Catheter Care Research Articles

Adherence to evidence-based guidelines for indwelling urinary catheter management: A cross-sectional study

BackgroundUrinary tract infections from indwelling urinary catheters are amongst the most common healthcare acquired infection. Correct adherence to evidence-based guidelines has been shown to reduce these infections. There is limited Australian data on adherence to these guidelines. AimTo examine the prevalence of use of indwelling urinary catheters and identify the rate of adherence to evidence-based guidelines. MethodsA cross-sectional study design using an audit tool was conducted at a major metropolitan teaching hospital (>600 beds) over 2-days in May 2019 in Western Australia. FindingsPrevalence of use of indwelling urinary catheters (n = 67 of 522 patients, 12.8%) was low. There was good compliance with observed catheter care apart from securement of the catheter. There was poor compliance with documenting the planned date for catheter removal and daily perineal/penile hygiene (2.9%–18.6%). DiscussionThe observed care was generally compliant apart from securement. We attributed this to the possible lack of securement devices available on the general wards. Documentation was poorly completed at our centre and commonly reported in the literature. The introduction of prompting documentation using stickers may be useful in overcoming this shortfall in compliance. ConclusionThis audit will allow us to target areas for improvement in catheter care and ensuring accurate and complete documentation. More research is needed in obtaining information around the evidence-based guidelines and relationship to clinical development of catheter associated urinary tract infection.

Assessment of Knowledge, Attitude and Practice on Prevention of Catheter-associated Urinary Tract Infection (CAUTI) among Health Care Professionals Working in a Tertiary Care Teaching Hospital

Catheter-associated Urinary Tract Infection (CAUTI) is a common healthcare-related infection occurring in patients admitted for various ailments. Approximately 80% of hospital acquired Urinary Tract Infections (UTIs) are catheter associated. The purpose of the current research was to find out the level of knowledge, attitude and practice on prevention of CAUTI among healthcare professionals working in tertiary care hospital. A descriptive study was done among 95 health care working in tertiary care hospital in Chennai. The researchers administered standard questionnaire and statistically explored the knowledge, attitude, and practice levels about prevention of CAUTI among the participants. Among 95 participants, 28.4% and 71.6% of the individuals had moderately adequate knowledge and adequate knowledge about CAUTI. About 4.2% of the participants had unfavourable, 88.4% had moderately favourable and 7.4% had favourable attitude towards prevention of CAUTI. About 4.2% of the individuals had moderately adequate and 95.8% had adequate practice towards the prevention of CAUTI. There was significant correlation between attitude and practice. The professional experience of the participants showed statistically significant association with the level of practice among the demographic variables. In our present study, we found out that health care professionals had adequate knowledge, attitude, and practice on prevention of CAUTI. Medical education programs, frequent auditing with a checklist about catheter care must be conducted to maintain the achieved knowledge and practice levels.

Preventing Hospital-Acquired Pressure Injuries by Using a Tiered Protocol in Children Receiving ECMO in the Pediatric Intensive Care Unit.

Preventing Hospital-Acquired Pressure Injuries by Using a Tiered Protocol in Children Receiving ECMO in the Pediatric Intensive Care Unit.

Obesity and risk of catheter-related infections in the ICU. A post hoc analysis of four large randomized controlled trials.

Obesity increases the risk of nosocomial infection, but data regarding the role of body mass index (BMI) in catheter related infections are scarce. We used the data gathered from four randomized, controlled trials (RCTs) to investigate the association between body mass index (BMI) and intravascular catheter infections in critically ill obese patients. Adult obese patients who required short-term central venous, arterial or dialysis catheter insertion in the intensive care unit (ICU) were analyzed. The association between BMI and major catheter-related infection (MCRI), catheter-related bloodstream infection (CRBSI) and catheter tip colonization was estimated using univariate and multivariate marginal Cox models. Exploratory analysis using dressing disruptions was added. A total of 2282 obese patients and 4275 catheters from 32 centers were included in this post-hoc analysis. Overall, 66 (1.5%) MCRI, 43 (1%) CRBSI and 399 (9.3%) catheter colonizations were identified. The hazard ratio (HR) for MCRI, CRBSI and colonization increased with BMI. After adjustment for well-known infection risk factors, the BMI ≥ 40 group had an increased risk for MCRI (HR 1.88, 95% CI 1.13-3.12, p = 0.015), CRBSI (HR 2.19, 95% CI 1.19-4.04, p = 0.012) and colonization (HR 1.44, 95% CI 1.12-1.84, p = 0.0038) compared to the BMI < 40 group. The mean dressing disruption per catheter was increased in the BMI ≥ 40 group (2.03 versus 1.68 in the BMI < 40 group, p = 0.05). Using the largest dataset ever collected from large multicentric RCTs, we showed that patients with BMI ≥ 40 had an increased risk for intravascular catheter infections. Targeted prevention measures should focus on this population with a particular attention to catheter care and dressing disruption.

