Various aspects on indwelling urinary catheter treatment and its relation to asymptomatic bacteriuria and urinary tract

Vollständiger Abstract

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Catheter-associated urinary tract infection (CAUTI) is one of the most common kinds of patient harm. One way of introducing bacteria into the urinary tract is by inserting a contaminated indwelling urinary catheter (IUC) due to non-aseptic handling during insertion or during maintenance of the IUC and/or the attached urine collection bag. Another way is to leave the IUC in place. The longer the dwell time the greater the risk of bacteriuria. In Sweden, the recommendations from The National Board of Health and Welfare on IUC-insertion procedure has shifted gradually from requiring sterile catheter to accepting non-sterile catheter over the years. In parallel, various denominations has been introduced for IUC-insertion, one of them called clean/nonsterile technique. In 2012 the European Association for Urology Nurses (EAUN) published a guideline on urethral catheterisation requiring sterile IUC and aseptic technique during procedure. The Swedish national Handbook for Healthcare was inspired by it and revised its recommendations. Though, different hospitals had differing requirements on sterility during IUC-insertion procedure. The overall aim with this thesis was to gain increased knowledge in various aspects on indwelling urinary catheter treatment and its relation to asymptomatic bacteriuria and urinary tract infection.In Study I, a cross-sectional survey, we used a structured questionnaire to explore how registered nurses and assistant nurses from three departments at hospital A described their IUC-insertion procedure in relation to what they called their insertion technique, and whether they followed the hospital guideline for urethral catheterisation. Of 492 included in the study analyses at hospital A, 58% (n=287) said that they followed the hospital guideline. Irrespective of the origin of the denomination used, "clean/non-sterile technique" was used significantly more often by the registered nurses (244/308 vs 104/179, P