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RAJIV GANDHI UNIVERSITY OF HEALTH
SCIENCES, BANGALORE-KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS
FOR DISSERTATION
1.
NAME OF THE
CANDIDATE
AND ADDRESS
Mr.LALIT KUMAR SHARMA
1st YEAR M.Sc (NURSING)
ADHARSHA COLLEGE OF NURSING,
BANGALORE- 43, KARNATAKA
2
3.
4.
NAME OF THE
INSTITUTION
ADHARSHA COLLEGE OF NURSING.
COURSE OF
THE STUDY
AND SUBJECT
1ST YEAR M.Sc(NURSING)
BANGALORE.
MEDICAL & SURGICAL NURSING
DATE OF
ADMISSION
5.
TITLE OF THE
“A study to evaluate the effectiveness of planned
TOPIC
teaching programme regarding prevention of
urinary tract infection in client with indwelling
catheter on knowledge on practice among staff
nurses working in selected hospitals, Bangalore.”
6. BRIEF RESUME OF THE INTENDED WORK:
INTRODUCTION
Indwelling catheter is a Foley catheter. A Foley catheter has a balloon
attachment at one end. After the Foley catheter is inserted, the balloon is
filled with sterile water. The filled balloon prevents the catheter from
leaving the bladder.1
The renal system consists of all the organs involved in the formation
and release of urine. It includes the kidneys, ureters, bladder and urethra.
The kidneys are bean-shaped organs which help the body produce urine to
get rid of unwanted waste substances. When urine is formed, tubes called
ureters transport it to the urinary bladder, where it is stored and excreted via
the urethra. The kidneys are also important in controlling our blood pressure
and producing red blood cells.2
According to medical dictionary urinary tract infection is the infection
of the kidney, ureter, bladder, or urethra. Common symptoms include a
frequent urge to urinate and a painful, burning when urinating. More females
than males have UTIs.3
A urinary tract infection (UTI) is a bacterial infection that affects any
part of the urinary tract. The main etiologic agent is Escherichia coli.
Although urine contains a variety of fluids, salts, and waste products, it does
not usually have bacteria in it. When bacteria gets into the bladder or kidney
and multiply in the urine, they may cause a UTI. Bladder infections are most
common in young women with 10% of women getting an infection yearly
and 60% having an infection at some point in their life. Pyelonephritis
occurs between 18—29 times less frequently.5
INDWELLING CATHETER:
Any catheter which is inserted into the bladder and allowed to remain
in the bladder is called an indwelling catheter. A common type of indwelling
catheter is a Foley’s catheter. A Foley catheter has a balloon attachment at
one end. After the foley catheter is inserted, the balloon is filled with sterile
water. The filled balloon prevents the catheter from leaving the bladder.6
Statistics about Urinary tract infections Prevalence in types of Urinary
tract infections cystitis: 6.2 million adults self-reported having a bladder
infection for more than 3 months in the US 1988-1994 (Weighted Analysis
of 1988-1994, NHANES, NIDDK)Urinary tract infections (child): 3% of
girls and 1% of boys before age 11. 1-in-5 women lifetime.7
Prevalence statistics for urinary tract infections:
The following statistics relate to the prevalence of Urinary tract infections:

1 in 5 women will develop UTIs in their lifetime in America (Kidney
and Urology Foundation of America)

34% of adults over 20 self-reported having at least one occurrence of
a urinary tract infection in the US 1988-1994 (Weighted Analysis of
1988-1994 NHANES, 2003, NIDDK)

13.9% of adults aged 20-74 who self-reported having urinary tract
infections were men in the US 1988-1994 (Weighted Analysis of
1988-1994 NHANES, 2003, NIDDK)

53.5% of adults aged 20-74 who self-reported having urinary tract
infections were women in the US 1988-1994 (Weighted Analysis of
1988-1994 NHANES, 2003, NIDDK)
Prevention starts with the health care provider, except in special
circumstances, all urinary catheter should placed in a sterile fashion.