Urinary Catheter Care Approach for Urinary Tract Infection among Nurses in Tertiary Care Hospital

Urinary tract infections (UTIs) are the most common infection in hospital setting, the period of hospital-derived waste that affects individuals today. A significant number of seventy-five percent of urinary tract infections acquired in the hospital are associated with the use of a permanent bladder catheter (IDC), considering that there are about 15-25% chance of an inpatient requiring catheter insertion during your stay [1].

Comparing catheter related bloodstream infection rate between cuffed tunnelled and non-cuffed tunnelled peripherally inserted central catheter.

To compare catheter related blood stream infection (CRBSI) rate between cuffed tunnelled and non-cuffed tunnelled PICC. We prospectively followed 100 patients (50:50 cuffed and non-cuffed PICC) and compared CRBSI rate between these groups. Daily review and similar catheter care were performed until a PICC-related complication, completion of therapy, death or defined end-of-study date necessitate removal. CRBSI was confirmed in each case by demonstrating concordance between isolates colonizing the PICC at the time of infection and from peripheral blood cultures. A total of 50 cuffed PICC were placed for 1864 catheter-days. Of these, 12 patients (24%) developed infection, for which 5 patients (10%) had a CRBSI for a rate of 2.7 per 1000 catheter-days. Another 50 tunnelled non-cuffed PICCs were placed for 2057 catheter-days. Of these, 7 patients (14%) developed infection, for which 3 patients (6%) had a CRBSI. for a rate of 1.5 per 1000 catheter-days. The mean time to development of infection is 24 days in cuffed and 19 days in non-cuffed groups. The mean duration of utilization was significantly longer in non-cuffed than in cuffed group (43 days in non-cuffed vs 37 days in cuffed group, p = 0.008). Cuffed PICC does not further reduce the rate of local or bloodstream infection. Tunnelled non-cuffed PICC is shown to be as effective if not better at reducing risk of CRBSI and providing longer catheter dwell time compared to cuffed PICC.

Effects of a mobile phone application for graduate nurses to improve central venous catheter care: A randomized controlled trial.

To develop and test a mobile phone application (app) for graduate nurses on the use and care of central venous catheters. A randomized controlled trial was conducted at a teaching hospital in the central east coast of Taiwan. Recruitment occurred from 1 August 2019 -31 October 2019. All graduates (N=90) attending a 2-week induction program attended a lecture and completed a 10-item questionnaire on central venous catheter assessment and care at the end of Week 1 (Time 1). Volunteers were then randomly allocated to receive a link to the learning app on their mobile phone (n=39 Group A) or control condition (N=40 Group B). One week later, all graduates completed the knowledge assessment (Time 2) and a simulated clinical assessment with a mannequin. Skills were assessed using an 11-item, direct observation of procedural skills form. Only data from consenting participants were analysed. Compared with controls, nurses receiving the intervention reported significantly better knowledge (t=-7.98, p<.001, CI=20.9~34.8) and skill scores (t=2.83, p=.006, CI=1.14~6.61). More frequent use of the mobile phone app was associated with higher knowledge (r=0.39, p=.02, CI=0.11~0.99) and skills (r=0.42, p=.008, CI=0.17~1.03). Mobile app instruction for graduate nurses on central venous catheter care increased specific knowledge and skills compared with conventional methods of instruction. Implementation of mobile phone application technology can be considered a feasible means to proactively provide training and education. Mobile phone apps could be developed for a range of clinical procedures and various settings. Future studies with a larger sample and a longitudinal follow-up are warranted to confirm results.

