Nursing management in the control of urinary tract infection (UTI) in institutionalized elderly with long-term catheterization

Abstract

The aim of this prospective descriptive observational study was to describe the nursing management of long-term urinary indwelling catheters of qualified nurses caring for elderly male persons in a local general public residential home. Urinary tract infection (UTI) is a common recurrent problem among people with long-term indwelling catheters (Wilde 2003). Conversely, nurses seem to underestimate the importance of best practice as regards to urinary catheter management. This is highlighted by the estimated increase in number of affected patients due to potential risk factors per year (Linsday 1999, Lindsay 2000). This study attempted to describe the local situation, where nurses' management was addressed. Additionally, the ward environment was also assessed for factors that may enhance or inhibit optimum practice. A convenience sample of ten elderly and ten nurses consented to participate in this study. All the qualified nurses were of different age groups, educational background and clinical experience. Each nurse was observed while caring for an individualized elderly for six hours during the morning. This time was the most appropriate one as nursing care is more intense and more clinical practice is carried out. Hence a total of 60 hours of observational data was collected by non-participant method in which several practices and techniques were expected to be carried out. However, only 4 urinary catheter insertions were actually performed yet, all 4 particular nurses missed out the proper aseptic technique. Moreover, even when carrying out other nursing skills, involved with long-term indwelling catheters' management, nurses seemed to perform the techniques poorly by missing out some aspects of infection control. In addition, cross contamination occurred by various methods such as using the same pair of gloves when adopting task allocation system. Findings suggest the need for periodic in-service training, stressing the correct techniques and potential complications of urinary catheterization. Furthermore, policies and procedures which outline the technical requirements of infection control as regards to indwelling catheters are to be more adhered to and facilities such as alcohol hand rub dispensers should be made more available in strategic places throughout the wards.