Socio-demographic characteristics of the study participants
A total of 408 respondents filled and returned the questionnaire which makes a response rate of 96.7% (Table1).
Table 1: Sociodemographic characteristics of nurses working at public hospitals in West Shoa Zone, Oromia, Ethiopia (n= 408)
Variable
|
Frequency
|
Percentage (%)
|
Gender
Female
Male
|
187
221
|
45.8
54.2
|
Age
20-24
25-29
30-34
35 or above
|
39
165
129
75
|
9.6
40.4
31.6
18.4
|
Religion
Protestant
Orthodox
Muslim
Other*
|
256
112
23
17
|
62.7
27.5
5.6
4.2
|
Marital status
Single
Married
Other**
|
209
184
15
|
51.2
45.2
3.6
|
The current level of education
Diploma
First degree
Masters and above
|
32
357
19
|
7.8
87.5
4.7
|
Total year of experience
6 month-2years
3years -6years
7 years -10years
greater than 10 years
|
80
186
80
62
|
19.6
45.6
19.6
15.2
|
Current working area
Surgical ward
Gyn ward
Pediatric
ICU
OR
OPD
Emergency ward
Others
Medical ward
|
60
41
43
40
60
42
41
16
65
|
14.8
10
10.6
9.9
14.8
10.2
10
4
16
|
Other*(Catholic, wakefata and Jehovah witness), Other** (Divorced, Separated and Widowed)
Knowledge of nurses towards catheter-related urinary tract infection prevention
Out of study participants, 259 (63.5%), had adequate knowledge towards CRUTI prevention. Most, 330(80.9%) of the study participants, correctly responded that routine use of antiseptic lubricants decreases the risk of infection during urinary catheterization while 360 (88.2%) and 312(76.5%) know hand washing before and after handling urinary catheterization decrease catheter-related urinary tract infection respectively (Table 2).
Table 2: Distribution of knowledge of CRUTI of nurses working at public hospitals in West Shoa Zone, Oromia, Ethiopia (n=408)
Variables
|
Category
|
Frequency
|
Percentage (%)
|
Routine use of antiseptic lubricants decreases the risk of infection during urinary catheterization
|
Yes
No
Don’t know
|
330
68
10
|
80.9
16.6
2.5
|
Maintaining Urinary catheters is important to use Closed Drainage System
|
Yes
No
Don’t know
|
340
57
11
|
83.3
14.0
2.7
|
Hand hygiene before handling catheterization is important to prevent catheter-related infection.
|
Yes
No
Don’t know
|
360
41
7
|
88.2
10.0
1.8
|
Wearing pair of the surgical glove during the procedure handling decrease the risk of infection
|
Yes
No
Don’t know
|
340
60
8
|
83.3
14.7
2.0
|
Hygiene of the urethral meatus is important before inserting catheterization
|
Yes
No
Don’t know
|
336
58
14
|
82.4
14.2
3.4
|
Hand hygiene After Handling the urinary catheter is decreased catheter-related urinary tract infections
|
Yes
No
Don’t know
|
312
81
15
|
76.5
19.9
3.6
|
Catheterization is done under the sterile procedure
|
Yes
No
Don’t know
|
352
41
15
|
86.3
10.0
3.7
|
Securing an indwelling catheter properly after insertion can prevent movement and urethral traction
|
Yes
No
Don’t know
|
334
53
21
|
81.9
13.0
5.1
|
During catheterization Adequate fixation is important
|
Yes
No
Don’t know
|
334
36
38
|
81.9
8.8
9.3
|
Unless contraindicated, the use of the smallest bore catheter size is better than the largest bore
|
Yes
No
Don’t know
|
278
92
38
|
68.2
22.5
9.3
|
Bladder irrigation, installation, or washout using an antiseptic or antimicrobial agent is beneficial to prevent Catheter-related urinary tract infection
|
Yes
No
Don’t know
|
302
83
23
|
74.0
20.0
5.6
|
The practice of nurses on catheter-related- urinary tract infection prevention
From the total nurses participated in the study, 141 (34.6%) had good practice towards CRUTI prevention. This finding is almost not analogous with the result of the observational study, which identified14 (27.5%) good practice (Table 3).