Hindrances of peripherally inserted central catheter care of leukemia patients: a qualitative study.

A peripherally inserted central catheter (PICC) needs regular care. However, clinical observations found that some discharged leukemia patients in mainland China had not complied with the requirement of regular care. Our study aims to explore the facilitators and hindrances of regular cares of PICC in leukemia patients with the Colaizzi phenomenon analysis. This qualitative report used the descriptive phenomenological method to collect information and was conducted in accordance with the COREQ checklist. By purposive sampling, 11 leukemia patients with PICC were selected and interviewed in the Department of Hematology of a first-class hospital in Wuhan (central China). The interviews were conducted from March 2016 to May 2017. Two facilitators for PICC care were extracted through interviews, including fear of nosocomial infection and convenience for treatment. Eleven hindrances were summarized, including high costs, unavailability of local services, worries about affecting family members, a lack of health awareness, inconvenient transportations, fluke minds, physical discomfort, fears of leukemia and chemotherapy, short chemotherapy intervals, damage to appearance, and no insurance coverage of costs. Leukemia patients' compliance with PICC care was hindered by several factors. The improvement of PICC care may need joint efforts of patients, nursing professionals, hospitals' managerial staff, and governments.

A review of peripherally inserted central catheters and various types of vascular access in very small children and pediatric patients and their potential complications

Accessing the veins for blood delivery, sampling or nutrition is a critical factor in the process of care and management of pediatric patients. In this regard, the peripherally inserted central catheter (PICC) is one of the main alternatives which could be applied effectively as traditional central venous devices in neonates and adults. Due to their essential role in providing safe central venous entry, PICCs could be applied extensively in patients who are critically ill. The main aims of the present study are to review approximately all relevant publications concerning PICC procedures, any possible complications, and the most appropriate decision for preventing these complications due to their high mortality rate. We carried out a comprehensive search on PubMed, HubMed, EMBASE, MEDLINE, Science Direct, Scopus, MEDLINE, and EMBASE databases for identifying the most relevant publications related to potential complications following the application and insertion of PICCs in hospitalized children and infants. Through appropriate care of catheters, the rate of possible infectious, mechanical and thrombotic complications would decrease considerably compared to those patients who received traditional central venous catheters. However, the process of vascular access in neonatal and children is very challenging. Any delay or denying treatment due to the lack of vascular access is intolerable. In this regard, anesthesiologists must achieve extra knowledge of various vascular devices.

Systematic development of an mHealth app to prevent healthcare-associated infections by involving patients: ‘Participatient’

IntroductionIn hospital care, urinary catheters are frequently used, causing a substantial risk for catheter-associated urinary tract infections (CAUTI). Patient awareness and evaluation of appropriateness of their catheter through mHealth could decrease these healthcare-associated infections. However, patient engagement via mHealth in infection prevention is still limited. Therefore, we describe the systematic development and usability evaluation of the mHealth intervention Participatient, to prevent CAUTI, aiming for optimal adoption of the app in the clinical setting. MethodThe CeHRes roadmap was used as development guideline, operationalizing phases for (1) contextual inquiry (observations and interviews), (2) value specification (interviews with probing) and (3) design in multiple steps and in co-creation with end-users. During phases 1 and 2, semi-structured interviews were conducted with fifteen patients and three nurses. The design phase was combined with the minimum viable product development strategy, with a focus on early cyclic steps of prototyping. ResultsIn phase 1, patients acknowledged the risks of catheter use. Patients in phase 2 valued endorsement of a mHealth application by healthcare workers and reported to own a smartphone. Both patients and nurses recognized the need for useful modules in the app besides catheter care. Based on the needs and values as found in phase 2, the Participation app was developed. Based on usability tests in phase 3, content, text size, plain language, and navigation structures were further amended, and images were added. ConclusionThis study provides real-world insight in the developmental strategy for mHealth interventions by involving both patients and care providers. Development of an app using thorough needs-assessment provided understanding for its content and design. By developing an app providing patients with reliable information and daily checklists, we aim to provide a tailored tool for communication and awareness on catheter use for the whole ward, and a potential blueprint for mHealth development.