Insertion of non sterile catheter or using a nonsterile technique is much more
likely to result in a urinary tract infection.8
Routine care of the indwelling catheter must include daily cleansing
of the urethral area and the catheter with soap and water. Clean the area
thoroughly after all bowel movements to prevent infection. Increase the fluid
intake to 3000 cc of fluid per day. Also always keep the drainage bag lower
than the bladder to prevent a back up of urine into the bladder. Empty the
drainage device at least every 8 hours or when it is full.9
6.1 NEED FOR THE STUDY
Use of indwelling catheter is common in Intensive care unit, Urological
wards. And even medical and surgical units. Catheter associated all risk
factor, increase urinary tract infection as the duration of catheter use
increase; the estimated risk for infection is at least 5% per day of
catheterization. Among all risk factor, increased duration of catheterization
is the greatest for development of a urinary tract infection.10
Urinary tract infection account for 32% of all health care –associated
infection and are the most common nosocomial infection in intensive care
units. Urinary catheters are used routinely in ICUs, usually for frequent and
accurate monitoring of urinary output. Once inserted, catheters tend to
remain in place after appropriate indications for their use. Urinary infection
in critically ill patient are associated with increase in length of stay and
mortality.11
Use of indwelling catheter can lead to complications. Most
commonly catheter is associated with urinary tract infections. Duration of
catheterization is the major risk factor. These infections can result in sepsis,
prolonged hospitalization, additional hospital costs and mortality.12
During my clinical work and supervision of students in clinical
I
observed that the nursing staff posted in ICUs, Urological ward, surgical
ward are not aware about urinary tract infection in client with indwelling
catheter. If proper aseptic technique is maintained
during catheterization
and post catheterization nosocomial infection can be prevented. Routine
care of catheter can reduce the rate of urinary tract infection with indwelling
catheter. During my clinical supervision I had taught few nurses on
prevention of urinary tract infection in client with indwelling catheter and
the outcome was positive, so the researcher found it is necessary to assist the
effectiveness planned teaching programme on prevention of urinary tract
infection in client with indwelling catheter on knowledge on practice
among staff nurses working in selected hospitals, Banglore.13
6.2 REVIEW OF LITERATURE
According to Nancy burns ,the review of literature is a
research report and
it is a summary of current knowledge about a
particular problem and includes ,what is known and what is not known
about the problem. The literature is received to summarize knowledge for
use in practice or to provide basis for conducting a study.14
Fortis hospital Mohali (India) conducted a study on prevention of
urinary tract infection in client with indwelling catheter under the
chairmanship of Dr.Ashish Banargy and named as
THE
FORTIS
APPROACH . Practices were monitored, certain observations were made
and a team
under the stewardship sister in-charge of that ICU
constituted .Education session were held with entire
was
staff of the unit.
Changes were made in practices, and these changes were so positive.
As a result, the incidence of urinary tract infection was reduce from
ZERO for a FOUR month period. The staff was felicitated, they were
publicly rewarded and motivation level went up considerably. However
over a period of time, UTIs started again. This only emphasizes the need for
constant efforts and re-dedication to the cause of stamping out HAI.. The
ward leadership has to be motivated- they must know what has to be done,
and ensure that all staff from the nurses to be cleaning staff (including
doctors) know what their role is.15
Hinrichsen SC, Souza AS, Costa A, Amorim MM, Hinrichsen MG,
Hinrichsen SL. Of universidade de campina Grande,Paraiba,PB conducted a
study on Factors associated with bacteriuria after indwelling urethral
catheterization in gynecologic surgery . OBJECTIVES: To determine the
frequency and risk factors associated to bacteriuria after urinary
catheterization in women submitted to elective gynecological surgery.
METHODS: A cohort study was carried out among women submitted to
gynecological surgery after urinary catheterization. This study took place at
the Instituto de Medicina Integral Professor Fernando Figueira' from January
to May of 2007. Uroculture samples were collected during two periods: in
the first 24 hours and seven to ten days after catheter removal. To
demonstrate the association between risk factors and bacteriuria, the relative
risk was calculated with a confidence interval of 95%. RESULTS: This
study included 249 women. At 24 hours after catheter removal, 23.6% of the
urocultures collected were positive, while on days 7 to 10 this was reduced
to 11.1%. Of all participants studied only 2.4% had symptomatic bacteriuria.
