NURSES KNOWLEDGE AND PRACTICE ON THE APPLICATION OF ASEPTIC TECHNIQUE DURING URINARY CATHETERIZATION IN HOSPITALS OF LIMBE HEALTH AREA

Abstract

Urinary catheter is considered as a single biggest risk factor for acquired urinary tract infections (UTIs), and more than 80% of all acquired UTIs are attributable to catheter use [38]. Aseptic techniques are precautionary methods followed  in  any  procedure where there is a possibility of introducing microorganisms into the patient’s body(6).

Poor adherence to aseptic techniques results in considerable morbidity and mortality, even in countries with well-established infection control program [6], Yearly13,000 deaths occur due to urinary tract infection related to urethral catheters[11]. Nursing driven discontinuation protocols are an effective means of decreasing catheter days and subsequently decreasing CAUTI rates. Each day a catheter remains in place the risk for infection increased by 7%.

This study was carried out to understand what the nurses knew about aseptic techniques, how they did it and the factors hindering them from carrying out aseptic techniques protocol during urinary catheterization.

This was a survey, observational and cross-sectional hospital-based study that involved 101 participants drawn conveniently from the LRH, Bota Hospital, Manyemen Annex and Family Foundation Clinic. Data were collected using a semi-structured self-administered questionnaire and an observation guide was done using a check list. Data entries done using Epidata excel and analysed using (SPSS) Standard version, Release 21.0 (IBM Inc. 2012).

81.0% (81) of respondents showed a good knowledge attitude mastery of urinary catheterization and prevention of CAUTI, while 19.0% (19) of the nurses had insufficient knowledge related to attitude. Thematic reviews also brought out some areas to be addressed in future.

Therefore the administration has to put in measures to improve on the level of AT practice.

CHAPTER ONE
INTRODUCTION

1.1 Background of Study

The concept of disease transmission and prevention has existed for thousands of years, it began with evil as a means of disease causation and transmission and has ranged to bacterial and viruses as the causative agents. The concept of hand washing as the main means of maintaining AT was brought up by Oliver Wendel in 1843 [46]. Health workers were advised to wash their hands before doing patient examinations so as to prevent contamination [10].

Equally aseptic technique has been considered the most important tool in nosocomial infection control since Florence Nightingale observed its immense effect in reducing the death of soldiers during the Crimean war. She was a pioneering nurse, writer and statistician, it was through her observations that the link between sanitary conditions and healing became recognized and established. She insisted on adequate hand washing, good diet, AT practices and this led to a drop in mortality from 42.7 to 2.2 percent. Nightingale even understood the relevance of medical hygiene before the science of pathogens came into existence, this is to say hygienic practices which later led to asepsis practices started even before the discovery of microorganisms [5].

Florence and her team of nurses found wounded soldiers being badly cared for by overworked medical staff. Medicines were in short supply; hygiene was being neglected and mass infections were common. Therefore, she and her colleagues began by thoroughly cleaning the hospital and equipment and reorganizing patient care [5]. Florence insisted on adequate hand washing, lighting, diet, hygiene, and aseptic procedure in caring for patients. She understood even then that the mind and body worked together, that cleanliness – the predecessor to our clean and sterile techniques of today was a major barrier to infection, and that it promoted healing.

As such, our clean and AT practices during urinary catheterization today originated from Nightingale understands of cleanliness as a major barrier to infection [46]. The improper practice of AT can lead to Health Care Associated Infections (HCAIs) which is a public health problem, the prevalence in the developed countries ranges from 5 to 15% whereas the magnitude of the problem is still underestimated or unknown in developing countries mainly because the diagnosis is complex and surveillance requires expertise and resources[1]. Nosocomial infections are leading cause of death in the United States and are associated with significant morbidity.

Urinary catheters are used to drain the bladder, the health care provider may recommend that patients sue it if there is; Urinary incontinence (leaking urine or being unable to control when you urinate) Urinary retention (being unable to empty your bladder when you need to) Surgery on the prostate or genitals. Hand washing has been a means of maintaining aseptic technique in the past to minimize the spread of infection to patients and health professionals(3). Aseptic techniques are precautionary methods followed  in  any  procedure where there is a possibility of introducing microorganisms into the patient’s body(6).

However, the details of the aseptic techniques vary from one centre to the other, but they are similar in principle.  Improper practice of aseptic techniques could lead to healthcare associated infections(HCAI) in the hospital setting(6).  Studies have shown that at least 40% of primary bacteraemias in patients in medical and surgical wards are associated with intravenous catheterization (3,6).   Prevention of these infections has a major positive impact on the total in hospital morbidity and mortality as well as the economy of the hospital (6).

Despite the guidelines developed in most countries, compliance with aseptic precautions is known to be internationally suboptimal(1,4). It is said that nurses are more cautious and tend to follow the aseptic precautions during complex procedures and when assisting during  epidural catheterization, lumbar puncture  and in special settings such as operating theatres and intensive care units(7). But the proper practice of aseptic technique is not solely isolated to the operation theatre; it has a place in every clinical procedure whether complex or simple.

Catheter associated urinary tract infections (CAUTI) are the leading cause of secondary health care-associated bacteremia (8). About 75% of urinary tract infections acquired in the hospital are because of the urinary catheters. Inappropriate placement and prolong use of indwelling urinary catheter is one of the main risk of catheter associated urinary tract infection. Catheter associated urinary tract infection is caused by many organisms. The frequent pathogens associated are E.Coli (21.4%), Candida spp (21%), Enterococcus (14.9%), Pseudomonas Aeruginosa(10%), Klebsiella Pneumoniae( 7.75) and Entero-bacterspp (9).