Nursing assistance in patient care with external ventricular drain: a scoping review.

to map the available evidence about nursing care aimed at adult patients using external ventricular drain. this is a review using the scoping review method. Initially, 965 studies were identified and, after the eligibility criteria, a sample of 54 publications was obtained. Each of them was assessed according to GRADE, resulting in three studies with high quality; 14 with moderate quality; 32 with low quality; and five with very low quality. It was highlighted 20 nursing care subdivided into nine categories, namely: drainage system; bed positioning and mobilization; catheter care; monitoring of intracranial pressure; and medication administration. the scoping review made it possible to identify the main nursing care directed to adult patients undergoing placement of external ventricular drain from the evidence available to date.

Reduction of Tunnelled Haemodialysis Catheters Related Infections by Intervention and Training: A 12 and 18-month Audit

Introduction: Catheter-Related Blood Stream Infections (CRBSI) are an important complication of both non tunnelled and tunnelled haemodialysis catheters, but are often poorly reported for tunnelled haemodialysis-catheters. Aim: To assess the rate, aetiology, and outcomes of CRBSI in patients using a tunnelled catheter at 12-month and 18-month audits at the newly-opened haemodialysis unit having care bundle as a part of routine catheter care. Materials and Methods: A retrospective cross-sectional study involving two audits of CRBSI risk (12-month and 18-month audit) was conducted by the dialysis unit doctors and nursing staff at Medanta Super-Specialty Private Hospital, Indore, Madhya Pradesh, India. Centres for Disease Control (CDC) and prevention core intervention/care bundle for Blood Stream Infections (BSI) reduction were incorporated as a part of routine catheter care. The 12-month (May 2018 to April 2019) and 18-month (May 2018 to November 2019) internal clinical audit were evaluated to assess the impact of care bundle on incidence of CRBSIs. Kidney-Disease- Outcome Quality-Initiative (KDOQI)-2006-criteria was used to define CRBSI. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 19.0 software (IBM Corporation, New York, United States). Descriptive and dispersion statistical analysis was done for studied variables. Results: Total patients in 12-months audit with tunnelled haemodialysis catheter were 14 (7 male and 7 female) with median age 64 years and in 18-months audit patient with tunnelled haemodialysis catheter were 18 (11 male and 7 female) with median age 67.5 years. CRBSI incidence was 2.58 per 1000 catheter days at the end of 12-month, with 132 (71.25-202.25) days of median catheter use. Over the 18-month, the incidence of CRBSI dropped to 1.99 per 1000 catheter days. Median period of catheter use increased to 149.5 (83.5-294.5) days. The primary organisms isolated were predominantly gram negative bacterias. Conclusion: Tunnelled catheters may be a reasonable alternative vascular access for haemodialysis in patients with arteriovenous fistula failure as implementation and maintenance of multidisciplinary care bundle reduces CRBSI rate in such patients.

Knowledge of Nurses toward Prevention for Catheter-Associated Urinary Tract Infection in Public Hospitals at Amran City, Yemen

Background of the study: Catheter-associated urinary tract infection (CAUTI) is the most prevalent healthcare-associated infection worldwide, according to reports. Nurses are also accountable to acquire appropriate knowledge and practices of catheter care that will prevent UTI. Nurses’ knowledge is seen to be one of the most important factors in their practice. Aim of the study: To assess the nurse’s knowledge toward the prevention of catheter-associated urinary tract infection in public hospitals at Amran City. Methods: A descriptive cross-sectional study was conducted among nurses at public hospitals in Amran City, Yemen. A convenience sampling technique was of the study consisted of 93 nurses from different public hospitals that were participated in this study. Self-administered questionnaire was used to collect data from March 2021 to April 2021. Results: The distribution of nurses’ ware female 65.6%, belonged to age group between (25 to <30 years) 43.0%. The Diploma degree was the most available qualification 88.2%, 81.7% between 1 - 5 years’ experience as nurses. Knowledge regarding prevention of catheter-associated urinary tract infection was fair 72%, while 18.3% had a good. There is a significant statistical difference between knowledge level regarding prevention of CAUTI, and sex (P-value = 0.042). Conclusion: Most of nurses had fair knowledge level regarding prevention of catheter-associated urinary tract infection. Recommendations: We recommended increasing the knowledge of nursing staff through the courses training, workshop, and curriculums.