Table 3: Distribution of catheter-related urinary tract infection prevention practice among nurse in public hospitals of West Shoa Zone, Oromia, Ethiopia (n= 408)
Practice related question
|
Never
|
Rarely
|
Sometimes
|
Most of the time
|
Always
|
N (%)
|
N (%)
|
N (%)
|
N (%)
|
N (%)
|
Washing hands before inserting a urinary catheter
|
33 (8.1)
|
64(15.7)
|
36 (8.8)
|
126(30.9)
|
149 (36.5)
|
Cleaning the urethra with an antiseptic solution before inserting a urinary catheter
|
170(41.7)
|
30 (7.4)
|
53 (13)
|
126(30.9)
|
29 (7.1)
|
Washing hands after insertion of a urinary catheter
|
23 (5.6)
|
40 (9.8)
|
44(10.8)
|
89 (21.8)
|
212 (52)
|
Secure indwelling catheter after insertion to prevent movement and urethral traction
|
25 (6.6)
|
30 (7.4)
|
37 (9.1)
|
120(29.4)
|
196 (48.0)
|
Protecting the catheter and collecting tube from kinking
|
19 (4.7)
|
41(10.0)
|
32 (7.8)
|
119(29.2)
|
197 (48.3)
|
Document catheter insertion date and expected date of removal
|
30 (7.4)
|
46(11.3)
|
42(10.3)
|
122(29.9)
|
168 (41.2)
|
Keep the collecting bag below the bladder level
|
22 (5.4)
|
26 (6.4)
|
26 (6.4)
|
100(24.5)
|
234 (57.4)
|
Keep the urine collecting bag out off the floor
|
47 (11.5)
|
34 (8.3)
|
54(13.2)
|
128(31.4)
|
145 (35.5)
|
Protecting yourself from cross-contamination during catheter removal
|
13 (3.2)
|
51(12.5)
|
16 (3.9)
|
105(25.7)
|
223 (54.7)
|
Use standard precautions when handling the catheter or collecting system
|
13 (3.2)
|
47(11.5)
|
31 (7.6)
|
135(33.1)
|
182 (44.6)
|
Record date of catheter removal
|
45(11.0)
|
58(14.2)
|
33(8.1)
|
101(24.8)
|
171(41.9)
|
Distribution of nurses’ attitude towards catheter-related urinary tract infection prevention
Out of the total participants, 277(67.9%) had a favorable attitude towards CRUTI prevention. accordingly, 163(40%) and 178(43.5%) agreed and strongly agree that wearing gloves and gowns can decrease the incidence of catheter-related urinary tract infection during any manipulation of the catheter or collecting bag respectively (Table 4).
Table 4: Distribution of nurses' attitudes regarding catheter-related urinary tract infection prevention at public hospitals in West Shoa Zone, Oromia, Ethiopia (n=408).
Variable
|
Response
Strongly
Disagree Disagree Neutral Agree Strongly agree
|
N (%)
|
N (%)
|
N (%)
|
N (%)
|
N (%)
|
Training about basic catheter care helps to prevent catheter related urinary tract infections
|
24 (5.9)
|
15 (3.7)
|
18 (4.4)
|
144 (35.3)
|
207 (50.73)
|
Catheter-related urinary tract infection is not a very serious disease
|
179 (43.9)
|
164 (40.2)
|
27 (6.6)
|
29 (7.1)
|
9 (2.2)
|
It helps to reduce Catheter-related urinary tract infections if catheter-related infection prevention is on the high priority list in hospitals
|
30 (7.4)
|
35 (8.6)
|
21 (5.1)
|
148 (36.4)
|
174 (42.64)
|
Catheter-related infection is a common problem and almost impossible to prevent.
|
150 (36.8)
|
152 (37.3)
|
23 (5.6)
|
44 (10.8)
|
39 (9.6)
|
Maintaining a closed drainage system prevents Catheter-related infection
|
29 (7.1)
|
25 (6.1)
|
45 (11)
|
138 (33.8)
|
171 (41.9)
|
Aseptic precautions may not be needed for removing the urinary catheterization
|
160 (39.2)
|
166 (40.7)
|
16 (3.9)
|
32 (7.8)
|
34 (8.3)
|
The catheter can be inserted when it is convenient for the healthcare provider (HCP)
|
125 (30.6)
|
99 (24.3)
|
24 (5.9)
|
97 (23.8)
|
63 (15.44)
|
Adequate fixation of a urinary catheter is important during catheterization
|
22 (5.4)
|
21 (5.1)
|
28 (6.9)
|
135 (33.1)
|
202 (49.5)
|
From the study participants, 305(74.5%) reported that their hospital has a hand washing facility near to or inside wards, 336 (82.4%) have accessed infection prevention guidelines in their working departments and 209 (51.2%) have taken in-service training on urinary catheter procedures or related infection prevention.
