Bangalore, karnataka proforma for registration of subject for dessertation name of the : Ms. Jinis jose candidate and



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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR DESSERTATION
1. NAME OF THE : Ms. JINIS JOSE

CANDIDATE AND 1ST YEAR M.sc NURSING,

ADDRESS KEMPEGOWDA COLLEGE OF NURSING,

K.R ROAD, V.V PURAM,

BANGALORE-560004
2. NAME OF THE : KEMPEGOWDA COLLEGE OF NURSING,

INSTITUTION BANGALORE-560004
3. COURSE OF STUDY : 1ST YEAR M.sc NURSING,

& SUBJECT MEDICAL SURGICAL NURSING
4. DATE OF ADMISSION : 15/6/2009
5. TITLE OF THE TOPIC : “A STUDY ON ASSESSING THE KNOWLEDGE AND PRACTICE AMONG

NURSES REGARDING PREVENTION OF URINARY TRACT INFECTION IN PATIENTS ON INDWELLING CATHETER AT KEMPEGOWDA INSTITUTE OF MEDICAL SCIENCES, HOSPITAL AND RESEARCH CENTRE BANGALORE WITH A VIEW TO DEVELOP AN INFORMATION BOOKLET.”

6. BREIF RESUME OF THE INTENDED WORK:
6.1. NEED FOR THE STUDY:

Knowledge is of no value



Unless you put it into practice”

{Anton Chekhov}



Urinary tract infections represent the second most often observed infectious diseases in the community. Urinary catheterization is a known source of bacterial infections, which in the worst-case scenario can lead to death. More than 5 million patients every year will be catheterized. The patients catheterized for more than seven days, up to 25 percent will develop catheter associated urinary tract infection. It is the most common nosocomial infection, comprising more than 40 percent of all hospital-acquired infections1.
More than 100,000 people are hospitalized annually because of urinary tract infection. More than 15% people who develop gram negative bacteraemia and die, one third of these are caused by bacterial infections originating in the urinary tract. Most of these infections 66% to 86% follow mainly urinary catheterization2.
Catheter-related urinary tract infection is the most common nosocomial infection seen in medical intensive care units accounting for 31%. The daily incidence of bacteriuria in catheterized patients is approximately 3–10%. Among patients with bacteriuria, up to 25% will develop symptoms of local urinary tract infection and about 3% will develop bacteremia.It is estimated that 10-12% of hospital patients and 4% of patients in the community have a urinary catheter at any one time .Urinary tract infections account for almost half of all health care-associated infection and a significant number of these infections are related to the insertion of urinary catheters3.
A study on “Nosocomial Urinary Tract Infections in Urologic Patients: Assessment of a Prospective Surveillance Program Including 10,000 Patients”. In this study the incidence of hospital acquired urinary tract infection in catheterized patients has been estimated at approximately 20%. A total of 10,054 consecutive patients were included, 52% were catheterized. The median incidence of catheter-related hospital acquired urinary tract infection in catheterized patients was 13.0%4.
A study on “Catheter related urinary tract infection” was conducted in Canada. The study revealed that for either short- or long-term catheters, the infection rate is about 5% per day5.
A study on “Care of patients with long term indwelling urinary catheters” revealed that the common complications of long-term indwelling catheters are bacteriuria, encrustation, and blockage and the risk factors for bacteriuria include female gender, old age, and long-term indwelling catheter use6.
A study on “Device-associated nosocomial infections in 55 intensive care units of 8 developing countries” revealed that catheter-associated urinary tract infections were 3.9% per Foley catheter7.
Investigators personal clinical experience also revealed that the patient with catheter, developed more infections. Hence the investigator feels the need for bringing about awareness among nurses regarding prevention of urinary tract infection in patients on indwelling catheter. Further this study will help the nursing professionals in gaining an insight regarding urinary tract infection and its prevention.
6.2. REVIEW OF LITERATURE:

A study on “Decreasing urinary tract infections through staff development, outcomes, and nursing process” conducted in USA .The study reveals that early discontinuance of catheters, proper insertion and care techniques will help to improve outcomes8.