Risk of bacteriuria at 7/10 days was reduced when the patient reported a
positive history of treatment for vulvovaginitis in the previous three months.
However this association was not found after multivariate analysis. There
was no significant association with age, education, stage of reproductive
phase, number of pregnancies and deliveries, type and duration of surgery,
type of anesthetics, use of prophylactic antibiotic, professional who
introduced the catheter and time of urinary catheterization. CONCLUSION:
Frequency of bacteriruria was 23.6% at 24 hours and 11.1% seven days after
catheter removal. There was no association between bacteriuria at 7/10 days
and any of the variables analyzed.hours and 11.1% seven days after catheter
removal. There was no association between bacteriuria at 7/10 days and any
of the variables analyzed.16
Puri J, Mishra B, Mal A, Murthy NS, Thakur A, Dogra V, Singh D.
of Department of Microbiology, G.B. Pant Hospital, New Delhi, 100002,
India conducted a study(2002) on Catheter associated urinary tract infections
in neurology and neurosurgical units. OBJECTIVE: Catheter associated
bacteriuria is the most common infection acquired in hospitals. The
objective of the study was (1) to study the incidence of bacteriuria
following indwelling urethral catheterization in patients with short-term vs
long-term catheterization (2) to define the antibiotic resistance pattern
among these isolates so that the study can provide guidelines for choosing an
effective antibiotic against infections in catheterized patients. METHODS:
This is a prospective study carried out over a period of18months in
Neurology/Neurosurgical patients who had indwelling catheters for > or
=48h.RESULTS: In this study, 68 out of 800 (8.5%) adult inpatients
acquired urinary tract infection following indwelling bladder
catheterizations.The riskwas significantly higher for female, elderly
patients,critically ill and Patients on prolonged catheterization. Among the
bacterial pathogens, Escherichia coli was the commonest organism isolated
(32.9%) followed by Pseudomonas sp.(15.1%) and Staphylococcus aureus
(12.3%). Candida sp. comprised 13.7% of all isolates. Among Gram
negative bacterial pathogensmaximum number of isolates were sensitive to
Amikacin (sensitivity of42%). All Gram positive organisms were however
sensitive to Vancomycin.A study conducted by Salamon L., Aurora St.
Luke's Medical Center, Milwaukee, WI, USA.(2009) on “Catheterassociated urinary tract Infections: a nurse-sensitive indicator in an inpatient
rehabilitation Program” the abstract is as: Urinary tract infections account
for 40% of all Hospital-acquired infections; 80%of those infections are
associated with Indwelling urethral catheters. To meet the requirement for
medical necessity, patients are being admitted to rehabilitation programs
earlier in their hospital stays than in the past. As a result, there has been an
increase in the use of urinary catheters, which prompted an evaluation of
infection rates. A collaborative project between nursing and infection control
was designed to collect baseline data on catheter-associated urinary tract
infections (CAUTI) in a non intensive care unit inpatient setting. Two
inpatient rehabilitation units within our health system participated. The
purpose of this article is to share the process used to determine a baseline
CAUTI rate, the interventions implemented to reduce use of catheters, and
the outcomes associated with this project. The results demonstrate an overall
reduction in the use of catheters, as well as a reduction in CAUTI.
Prasad A, Cevallos ME, Riosa S, Darouiche RO, Trautner BW. Of
Department of Internal Medicine, New York Medical College-Westchester
Medical Center, Westchester, NY, USA. Conducted a study (2009) on ” A
bacterial interference strategy for prevention of UTI in persons practicing
Intermittent catheterization.”
STUDY DESIGN: Non-randomized pilot trial. OBJECTIVES: To determine
whether Escherichia coli 83972-coated urinary catheters in persons with
spinal cord injury (SCI) practicing an intermittent catheterization program
(ICP) could (1) achieve bladder colonization with this benign organism and
(2) decrease the rate
of symptomatic urinary tract infection (UTI).
SETTING: Outpatient SCI clinic in a Veterans Affairs hospital (USA).
