Utilization of catheter associated urinary tract infection bundle among critical care nurses - Kenyatta National Hospital

Abstract

Majority if not all patients admitted in the Critical Care Units (CCU) have indwelling urinary catheters. These catheters stay for the entire period that these patients are admitted, hence the risk of developing Catheter Associated Urinary Tract Infections (CAUTI). Due to the high prevalence of CAUTI worldwide, the Centre of Disease Control (CDC) initiated reduction strategies. These strategies were bundled into prevention care bundles recommended as gold standard in caring for catheterized patients. The prevalence has still remained high even with the introduction of the bundles increasing the morbidity, mortality, hospital stay and cost. Nurses are charged with the responsibility of catheter care making them accountable for the utilization of the CAUTI bundle. This bundle should be utilized all the time during patient care. Study objective: To determine the extent of Catheter Associated Urinary Tract Infection bundle utilization among critical care nurses at Kenyatta National Hospital. Methodology: This was a cross-sectional descriptive study on 95 nurses. Cochrane formula was used to determine the sample size which was selected using cluster sampling that comprised of the critical care units. Systematic random sampling was used in each cluster. A structured questionnaire and an observation checklist was used to collect data based on the elements of the bundle. Analysis of data was done using the Statistical Package for Social Sciences (SPSS) version 21.0. Descriptive statistics that is mean, mode, median & standard deviation and inferential statistics that is chi-square test, odds ratio & pearsons’ correlation were used to analyze the data which was presented in form of figures and tables. Results The nurses utilized the bundle though some elements were better utilized than others. The nurses who had knowledge on the bundle utilized it 24.1 times more than those who did not [OR 24.1; 95% CI 6.7 - 104; P < 0.01]. It was also noted that utilization of the bundle was 36.2 times higher among the nurses who knew about the bundle elements [OR 36.2; 95% CI 9.98 - 144; P< 0.001]. Generally, the nurses utilized the bundle. They also adhered to the bundle at 49.5% (P>0.005) though there was no statistically significant association between the demographic characteristics and adherence to the bundle. There was a weak correlation between the reported and observed bundle utilization [r = 0.043; 95% CI 0.16 – 0.24; P = 0.678]. Conclusion Nurses working at Kenyatta National Hospital’s critical care units utilized and adhered to the bundle. There was a weak correlation between the observed and reported bundle utilization. The nurses faced various challenges that hindered their practice on bundle utilization and adherence. The challenges which hindered utilization and adherence to the bundle were resources, resistance to change, lack of audits, continuing medical education and standardized way of practice that is standard operating procedures, checklist. It is therefore recommended that there be continuing medical education on the bundle within the units, formulation of standard operating procedures and checklist, clinical audits and reaudits and the nurses be provided with enough resources. Further research is needed on other aspects of the bundle and in different settings, the culture preventing transfer of knowledge into practice by the nurses and challenges.