A study on “Effectiveness of multifaceted hospital wide quality improvement programs featuring an intervention to remove unnecessary urinary catheters at a tertiary care centre in Thailand” conducted in Thailand. A total of 2,412 patients were enrolled in the study. The study revealed that a multifaceted intervention to remind physicians to remove unnecessary urinary catheters can significantly reduced the duration of urinary catheterization and the infection rate9.

A study on “Catheter Associated Urinary Tract Infection: New aspects of novel urinary catheter” conducted in Korea. The study revealed that the underlying cause of catheter associated urinary tract infection is the formation of a pathogenic biofilm on the surface of the indwelling urinary catheter and the use of antibiotic-coated catheters provide control against catheter associated urinary tract infection and the sole effective preventative strategy is the use of a closed drainage system and removal of the catheter as soon as possible10.


A prospective study of “catheterized patients from the time of catheter insertion, sampled urine daily from the specimen port and collection bag, to attempt to assign an extra or intraluminal route of acquired infection” The study revealed that any passage of a catheter can introduce bacteria into the bladder. Once the catheter is in place, bacteria appear to enter the bladder along the exudates that forms around the catheter in the urethra (extraluminal infection). Intraluminal infection can occur because of failure of closed drainage or contamination of the urine collection bag11.
A study on “Epidemiology of intensive care unit-acquired urinary tract infections” reveals that nosocomial urinary tract infections frequently complicate the course of patients admitted to intensive care units. The factors associated with the development of these infections include increased duration of urinary catheterization, female sex, intensive care unit length of stay, and preceding systemic antimicrobial therapy12.
A study on “Control of the duration of urinary catheterization: impact on catheter-associated urinary tract infection” conducted in France. The frequency of late catheter associated urinary tract infection among catheterized patients in all five departments decreased from 10.6 to 1.1 per 100 patients and the incidence of late catheter associated urinary tract infection decreased from 12.3 to 1.8 per 100013.
A study on “etiologic agents and risk factors in nosocomial urinary tract infections” was conducted at Turkey. The study revealed that, the cumulative incidence of nosocomial urinary tract infections was 1.04% and episode rate of nosocomial urinary tract infections was 1.19%. The most important risk factor for nosocomial urinary tract infections were detected as urinary catheterization (78.8%)14.

A study on “Reduction of urinary tract infections acquired in an intensive care unit during a 10-year surveillance program” conducted at Edouard Herriot Hospital. The study revealed that a 66% reduction of urinary catheter-related infections acquired by patients hospitalized was observed between 1995 and 2004 after adjustment on age, gender, antibiotic use at admission, and duration of exposure to urinary catheter15.


A study on “Nursing interventions to reduce the risk of catheter-associated urinary tract infection” conducted by St.Joseph hospital, Washington. The study revealed that the insertion of a silver alloy-coated catheter reduce the risk of urinary tract infection for up to 2 weeks in adult patients managed by short- term indwelling catheterization and the insertion of an antibiotic-impregnated catheter reduce the infection risk for up to 7 days and the selection of a smaller French sized catheter also reduces the infection risk16.
A study on “Nursing interventions to reduce the risk of catheter-associated urinary tract infection” conducted by Colombia hospital USA. The study revealed that the following interventions reduce the incidence of urinary tract infection in patients managed by short-term indwelling catheterization. (1) Staff education about catheter management, combined with regular monitoring of urinary tract infection incidence. (2) A facility-wide program to ensure catheterization only when indicated and prompt removal of indwelling catheters, (3) daily cleansing of the urethral meatus using soap and water (4) maintenance of a closed urinary drainage system. (5) Routine catheter changes every 4 to 6 weeks reduce urinary tract infection incidence in patients managed by long-term catheterization17.
6.3. STATEMENT OF THE PROBLEM:
“A study on assessing the knowledge and practice among nurses regarding prevention of urinary tract infection in patients on indwelling catheter at Kempegowda Institute of Medical Science And Research Centre Bangalore with a view to develop an information booklet.”

6.4. OBJECTIVES OF THE STUDY:


  1. To assess the knowledge of staff nurses on prevention of urinary tract infection in patients on indwelling catheter.




  1. To assess the practices of staff nurse regarding prevention of urinary tract infection in patients on indwelling catheter.

3. To find out the correlation between knowledge scores and practice scores among staff nurses.


4. To find out the association between knowledge scores and practice scores among staff nurses with selected demographic variables.

