116 |  |  |
| | | from | 116 | | |
Abstract
Urinary tract infection (UTIs) is the most common type of hospital-acquired infection that is mostly linked with the indwelling urinary catheter use, that is, catheter-associated UTIs (CAUTIs).
Several strategies to prevent the occurrence of CAUTI have been considered, all of which point to a fundamental principle: restricted indication, performed according to guideline recommendations, insertion with aseptic technique, care in maintenance and rigor regarding the permanence time of the UC and removal of catheter as early as possible.
When a facility uses an interdisciplinary, collaborative,educational, bedside and patient-centered approach to increasing staff awareness of patients at risk, it can precipitate a cultural change that results in improved clinical results, increased medical director and administrator engagement, improved staff and patient satisfaction, and a reduction in hospitalizations and readmissions.
The aim of this study was:
To assess safety practices provided to patients with urinary catheter care by health care workers.
Materials and method
Research Design: A descriptive research design was utilizedin this study.
Setting: This study was conducted at the medical and surgicalunits of the Alexandria police hospital.
Subject: The study subjects consisted of all healthcare workers who were involved in providing patient care for patients undergoing urinary catheterization in previously mentioned setting.
A total of fortyhealth care workers will be recruited (approximately (5) Doctors thirty two nurses and three workers.
Tools of the study:
Two tools were used for the purpose of data collection
Tool I:
Health Care Workers socio demographic data and clinical data of patients with urinary catheter, structured interview schedule:
This tool will be developed by the researcher after review of related literature to identify characteristics of H.C.Ws and patients. It will include two parts.
Part 1:
1. Socio demographic data forHealth Care Workers :
This item will include name, age, gender, job title, qualification, years of experience, and attendance of previous in service training program(s) related to infection control.
2. Patient clinical data:
These date will include patient name, age, gender, patient unique hospital number, date of urinary catheter insertion, signs and symptoms of urinary tract infection as: increases body temperature, supra pubic pain or tenderness, complete blood count, urine analysis...etc.
Tool II:
Catheter Associated Urinary Tract Infection (CAUTI) care bundle observational checklist sheet:
This sheet will be developed by the researcher based on relevant literatureto assess safety practices related to urinary catheter care.It will be in the form of scoring system and comprise items of safety practices and it will consist of four parts:
A. Safety practices during insertion of indwelling urinary catheter:
- Alternative for catheterization are explored.
- Check the clinical indication for catheterization is met.
- The person inserting the catheter has received training to do so.
- The person inserting the catheter has performed hand hygiene immediately before undertaking the procedure. Etc…
B. Maintenance safety practices of indwelling urinary catheter:
- Perform hand hygiene before and after catheter care procedureand wear gloves prior to each procedure
- A clinical indication for catheterization remains.
- The catheter has been continuously connected to the drainage system
- There is a daily documented assessment of the need for UC. Etc…
C.Safety practices during removal of the urinary catheter:
- Timing of catheter removal.
- Remove the catheter as soon as no longer needed
- Ensure the patient understand the procedure and gain consent to remove the catheter.
- Maintain privacy of the patient.
- Document the date and time of catheter removal.
- Record urine output until the frequency and voided volume is satisfactory.
- Ask the patient to observe any signs of voiding difficulties and report these immediately.
D.Safety practices during decontamination of theurinal:
- Clean the container with soap and water.
- Usingthe disinfectant solution for 10 min.
- If the container is for single use it must not be reused – with or without decontamination.
- Rinsing the urinal by running water.
The main results of this study were:
1. The findings of this study revealed that more than half of the studied patients were in the age group of 50-60 years, also the highest percentage of the studied patients were females.
2. Nearly three quarters of the studied health care workers aged less than 30 year, alsomore than two thirds of them were females, majority of the studied health care workers were nurses had secondary school of nursing, more than two fifthof the studied healthcare workers had less than five years, and majority of themattended previously educational or training courses about infection control.Among them, more than one third attended three and more programs.
3. More than one quarter of patientswere admitted for more than 25 days,and majorityof themhad FUC for more than or equal 4 days, less than one third of thispatients developed a UTI infection, among them fever was themain manifestation of UTI as reported by all patients, followed by positive urine culture.
4. Majority of physicians didn’t check of clinical indication for catheterization and alternatives for catheterization, and didn’t insert the urinary catheter under aseptic non touch technique.
5. Majority of nurses maintain the FUC connection to the drainage system, and the drainage bag kept lower thanthe patient urinary bladder and ensure that tubing are not on the floor, avoid twisting or kinking the FUC and being secured to the patient’s legin the first day after insertion of the urinary catheter for the rest of days the majority of nurses didn’t do that especially in the evening shift.
6. Lower safety practice scores were more present among those patients who develop UTI.
7. The more years of experience, the more safety practices performed, where highest mean was noticed among those with 20 years and more of an experience. In addition,those who attendance of the training program about infection control had higher safety practices mean score especially those who attend it several times.
8. Urinary tract infection was more prevalent among those patients aged 55 years and more compared to those aged less than 45 years (41.7%and 33.3%, respectively) as well among female patients (35.3%) and those admitted to the surgical department (36.4%) and hospitalized for 25 days and more.
Conclusion and Recommendations:
• The majority of healthcare personnel (physicians, nurses and workers) in Alexandria Police Hospitalwere unsafe in their practice to standard infection control precautions.
• Absence of policy and procedure manual related o FUC insertion, maintenance, and removalwas the most reason for unsafe practices.
• The highest safety practice was among those aged 40 years. Moreover,the more years of experience, the more safety practices performed, in addition those who attendance of the training program about infection control had higher safety practices.
The main recommendations are:-
• Health Care Workers (HCWs) should be attentive to maximal sterile barrier precautions, compliance of urinary catheter care bundle can improve patient adherence to safe best practices,and In-service training program should be available to all healthcare workersabout UC insertion and care.
• Development of documentation system and multidisciplinary guidelines of care for urinary catheter insertion; maintenance and removal.
• Training and conferences must be conducted to discuss CAUTI and updating guidelines for safe improvement .
• Policies and procedures related to management of patients attached with FUC have to be developed, updated and continually reviewed.
• Rules and regulations should be taken against incompliant health care workers through hospital administration.