Hospital readmission in stroke survivors one year versus three years after discharge from inpatient rehabilitation: Prevalence and associations in an Asian cohort.

ObjectiveTo examine the prevalence and risk factors for readmission after inpatient rehabilitation in stroke survivors, in a developed multi-ethnic Southeast Asian country.MethodsA retrospective cohort study of 1,235 stroke survivors who completed inpatient rehabilitation in a tertiary rehabilitation centre.ResultsA total of 296 (24.0%) patients with stroke were readmitted within the first year, and 87 (7.0%) patients were readmitted 1–3 years after stroke. Significant risk factors for readmission of patients in the first year post-stroke were older age (p = 0.027), lower admission Functional Independence Measure (FIM) motor (p = 0.001) and cognition scores (p = 0.025), a Charlson Comorbidity Index (CCI) ≥1 (p < 0.001) and the presence of at least one medical complication during initial hospitalization (p < 0.001), while FIM gain was found to be protective (p < 0.001). Looking at readmission after 1 year post-stroke, a CCI ≥1 (p < 0.001) and the presence of medical complications during initial hospitalization (p < 0.001) were risk factors for readmission, while FIM gain (p = 0.001) was protective. Common causes for readmission include recurrent stroke and falls.ConclusionThere is a high readmission rate in stroke survivors, even after the first year post-stroke. Interventions, such as fall risk assessments, vaccinations, meticulous catheter care, intensified secondary risk factors interventions and continued post-discharge rehabilitation, may hold promise for reducing readmission rates.LAY ABSTRACTReadmission of stroke patients results in high morbidity and healthcare costs. Although many studies have examined readmission of stroke survivors in the first year post-stroke, there is a scarcity of studies into readmission after the first year post-stroke, and the effect of rehabilitation on these patients. This study investigated 1,235 patients 3 years post-stroke rehabilitation. Of these patients, 296 (24.0%) were readmitted within the first year, and 87 (7.0%) were readmitted 1–3 years post-stroke. Significant risk factors for readmission included older age, lower functional scores on admission, presence of chronic medical conditions and medical complications during their initial hospital stay. However, functional improvement during inpatient rehabilitation was associated with a reduced readmission rate. This study demonstrates that there is a high readmission rate even after the first year post-stroke. It also highlights the importance of rehabilitation in reducing readmission in stroke survivors.

Microbiological profile, comorbidity, incidence and rate analysis of catheter associated urinary tract infections in adult intensive care

Introduction: Catheter-associated urinary tract infections (CAUTI) being the commonest hospital-acquired infection (HAI) [40%], its burden, aetiology along with antibiotic susceptibility is essential to implement and monitor an effective infection control program. Aims: To assess the incidence and rate of CAUTI in a tertiary care hospital and to identify the common organisms and their antibiotic sensitivity pattern. Settings and Design: Prospective hospital based observational study was carried out in a tertiary care hospital in South Tamilnadu for a period of 2 months (June 2016 to July 2016) after obtaining the Institutional Ethics committee approval. Materials and Methods: Total of 100 catheterized adult ICU patients were observed for signs of UTI on a daily basis. On clinical suspicion of UTI, urine sample was analysed microbiologically. CAUTI among various gender and age groups; pathogenic isolates, antibiotic sensitivity pattern and associated co-morbid conditions were expressed as percentages Results: Incidence of CAUTI was 16/100 catheterization. Device utilization ratio was 0.72. CAUTI rate was 36.2/1000 catheter days. CAUTI was commonly seen among patients with >80 years, females with altered sensorium. Diabetes mellitus (35.7%) was the most common comorbid condition followed by TB (25%). Risk of CAUTI after 3-5 days of catheterization was 11.7% and proportionately increased with prolonged catheterization (100% if >20 days). Escherichia coli (37.5%) followed by Candida Spp. (25%) were common pathogens among 3-5days of catheterization. Pseudomonas Spp. was the commonest isolate after one week of catheterization. Imipenem, colistin resistance was highest among pseudomonas. Conclusions: CAUTI rate was higher than the benchmark set by NHSN (0-4). Appropriate health education, strict infection control practices, appropriate antibiotic policy, proper guided bundle care of catheter are need of the hour to prevent the CAUTI. Keywords: Adult ICU, CAUTI, Comorbid