6.5. HYPOTHESES:
H1 - There will be a significant correlation between knowledge scores and practice scores.
H2 - There will be an association between knowledge scores and practice scores with selected demographic variables.
6.6. OPERATIONAL DEFINITIONS:
Knowledge: It refers to the information about the prevention of urinary tract infection among nurses in patients on indwelling catheter.
Practice: It refers to the observed activities of nurses regarding prevention of urinary tract infection in patients on indwelling catheter.
Staff nurse: It refers to registered nurse working at Kempegowda Institute of Medical Science Hospital and Research Centre, Bangalore.
Prevention: It refers to precautionary measures taken to avoid the occurrence of urinary tract infection.
Urinary tract infection: It refers to invasion of micro organisms into the urinary tract causing signs and symptoms of disease.
Indwelling catheter: It refers to a self retaining catheter which is introduced into the urinary bladder and secured inside for the purpose of draining urine.
Information booklet: It refers to a printed material regarding prevention of urinary tract infection among with indwelling catheter aimed at educating nurses.


7.

MATERIALS AND METHODS :

7.1.



SOURCE OF DATA :

Data will be collected from registered Nurses working at Kempegowda Institute of Medical Science Hospital and research Centre, Bangalore-04



7.2.

METHOD OF COLLECTION: Structured questionnaire method and

OF DATA observation checklist.

7.2.1.

STUDY SUBJECT :

Registered nurses working at Kempegowda Institute of Medical Science Hospital and research Centre, Bangalore-04.


7.2.2.

INCLUSION AND EXCLUSION CRITERIA:






INCLUSION CRITERIA :

Nurses present at the time of data collection and nurses who are willing to participate in the study.








EXCLUSION CRITERIA :

Nurses who are already exposed to educational programme on prevention of urinary tract infection in patients on indwelling catheter.

7.2.3.

RESEARCH DESIGN :


Descriptive study design.


7.2.4.

SETTING :

Kempegowda Institute of Medical Science Hospital and research Centre, Bangalore 04.


7.2.5.

SAMPLING TECHNIQUE :

Purposive sampling


7.2.6.

  1. SAMPLE SIZE :

  2. DURATION OF STUDY :

100 staff nurses

8 weeks



7.2.7.

TOOL OF THE RESEARCH :

  1. Structured questionnaire will be constructed into two parts:

  1. Part A: Demographic data

  2. Part B: Knowledge questionnaire regarding prevention of urinary tract infection in patients on indwelling catheter.

  1. Observation checklist to assess practice of staff nurses regarding prevention of urinary tract infection in patients on indwelling catheter.




7.2.8.

COLLECTION OF DATA :

After obtaining the consent from the participants, the investigator will collect data by using structured questionnaire and observe the practice by using the observation checklist.


7.2.9.

METHOD OF DATA :

ANALYSIS AND PRESENTATION

  1. The investigator will use appropriate descriptive statistics namely percentage, mean, median, standard deviation, mean percentage and inferential statistics namely unpaired t-test to measure significant correlation and Chi-square test (χ2) to analyze the data.

  2. The analyzed data will be presented in the form of tables and graphs where ever necessary.





7.3. DOES THE STUDY REQUIRE ANY INVESTIGATION TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS? IF SO PLEASE DESCRIBE BRIEFLY.
Yes, the study will be conducted on nurses regarding prevention of urinary tract infections in patients on indwelling catheter by using an information booklet.
7.4. HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.3?


  • Yes ethical clearance has been obtained from the authority of the institution.




  • Consent will be obtained from the participants prior to study.




  • Privacy, confidentiality and anonymity will be guarded.




  • Scientific objectivity of the study will be maintained with honesty and impartiality.



8. LIST OF REFERENCE:

  1. Cynthia T, Crosby. Prevention of catheter-associated urinary tract infections. Health care Purchasing News. July 2005.

  2. Lewis, Heitkember, Dirksen. Medical Surgical Nursing. Ed 7th. Mosby publication. 2005: 1172.

  3. Sanjay Saint, Richard H. Savel, Michael A. Matthay. American Journal of Respiratory and Critical Care Medicine.2006; 165: 1475-9.