Factors associated with knowledge of study participants on Catheter-related urinary tract infection prevention
Before and after an adjustment was made, age, current working unit, in-service training on CRUTI prevention, marital status, accessibility of internet, presence of infection prevention guideline, and library were found to be significantly associated with the knowledge of participants on CRUTI prevention.
In the current study, respondents whose ages were between 30 and 34 were about 2.8 times more likely to have adequate knowledge about CRUTI prevention than those 20-24 years old [aOR: 2.77, 95% CI: 1.15-6.65]. Respondents whose age is greater than or equal to 35 years old were three times more likely to be adequate knowledge about CRUTI prevention than those 20-24 years old [AOR: 3.14, 95% CI: 1.20-8.18].
This study revealed that nurses working in the intensive care unit (ICU) are three times more likely to have adequate knowledge on CRUTI prevention than those who had worked in the Medical ward [AOR:3.15,95% CI:1.13-8.75]. Those nurses who had taken in-service training are two times more likely to have adequate knowledge about CRUTI prevention than those who do not have taken training [AOR: 1.86, 95% CI: 1.11-3.14]. Those nurses, who have infection prevention guidelines in their working department were near to three times more likely to have adequate knowledge about CRUTI prevention than those who don’t have [AOR: 2.78,95% CI: 1.50-5.16]. Those participants, who responded that they have a library in their working setting were almost three times more likely to have adequate knowledge about CRUTI prevention than those who don’t have [AOR: 2.97,95% CI: 1.78-4.96]. Those participants who are single in their marital status are 2.4 times more likely to have adequate knowledge than those ever married [AOR: 2.44, 95% CI: 1.51-3.96]. The participants who have favorable attitude towards CRUTI prevention were more likely to have adequate knowledge about CRUTI prevention than those who do have unfavorable attitude [AOR: 2.10, 95% CI: 1.20-8.18] (Table 5).
Table 5: Bivariate and Multivariate analysis for factors associated with knowledge of catheter-related urinary tract infection prevention among Nurses at public hospitals in West Shoa Zone, Ethiopia (n =408)
Variable
|
Level of knowledge on
CRUT prevention
|
COR
(95%, CI)
|
AOR
(95%, CI)
|
P-value
|
Adequate (%)
|
Inadequate (%)
|
Gender
|
|
|
|
|
|
Female
|
125(66.8)
|
62(33.2)
|
1.31(0.87-1.96)
|
1.51(0.885-2.587)
|
0.135
|
Male
|
134(60.6)
|
87(39.4)
|
1
|
1
|
|
Marital status
|
|
|
|
|
|
Single
|
151(72.2)
|
58(27.8)
|
2.19(1.45-3.31)
|
2.442(1.51-3.96)
|
0.001*
|
Ever married
|
108(54.3)
|
91(45.7)
|
1
|
1
|
|
Age
|
|
|
|
|
|
20-24 years
|
19(48.7)
|
20(51.3)
|
1
|
1
|
|
25-29 years
|
89(53.9)
|
76(46.1)
|
1.23(0.613-2.479)
|
1.28(0.561-2.931)
|
0.555
|
30-34 years
|
95(73.6)
|
34(26.4)
|
2.94(1.403-6.165)
|
2.78(1.158-6.656)
|
0.022*
|
≥35 years
|
56(74.7)
|
19(25.3)
|
3.10(1.373-7.013)
|
3.14(1.204-8.181)
|
0.019*
|
Experience
|
|
|
|
|
|
6month-2years
|
43(53.8)
|
37(46.2)
|
1
|
1
|
|
3-6years
|
122(65.6)
|
64(34.4)
|
1.64(0.962-2.797)
|
1.70(0.866-3.349)
|
0.123
|
7-10years
|
53(66.2)
|
27(33.8)
|
1.69(0.892-3.199)
|
1.10(0.478-2.507)
|
0.831
|
>10 years
|
41(66.1)
|
21(33.9)
|
1.68(0.847-3.334)
|
1.06(0.441-2.551)
|
0.895
|
Current working area
|
|
|
|
|
|
Surgical ward
|
36(60)
|
24(40%)
|
1.29(0.632-2.616)
|
1.97(0.829-4.664)
|
0.125
|
Gyn ward
|
26(63.4)
|
15(36.6%)
|