Prevention of catheter associated urinary tract infections: Assessment of knowledge and practices among nurses in a tertiary care centre in Nigeria

Background: Catheter-associated urinary tract infections (CAUTI) are responsible for up to 80% of healthcare associated infections. Recommended strategies to prevent CAUTI are based on implementation of a ‘care bundle’. Nurses are responsible for catheter care, yet few studies have been conducted in developing countries to assess their understanding of CAUTI and the care bundle. The study aimed to assess the knowledge and practices toward prevention of CAUTI among nurses. Methods and materials: A cross-sectional study was carried out in a tertiary hospital in Edo state, Nigeria between January and July 2019 among 200 consenting nurses recruited through a systematic sampling process. Data was collected using pretested questionnaires. A checklist was used for observation of patients with an indwelling catheter to assess compliance with CAUTI maintenance bundle. Analysis was done using the Statistical package for social sciences. Ethical approval was obtained. Results: One hundred and eighty nurses completed the study giving a response rate of 90%. Majority, 138 (76.7%) had fair knowledge of CAUTI and its prevention, 42 (23.3%) had poor knowledge. Gaps in knowledge were observed in the areas of appropriate indications for urinary catheterization, catheter care including removal, and risk factors for CAUTI. One hundred and forty-nine (82,8%) respondents had positive attitude although slightly above half erroneously believed that catheter removal should be at the convenience of nurses. Neither knowledge nor attitude was associated with any demographic characteristic. One hundred and three (71.0%) respondents had good practice and 42 (29.0%) poor practice of the CAUTI bundle. Practice was not associated with any demographic variable, but significantly associated with knowledge (χ2 8.62, df = 1, p < 0.001). One hundred and fifty-eight (87.8%) respondents had received training on catheter care as part of their nursing education, however there was no association between previous training and knowledge or practice of CAUTI prevention. Findings from the check list showed meatal hygiene not performed daily (23.8%) and urine bag and tubing on the floor (38.1%). Conclusion: There is an urgent need for education intervention to improve the knowledge and practices of CAUTI prevention bundle among nurses in the study area.

Zero bloodstream infection in medical wards: Achievable?

Background: Nosocomial bloodstream infection (BSI) was a significant problem at medical wards Hospital Sungai Buloh, majority of which were central-line associated BSI (CLABSI). Central venous catheter (CVC) care was suboptimal. Although CLABSI prevention program in ICU is proven to be effective, it is less well studied in non-ICU settings. Hence, we embarked a project to achieve zero BSI in three busy medical wards at Hospital Sungai Buloh, a tertiary hospital. Methods and materials: A multimodal CLABSI risk reduction strategy was employed, using the 4 ‘E’ approach (Engage, Educate, Execute, Evaluate). The medical wards’ matrons, sisters and infection control link nurse (ICLN) were engaged to “champion” the BSI reduction program. Education was given to doctors and nurses, focusing on three key behaviours, which were: (1) insert CVC only when indicated; (2) take care of CVC properly; (3) remove CVC as soon as not needed. In addition, education sessions with ICLN were held to ensure they could identify BSI cases correctly based on CDC definitions. Education posters and visual cues were placed at strategic locations. CVC care bundle form was implemented. Prospective surveillance, which consist of monitoring process measure (compliance to CVC care bundle) and outcome measure (BSI rate), was done. These results were then feedback to the stakeholders on monthly basis. The study was divided into pre-intervention (January–May 2019), intervention (June and July 2019), and post-intervention periods (August and September 2019). Results: During the pre-intervention period, the rates of nosocomial BSI and CLABSI were average to be 6.4 cases/month and 3.4 cases/month respectively. During intervention period, the average rates were 8 cases/month and 4.5 cases/month respectively. After intervention, both rates reduced significantly to average 1 case/month (87.5% reduction in nosocomial BSI, and 77.8% reduction in CLABSI). In fact, we achieved zero CLABSI in August 2019. This corresponded with improved CVC care compliance from average 46% during intervention period to 83% compliance rate post-intervention. Conclusion: Zero BSI, even in non-ICU settings, is achievable via multimodal strategy. Currently, we are continuing our program to ensure sustainability in reduction of BSI rates.