  4. Veronique Merle Jeanne, Michèle Nouvellon Jean-François.Nosocomial Urinary Tract Infections in Urologic Patients: Assessment of a Prospective Surveillance Program Including 10,000 Patients. 2006 March;483–9.

  5. Nicole LE. Catheter-related urinary tract infection. Department of Internal Medicine. Canadian medical journal. 2007; 22(8): 627-39.

  6. Madigan E, Neff DF. Care of patients with long term indwelling urinary catheters. Online Journal of Issues in Nursing. 2007; 8(3).

  7. Goose, Never Event #4: Catheter Associated Urinary Tract Infections.2008 October; 575: Available at nursinghomelaw.strellislaw.com

  8. Ribby k. Decreasing urinary tract infections through staff development outcomes and nursing process Medical/Surgical Nursing.2005 Available at ribbyk@sjrmc.com.

  9. Yuekyen C, Warachan B. Effectiveness of multifaceted hospital wide quality improvement programs featuring an intervention to remove unnecessary urinary catheters at a tertiary care centre. Nursing Times 2005 March; 101(12): 64-67.

  10. Ha US,Cho YH.Catheter Associated Urinary Tract Infection: New aspects of novel urinary catheter. Int J Antimicrob Agents.2006 December; 28(6):485-7.

  11. Catheterized patients from the time of catheter insertion, sampled urine daily from the specimen port and collection bag, to attempt to assign an extra or intraluminal route of acquired infection. Published by Oxford University Press on behalf of the British Geriatrics Society.2006 June; 35(5):477-81.

  12. Bagshaw SM, Laupland KB. Epidemiology of intensive care unit-acquired urinary tract infections. Department of Critical Care Medicine. PMID: 16374221 PubMed - indexed for MEDLINE. 2006 February; 19(1):67-71.

  13. Crouzet J, Bertrand X, Venier AG. Control of the duration of urinary catheterization: impact on catheter-associated urinary tract infection. 2007 November .Annuals of Internal Medicine Article; 67(3):253-7.

  14. Akkoyun S, Kuloğlu F. Etiologic agents and risk factors in nosocomial urinary tract infections. Article in Turkish. 2008 April; 42(2):245-54.

  15. Vanhems P, Baratin D, Voirin N, Savey A, Caillat-Vallet E, Metzger MH. Reduction of urinary tract infections acquired in an intensive care unit during a 10-year surveillance program .2008 May; 26(5): Pp 299-310. Available at philippe.vanhems@chu-lyon.fr

  16. Parker D, Callan L, Harwood J. Nursing interventions to reduce the risk of catheter associated urinary tract infection: part1:staff education.Monitoring and care techniques. 2009 march; Available at http://www.ncbi.nlm.nih.gov/ sites/entrez

  17. Parker D, Callan L, Harwood J. Nursing interventions to reduce the risk of catheter-associated urinary tract infection: part 2: staff education, monitoring and care techniques. 2009 march; Available at http://www.ncbi.nlm.nih.gov/ sites/entrez




9


SIGNATURE OF THE :

CANDIDATE


10

REMARKS OF THE GUIDE:

The research topic selected by the candidate is relevant as it is emphasized on the knowledge and practice nurses regarding prevention of catheter associated urinary tract infection in patients with indwelling catheter.


11

NAME AND DESIGNATION

11.1

GUIDE :

Mr. M.S. SHIVANANDA,

PGDIRPM., M.Sc. (N).

Head of the Department and

Associate Professor,

Medical Surgical Nursing,

Kempegowda College of Nursing,

K.R. Road, V.V Puram,

Bangalore-560004.


11.2

SIGNATURE :


11.3

CO-GUIDE :



11.4

SIGNATURE :



11.5

HEAD OF THE :

DEPARTMENT

Mr. M.S. SHIVANANDA,

PGDIRPM., M.Sc. (N).

Associate Professor,

Medical Surgical Nursing,

Kempegowda College of Nursing,

K.R. Road, V.V Puram,

Bangalore-560004.




11.6

SIGNATURE :



12

REMARKS OF THE :

CHAIRMAN/PRINCIPAL

Topic selected for the study is relevant and forwarded for needful action.


12.1

SIGNATURE :











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