1.49(0.667-3.361)
|
1.47(0.588-3.653)
|
0.412
|
Pediatric
|
27(62.8%)
|
16(37.2%)
|
1.45(0.658-3.179)
|
1.80(0.707-4.639)
|
0.223
|
ICU
|
30(75%)
|
10(25%)
|
2.57(1.082-6.113)
|
3.15(1.133-8.752)
|
0.028*
|
OR
|
50(83.3%)
|
10(16.7%)
|
4.29(1.858-9.887)
|
2.73(1.073-6.939)
|
0.035*
|
OPD
|
25(59.5%)
|
17(40.5%)
|
1.26(0.574-2.766)
|
1.13(0.476-2.885)
|
0.792
|
Emergency
|
20(48.8%)
|
21(51.2%)
|
0.82(0.373-1.786)
|
1.21(0.49-2.988)
|
0.68
|
Others
|
10(62.5%)
|
6(37.5%)
|
1.43(0.464-4.394)
|
1.62(0.425-6.144)
|
0.489
|
Medical ward
|
35(53.8%)
|
30(46.2%)
|
1
|
1
|
|
Availability of hand washing facility
|
|
|
|
|
|
Yes
|
174(67.4)
|
84(32.6)
|
1.58(1.046-2.398)
|
0.81(0.456-1.444)
|
0.477
|
No
|
85(56.7)
|
65(43.3)
|
1
|
1
|
|
Availability of Guideline
|
|
|
|
|
|
Yes
|
235(69.9)
|
101(30.1)
|
4.65(2.705-8.007)
|
2.78(1.495-5.164)
|
0.001*
|
No
|
24(33.3)
|
48(66.7)
|
1
|
1
|
|
Availability of Library
|
|
|
|
|
|
Yes
|
184(76.7)
|
56(23.3)
|
4.07(2.659-6.242)
|
2.97(1.778-4.956)
|
0.001*
|
No
|
75(44.6)
|
93(55.4)
|
1
|
1
|
|
Training (in-service training)
|
|
|
|
|
|
Yes
|
160(76.6)
|
49(23.4)
|
3.30(2.159-5.039)
|
1.86(1.106-3.135)
|
0.019*
|
No
|
99(49.7)
|
100(50.3)
|
1
|
1
|
|
Availability of internet
|
|
|
|
|
|
Yes
|
207(66.6)
|
104(33.4)
|
1.72(1.084-2.738)
|
1.92(1.085-3.386)
|
0.025*
|
No
|
52(53.6)
|
45(46.4)
|
1
|
1
|
|
Attitude
|
|
|
|
|
|
Favorable
|
195(70.4)
|
82(29.6)
|
2.49(1.621-3.823)
|
2.10(1.204-8.181)
|
0.003*
|
Un Favorable
|
64(48.9)
|
67(51.1)
|
1
|
1
|
|
Factors associated with the practice of nurses towards catheter-related urinary tract infection prevention
After controlling for possible confounding factors, age, year of experience, availability of infection prevention guidelines, accessibility of internet, ever taking in-service training, and favorable attitude on CRUTIs prevention were found to be significantly associated with good practice catheter-related urinary tract infection prevention.
Accordingly, nurses whose age is within a range of 30 and 34 years were about three times more likely to have a good practice of CRUTI prevention activities than those aged 20-24 years [AOR: 3.09, 95% CI: 1.1-8.65] while those greater than or equal to 35 years old were more than three times more likely to have good practice of CRUTI prevention activities than those aged 20-24 years [AOR: 3.46, 95% CI: 1.18-10.15]. Nurses who have work experience of greater than 10 years had more than three times more likely to have good practice of CRUTI prevention activity than those who had work experience of between six months and two years [AOR: 3.65,95% CI: 1.48-9.10].
Nurses who were working in operation room were three times more likely to have good practice of CRUTI prevention than participants who are working in the medical ward [AOR: 3.02, 95% CI: [1.21-7.56]. Nurses who had taken in-service training on catheter related or any infection prevention were about two times more likely to have good practice of CRUTI prevention than those who hadn’t take training on CRUTI prevention [AOR: 1.91, 95% CI: 1.21-3.24]. Those nurses who have infection prevention guidelines in their working department were about two times more likely to have good practice of CRUTI infection prevention than those who don’t have [AOR: 2.37, 95% CI: 1.08-5.19]. Those nurses who have favorable attitudes were about two times more likely to have good practice of CRUTI prevention than those who have unfavorable attitudes [AOR: 1.89, 95% CI: 1.07-3.15] (Table 6).
