Catheter-associated urinary tract infection (CAUTI) prevention and nurses’ checklist documentation of their indwelling catheter management practices

Abstract
The purpose of this study was to investigate through an audit, nurses’ catheter management practices as documented in a newly introduced self-administered indwelling catheter management checklist that incorporated four components of catheter care in a catheter-associated urinary tract infection (CAUTI) prevention bundle. The components of the bundle of care are: minimising inappropriate catheter use, aseptic insertion of catheters, catheter maintenance based on guidelines, and ongoing review and evaluation of catheter necessity. Implementation of these care components significantly decreased bacteriuria rates and CAUTI when put together in standardised clinical checklists and performed collectively by nurses. A quantitative research design, as part of a mixed methods research that investigated the impact of a CAUTI education package on nurses’ knowledge and indwelling catheter management practices, was used for this study. The study was conducted at two surgical wards in a public hospital in Auckland. Fifty nurses completed 175 checklists.  Thirty-one percent (n=54) showed that all evidence based practices in the bundle of care were performed and documented by the nurses. The remaining checklists indicated that nurses did not perform some components of the bundle of care for unknown reasons. The findings were of sub-optimal performance of evidence-based catheter management practices by nurses. Whether this is a reflection of poor documentation or poor practice is not known. Catheter management practices impact on CAUTI prevention efforts when performed consistently as a bundle of care across all four components outlined in the checklist. Recommendations from this research include regular in-service education, complete and accurate documentation of care using the catheter maintenance checklist, regular audit of checklist use, and further research with a larger sample size.

Ngā ariā matua
Te whāinga matua ia o tēnei rangahau he tūhura, mā tētahi arotake, i ngā ritenga hakahaere rerenga wahi a ngā tapuhi kua tuhia ki tētahi rarangi whakamahara whakahaere rerenga wai noho tūmau, mā te tapuhi e āta tirotiro, kātahi anō ka whakaputaina ki te ao mahi, kei roto nei ētahi wehenga e whā o te tiaki rerenga wai i roto i tētahi pōkai ārai pokenga ia tōnga imi i takea mai i te rerenga wai. Ko ngā āhuatanga o roto i te pōkai taurimatanga he: whakaheke rawa i te whakamahi hē i te rerenga wai, te whakauru para-kore i te rerengawai ki roto i te tinana, te tiaki pai i te rerenga wai kia hāngai tonu ki ngā aratohu me te arotake pūputu i ngā rerenga wai me te tika o ngā pūtake i whakamahia ai.  Nā te whakatinanatanga o ēnei āhuatanga taurima I whakaheke te putanga o ngā pokenga mimi me te CAUTI ina kawea ngātahitia i roto i ngā rārangi whakamahara taurima tūroro, ina kawea tahitia hoki e ngā tapuhi. I whakamahia he hoahoa rangahau tatau, hei wāhi hoki o tētahi rangahau tikanga hanumi i tūhuratia ai te pānga o tētahi mōkihi mātauranga CAUTI mō te mātauranga o ngā tapuhi me ngā ritenga whakahaere rerenga wai noho tūmau, mō tēnei tirohanga. I kawea te rangahau nei i ētahi wāhanga tūroro hāparapara i tētahi hōhipera tūmatanui i Tāmakimakaurau. E rima tekau ngā tapuhi nāna i whakaoti i ngā rārangi whakamahara 175. Toru tekau mā tahi (n=54) ōrau i whakaahua ko ngā ritenga mahi i taunakitia i te pōkai taurimatanga i āta kawea, I āta tuhia hoki e ngā tapuhi. I te nuinga atu o nga rārangi whakamahara i kitea kāore ētahi o ngā tapuhi i mahi I ētahi o ngā wae o te pōkai taurimatanga, tē mōhiotia hoki te take.E ai ki ngā kitenga kāore i eke ki ngā taumata e tika ana ngā ritenga whakahaere rerenga wai i tautokona e ngā taunakitanga, o ngā tapuhi. Kāore i te mōhiotia mehemea he hua tēnei o te tuhinga ngoikore, kua hē rānei ngā whakahaere. Ka pā ngā ritenga whakahaere rerenga wai ki ngā mahi ārai CAUTI ina kawea ōritetia hei pōkai taurimatanga, puta noa i ngā wae e whā e puta ana i te rarangi whakamahara. Ko ētahi o ngā tohutohu mai i tēnei rangahau ko te akoranga pūputu i roto i te wāhi mahi, te āta tuhi i te katoa o ngā taurimatanga kia tika mā te whakamahi i te rārangi whakamahara mō te tiaki rerenga wai, te arotake pūputu i te whakamahinga rārangi whakamahara, me te hiahia kia haere tonu ngā rangahau me tētahi haonga tirohanga rahi kē atu.

Keywords / Ngā kupu matua
catheter-associated urinary tract infection / pokenga ia tōnga mimi i takea mai i te ngongo rerenga wai; infection prevention / te ārai pokenga; checklist /rārangi whakamahara; documentation / tuhinga; indwelling catheter management / whakahaere rerenga wai noho tūmau; bundle of care/ te pōkai taurimatanga