Optimizing the Catheter Care and Maintenance Strategy of Short-Term Catheterization among Hospitalized Patients in Microbiological Approach.

Objective To optimize the allocation of nursing resources, we investigate an alternative strategy for indwelling catheter cleaning. Methods The present study involved a total of 117 male patients and 54 female patients, who were catheterized after urinary surgery from Aug 2018 to Feb 2019. The samples of indwelling catheter cleaning solutions were divided by two parts for microbiological culture and microbiome analysis. Results No pathogenic bacteria were observed in the microbiological culture of the indwelling catheter cleaning samples from 24 h-uncleaned group and 48 h-uncleaned group. The microbiome analysis also showed no significant difference in bacterial diversity and quantity of the indwelling catheter cleaning solutions between the two groups. Conclusion The indwelling catheter cleaning for male after urinary surgery can be prolonged to 48 h. The result of this study provided reliable basis for optimizing the allocation of clinical nursing resources.

Improving Peripheral Intravenous Catheter Care for Children with Cancer Receiving Chemotherapy in Malawi

PurposeTo change pediatric oncology nursing management of peripheral intravenous catheter (PIVC) insertion and care based on current best evidence. Design and methodsPractice change strategies were developed, and nurses completed education on proper PIVC insertion, dressing placement, and ongoing PIVC assessment with emphasis on preventing chemotherapy extravasation. Nurses also completed a chemotherapy course as part of their orientation program. The plan for PIVC practice change was based on evidence from published research and established PIVC care guidelines. Pre-assessment data revealed numerous PIVC attempts and a high incidence of extravasation (42%) in children with cancer receiving treatment in Malawi. ResultsPost-assessment data nine months later resulted in a reduced extravasation rate from 42% to 4% using point prevalence assessments. PIVC insertion attempts reduced following education and guideline implementation; 81% of children required more than 3 PIVC insertion attempts before the practice change. Only 1% of PIVC insertions required more than 3 attempts after education and practice change implementation. Nurses completed a 32-item written examination before the chemotherapy course; the mean score was 50/100. Upon completion of the chemotherapy course, nurses obtained a mean score of 97/100 on the written examination. ConclusionsUsing an organized approach to nursing practice change improved PIVC care in children with cancer. Practice implicationsThis project provides evidence that nursing practice change strategies can be used in any setting including countries like Malawi with limited resources.

Predictors of Urinary Tract Infection after Benign Hysterectomy Performed at a Teaching County Hospital: Can We Improve Our Infection Rate

Study Objective To describe the rate of urinary tract infection (UTI) after benign hysterectomy at the county hospital and to evaluate clinical predictors of UTI at the time of discharge from the hospital. Design This is a retrospective cohort study. Patients were separated in two groups: those with and those without UTI within 30 days of their hysterectomy. Demographics, surgical procedures and outcomes were compared. Setting Teaching county hospital in Texas. Patients or Participants All patients undergoing hysterectomy for benign disease from January 2017 to December 2018. Interventions NA. Measurements and Main Results 474 patients were included in the study. Our patient population was comprised of Hispanics (70%), Obese (58.4%), diabetics (14.3%), menopausal (13.5%) and smokers (12.45%). Our minimally invasive rate was 70%. 14% of patients had an additional urogynecological procedure. Cystoscopy was used in only 49.2% of cases. 18.7% of patients were discharged the same day. 5% of patients were sent home with an indwelling catheter. The rate of UTI was 11.4% (54 patients). On univariate analysis, patients with UTI were more likely to be Hispanic, undergo a vaginal approach compared to a laparoscopic or abdominal route, undergo a concomitant urogynecological procedure, have a Foley catheter for longer than 24 hours and be sent home with an indwelling catheter (all p On multivariate regression and after adjusting for all significant variables, prolonged catheterization was the only significant predictor for UTI in our cohort, (14.8% versus 12.1%, OR=2.86(1.04-7.3), p=0.03). Conclusion Our UTI rate after benign hysterectomy is high and appears to be driven by the rate of prolonged catheterization. Improved patients education related to catheter care and possibly prophylactic antibiotics may be helpful in improving this rate and could be performed as a quality improvement project.