Table 6: Bivariate and multivariate analysis on factors associated to the practice of catheter-related urinary tract infection prevention among Nurses in public hospitals of West Shoa zone, Oromia, 2021 (n =408).
Variable
|
Level of practice on CRUTI Prevention
|
COR CI (95%)
|
AOR CI (95%)
|
P-value
|
|
Good practice
|
Poor practice
|
|
|
|
Age
20-24 years
25-29 years
30-34 years
≥35 years
|
7(17.9%)
29(16.6%)
66(51.2%)
39(52%)
|
32 (82.1%)
136 (82.4%)
63 (48.8%)
36 (48%)
|
1
0.98 (0.392-2.424)
4.79 (1.971-11.63)
4.95 (1.944-12.61)
|
1
0.98 (0.346-2.75)
3.09(1.1-8.649) 3.46(1.181-10.15)
|
0.965
0.032*
0.024*
|
Year of Experience
6month-2 years
3-6 years
7-10 years
>10 year
|
15(18.8%)
45(24.2%)
45(56.2%)
36(58.1%)
|
65(81.2%)
141(75.8%)
35 (43.8%)
26 (41.9%)
|
1
1.383 (0.719-2.66)
5.57 (2.727-11.382)
6 (2.821-12.763)
|
1
1.36 (0.628-2.943)
3.63 (1.55-8.47)
3.653 (1.48-9.101)
|
0.436
0.003*
0.005*
|
The current level of education
Diploma
BSc
Masters and above
|
8(25%)
225(35%)
8(42.1%)
|
24(75%)
232(65%)
11(57.9%)
|
1
1.62 (0.705-3.704)
2.18 (0.649-7.33)
|
1
2.46 (0.56-10.797)
2.47 (0.86-7.012)
|
0.233
0.09
|
Current working unit
Medical ward
Surgical ward
Gyn ward
Pediatric
ICU/NICU
Operation room
OPD
Emergency ward
Others*
|
15(23.1%)
11(18.3%)
11(26.8%)
13(30.2%)
18(45%)
39 (65%)
13 (31%)
14 (34.1%)
7 (43.8%)
|
50(76.9%)
49(81.7%)
30(73.2%)
30(69.8%)
22(55%)
21(35%)
29(69%)
27(65.9%)
9(56.2%)
|
1
0.75 (0.313-1.790)
1.22 (0.497-3.007)
0.44 (0.605-3.447)
2.73 (1.167-6.375)
6.19 (2.827-13.556)
1.49 (0.625-3.575)
1.73 (0.727-4.108)
2.59 (0.826-8.138)
|
1
0.55 (0.206-1.479)
0.88 (0.312-2.495)
1.08 (1.385-3.046)
1.58 (0.38-4.286)
3.02 (1.205-7.56)
1.01(0.364-2.82)
2.37 (0.865-6.538)
1.79 (0.488-6.542)
|
0.23
0.814
0.881
0.372
0.018*
0.979
0.097
0.38
|
Availability of hand washing facility
Yes
No
|
98 (38%)
43 (28.7%)
|
160 (62%)
107 (71.3%)
|
1.52 (0.987-2.353)
1
|
1.30 (1.729-2.308)
1
|
0.376
|
Availability of
guideline
Yes
No
|
129 (38.4%)
12 (16.7%)
|
207 (61.6%)
60 (83.3%)
|
3.12 (1.614-6.014)
|
2.37 (1.081-5.191)
|
0.031*
|
Availability of library
Yes
No
|
93 (38.8%)
48 (28.6%)
|
147 (61.2%)
120 (71.4%)
|
1.58 (1.035-2.416)
1
|
0.94 (0.515-1.702)
1
|
0.828
|
Availability of internet
Yes
No
|
130(41.8%)
11(11.3%)
|
181(58.2%)
86(88.7%)
|
5.61(2.882-10.939)
1
|
5.82(2.446-11.295)
1
|
0.001*
|
Attitude
Favorable
Unfavorable
|
109(39.4%)
32(24.4%)
|
168(60.8%)
99(75.6%)
|
2.007(1.260-3.198)
1
|
1.893(1.07-3.147)
1
|
0.028*
|