Most studies have focused on standard universal precautions and limited data is available regarding the practice of aseptic procedures. Maintaining the principles of asepsis when performing urinary catheterization and other invasive procedures is one of the fundamental approaches of preventing healthcare-acquired infections; so many research works have been conducted to assess nurses’ practice of aseptic technique in the care of patients in various units and wards but it is quite obvious that little have been carried out among nurses in health care settings in Cameroon. Nurses are often exposed to various infections during their clinical practice. Knowledge and compliance with standard aseptic procedures is essential to prevent hospital associated infections and protect patients from exposure to infectious.

Therefore this study aim at investigating the knowledge and practice of aseptic technique by nurses and the factors that hinders them from carrying out these procedures in Limbe Heath Area. Assessment of nurses’ compliance will provide a baseline in the reinforcement practical seminars to reduce the rate of nosocomial infections in the hospitals reduce rate of CAUTI and wakeup nurses conscious of aseptic technique when attending to patients.

1.2 Statement of the Problem

(i) Urinary catheterization is one of the most common procedures performed in hospitals especially in intensive care units. The urinary catheter is considered as a single biggest risk factor for acquired urinary tract infections (UTIs), and more than 80% of all acquired UTIs are attributable to catheter use [38].

(ii) Poor adherence to aseptic techniques results in considerable morbidity and mortality. Even in countries with well-established infection control programs(6). Hospital acquired infections (HAI) related to poor compliance with aseptic techniques is an important public health problem. Data on surgical site infections is not available in Cameroon; however it was stated that there is poor compliance with aseptic techniques during critical procedures(4).

(iii) Urinary tract infections are the 4th most common type of hospital acquired infection with an estimated 93,300 urinary tract infections (UTI) in acute care hospitals(8) . UTIs are accounting for more than 12% of infections reported by acute care hospitals. Research studies shows that when health care facilities, doctors, nurses and care teams are aware of infection problems, it is possible to take specific steps to prevent them(8).

(iv)       Poor practice of aseptic technique among nurses in the clinical settings has led to prolong hospital stay of patients as a result of cross transmission on infections. Nurses themselves could be infected as a result of poor aseptic technique from not putting appropriate gloves or neglect of hand washing before and after attending to patients with infectious diseases. Compliance with hygienic aseptic recommendation is poor worldwide (10). Therefore, it is imperative to formulate strategy that will improve the practice of aseptic techniques among nurses.

(v) The assessment of nurses’ practices of aseptic technique in the placement of urinary catheter will enable supervisors, clinical instructors and policy makers to know the area of deficiencies of nurses toward maintaining standard aseptic technique and factors that influence compliance with aseptic technique. Finding will help to tackle those area of deficiencies and will enhance nursing care delivery and minimize infections.

1.3. Justification of the Study

To explore the learning needs of nurses related to urinary catheterization and catheter associated urinary tract infection considering that, Aseptic technique is commonly used in surgery, equipment, vaginal labour dialysis, urinary catheters, intravenous (IV) lines and other draining devices [14]. Studying the practice of aseptic technique in Urinary catheterization will help improve in areas of lacking and factors hindering compliance to its practice in Cameroon [5].

Developing countries with limited standard guidelines for aseptic technique practices, limited up-to-date knowledge on the practice and insufficient resources available are experiencing greater challenges of overcoming infection prevention. Infection control is a very challenging problem to the public health sector in Cameroon with corresponding HAIs of 10 to 20% from a Cameroon public health report in September 2008. More so, an important aspect of nursing care is to improve on patient care by minimizing infection and ensuring patient’s wellbeing and this can be achieved by applying the principles of ATs during nursing procedures especially prevention of CAUTI as it is a very crucial aspect of nursing care [5]..

To initiate evidence base practice in nurses knowledge and practice in urinary insertion Safe aseptic technique is reliant on effective staff training in infection control, safe environments and equipment that is fit for purpose. Effective aseptic technique is dependent on healthcare organisations taking a systematic approach to asepsis management in general. The effective education and training of healthcare workers is paramount, as is ensuring equipment is fit for purpose and clinical environments promote asepsis [10]. Evaluation is a continuous process and re-evaluating practice and knowledge will maintain standard of care towards aseptic techniques for a safe work environment, hence Standardizing practice naturally reduces practice variability and the number of variables in practice.[10].

1.3.1 Significance of Study 

Results from this research will help bring out guidelines on how to handy materials and still maintain safe and sterile environment during catheterization.

This study will provide information on the needs of aseptic procedural practices among nurses and also the methods to achieve standard aseptic techniques, as seminars on continuous learning will be proposed to the hospitals. The findings will also serve as research baseline measurement for other researchers, so that records updates will be visible.

1.3.2 Aim

The aim of this study is to bring out knowledge and practice aseptic techniques in placing urinary catheter by nurses and the difficulties during the procedure.

1.4: General Objective

This study has a main objective to assess nurses’ knowledge and practices of aseptic technique in the placement of urinary catheter in Limbe health area.

1.4.1 Specific Objectives

1. Assess nurses’ knowledge of aseptic techniques during the placement of the urinary catheters.
2. To evaluate nurses’ practice of aseptic technique during urinary catheterization.
3. Identify the factors that affect the practice of aseptic technique during the placement of urinary catheterization among nurses in the Limbe health area.