METHODS: Participants had neurogenic bladders secondary to SCI, were
practicing ICP, had experienced at least one UTI and had documented
bacteruria within the past year. All participants received a urinary catheter
that had been pre-inoculated with E. coli 83972. The catheter was left in
place for 3 days and then removed. Participants were followed with urine.
cultures and telephone calls weekly for 28 days and then monthly until E.
coli 83972 was lost from the urine. Outcome measures were (1) the rate of
successful bladder colonization, defined as the detection (>or=10(2) cfu ml(1)) of E. coli 83972 in urine cultures for >3 days after catheter removal and
(2) the rate of symptomatic UTI during colonization with E. coli 83972.
RESULTS: Thirteen participants underwent 19 insertions of study catheters.
Eight participants (62%) became successfully colonized for >3 days after
catheter removal. In these 8 participants, the rate of UTI during colonization
was 0.77 per patient-year, in comparison with the rate of 2.27 UTI per
patient-year before enrollment. CONCLUSIONS: E. coli 83972-coated
urinary catheters are a viable means of achieving bladder colonization with
this potentially protective strain in persons practicing ICP.17
6.3 STATEMENT OF THE PROBLEM
“A study to evaluate the effectiveness of planned teaching programme
regarding prevention of urinary tract infection in client with indwelling
catheter on knowledge on practice among staff nurses working in
selected hospitals, Bangalore.”
6.4 OBJECTIVES OF THE STUDY
1 To evaluate the level of knowledge on practice staff nurses .on
prevention of urinary tract infection in clients with indwelling catheter
before implementation of planned teaching programme.
2 To evaluate the effectiveness of planned teaching programme
regarding prevention of urinary tract infection in client with
indwelling catheter.
3
To find out association between knowledge on practice of staff nurses
regarding prevention of urinary tract infection in client with
indwelling catheter with their selected demographic variables.
6.5 HYPOTHESIS
H1- The mean post test knowledge on practice score of the staff nurses
regarding prevention of urinary tract infection in client with indwelling
catheter will be significant than the mean pre test knowledge scores.
H2- There will be a significant association between the selected
demographic variables and the mean knowledge on practice score of
staff nurses regarding prevention of urinary tract infection in client
with indwelling.
6.6OPERATIONAL DEFINITIONS
KNOWLEDGE ON PRACTICE
Refers to the correct responses received from the staff nurses regarding
prevention of urinary tract infection in client with indwelling catheter as
elicited through a closed ended questionnaire.
EFFECTIVENESS
In term of significant gain in the mean post test knowledge score as
measured In this study it refers to the desired changes brought out by the
teaching programme and it’s Measurement by a structured knowledge
questionnaire prepared by investigator.
PLANNED TEACHING PROGRAMME
It refers to the systematically developed Teaching Programme and
instructions regarding Prevention of Urinary Tract Infection in client with
indwelling catheter with teaching aid designed for the staff nurses to practice
the same on the patients.
EVALUATE
It is statistical measurement between Pre and post test knowledge on practice
course of staff nurses regarding prevention of urinary tract infection in client
with indwelling catheter.
STAFF NURSES
A person who is completed either a diploma in general nursing or
B.Sc.(Nursing) qualification and working as a staff nurse in selected
hospitals, Bangalore.
PREVENTION OF URINARY TRACT INFECTION IN CLIENT
WITH INDWELLING CATHETER
It refers to the care rendered nurses to a patient who is on indwelling
catheter with the aim to minimize thereby preventing urinary tract infection.
6.7 ASSUMPTIONS
Nurses working in selected hospitals may have knowledge regarding urinary
tract infection in clients with indwelling catheter.
6.8 DELIMITATIONS
The study will be limited only to the registered staff nurses working in
hospitals of Bangalore, Karnataka.
7.0 MATERIALS AND METHODS
7.1 Sources of Data – Staff Nurses working in selected hospital in
Bangalore.
7.2 Method of Data Collection
Research Approach
: Evaluative research
Research design
: Quasi experimental method with
pre and post test Without control
group and experimental approach
was used.
