The Impact of Guidelines on Sterility Precautions During Indwelling Urethral Catheterization at Two Acute-Care Hospitals in Sweden - A Descriptive Survey
Abstract Background: To support a uniform and evidence-based practice for indwelling urinary catheterization in adults The European association of Urology Nurses (EAUN) published guidelines for this procedure in 2012. The Swedish national guidelines are based on the sterility precautions advocated by EAUN. Nevertheless, some hospitals have local guidelines with other requirements concerning sterility and leave to staff to decide what equipment to use and how to perform the catheterization. The aim of this study was to investigate the nurses´ self-reported sterility precautions during indwelling urethral catheterization at two acute-care hospitals, where the local guidelines differ in their sterility requirements. The study also aimed to analyse factors affecting the participants´ conformity with sterility precautions recommended in the EAUN-guidelines. Methods: A structured questionnaire with questions concerning the participant, working conditions and performance of indwelling urethral catheterization was left to 931 nurses in two acute care hospitals. Chi-square test, Fisher´s exact test and Mann-Whitney U-test were used for descriptive statistics. Logistic regression was used to analyse variables associated with practicing the sterility precautions as recommended in the EAUN-guidelines.Results: Answers were obtained from 852 persons (91.5 %). A majority of the participants called their insertion technique “non-sterile”. Regardless of what the insertion technique was called, the participants said that the IUC should be kept sterile during procedure. In spite of that not everyone used necessary sterile equipment to maintain the sterility of the catheter. The nurses´ conformity with all the sterility precautions as advocated in the EAUN-guidelines were associated with working at departments for surgery and cardiology (OR 2.50, CI 1.78-3.49) and years in profession (OR 1.54, CI 1.03-2.30). It was also associated with use of sterile set for catheterization (OR 2.03, CI 1.40-2.94), use of sterile drapes for dressing of the insertion area (OR 1.94, CI 1.25-3.00) and using the term “sterile technique” for indwelling urethral catheterization (OR 1.67, CI 1.13-2.47). Conclusions: To achieve a uniform practice in aseptic urethral catheterization national and local hospital guidelines should advocate same sterility precautions. Evidence-based guidelines should describe how sterility precautions are accomplished and should be implemented in healthcare-settings.