O1 - X – O2 O2 - O1 = E
The symbols used are explained as
follows.
O1=
Pre
Test
assessment
of
knowledge regarding prevention of
urinary tract infection in client with
indwelling catheter.
X = Presentation of
Teaching
Planned
Programme.
O2 = Post Test Assessment of
Knowledge regarding prevention of
urinary tract infection in client with
indwelling catheter.
E
= Effectiveness of Planned
Teaching Programme.
Sampling technique
:Non
probability
purposive
sampling.
Sample size
:50 staff nurses.
Setting of the study
: Study will be conducted at selected
Hospital. Bangalore.
7.2.1.: CRITERIA FOR SELECTION OF SAMPLE
INCLUSIVE CRITERIA
Staff Nurses who will be:
 working in selected hospitals, at Bangalore.
 present at the time of data collection.
 qualified as B.Sc. / Diploma in nursing and midwifery.
 willing to participate in the study.
EXCLUSIVE CRITERIA:
Staff nurses who will be:
 auxiliary nurse and midwife.
 student nurse.
 on leave during data collection period.
 not willing to participate.
7.2.2.: DATA COLLECTION TOOL:
It consists of knowledge questionnaire to evaluate the pre-test and post
test knowledge on practice of staff nurses regarding prevention of urinary
tract infection in clients with indwelling catheter. A planned teaching
programme will be prepared on the topic. Content validity of the tool will be
obtained in consultation with guide and experts in the field of Nephrology,
urology, urological nursing, education and biostatistics. Reliability of the
tool will be established by test-retest method.
collection will be from July-August-2011.
The tentative period of
7.2.3: METHOD OF DATA ANALYSIS
Descriptive and inferential statistics will be used for data analysis that
is mean. Standard deviation, frequency, percentage distribution and paired‘t’
test to compare the pre and post test knowledge on practice scores and chisquare (χ2) test to find out association with the level of knowledge on
practice and selected demographic variables of staff nurses.
7.3. DOES THE STUDY REQUIRE ANY INTERVENTIONS?
YES.
1. Intervention as a planned teaching programme on prevention of
urinary tract infection in clients with indwelling catheter will be
conducted for the staff nurses.
2. No other invasive procedures are performed as the intervention in
this study.
7.4. HAS ETHICAL CLEARENCE BEEN OBTAINED?
YES.
1. Confidentiality and anonymity of the subject will be maintained.
2. Informed consent will be obtained from the subjects.
3. A written permission from institutional authority and hospital
management will be obtained prior to the study.
8.List of References:
1.
http://www.medterms.com/script/main/art.asp?articlekey=5914#
2.
Ameerally P. Anatomy. UK: Harcourt Publishers Ltd; 2000
3.
Moore KL, Dalley AF. Clinically Orientated Anatomy. Canada:
Lippincott Williams & Wilkins; 1999.
4.
Ross MH, Gordon GI, Pawlina W. Histology : A Text & Atlas,
USA: Lippincott Williams & Wilkins; 2003.
5.
http://www.answers.com/topic/urinary-tract-infection-2
6.
http://www.wrongdiagnosis.com/u/urinary_tract_infections/prevalen
ce.html
7.
www.google.com
8.
www.pub med.com
9.
J-Infect 2002 April ; 44(3) : 171-5
10.
ashish .banergi @ fortis healthcare.com
11.
American journal of critical care. 2009:18(6): 535-541
12.
Rev Assoc med Bras. 2009 March-April: 55(2): 181-7.
13.
Rehabil Nursering 2009 November- December : 34(6):237-41.
14.
Spinal Card 2009 July: (7): 565-9. Epub 2009 January 13.
15.
Medical – Surgical Nursing 8th Edition – JOYCE M. BIACK, JANE
16.
HOKANSON HAWKS P-727.
17.
Archives internal medicine;vol.155 no.13,10 July,1995.
18.
Med Scape Today-Laura A stokowski RN,MS -02/03/09.
19.
Up To date for patient-Thomas Feeket-MD,Professor of Medicine &
Microbiology ,TemplemUniversity School of Medicine.