CAUTI is a Urinary Tract Infection (UTI) in a patient with a catheter present or within 48 hours of catheter removal. Prolonged catheterization is a risk factor for developing a CAUTI [1]. UTI is a common infection among health care settings. Urinary catheter insertion is considered the most important predisposing factor for CAUTI and almost 25% of them undergo urinary catheterization during their stay in the hospital [2] [3]. The most common hospital-acquired infection is CAUTI accounting for almost 40% of all nosocomial infections [4] [5]. Nurses are considered as the primary health care providers who are responsible for inserting and maintain urinary catheters, as well as the production of desired outcomes. Nurses are also accountable to acquire appropriate knowledge and practices of catheter care that will prevent UTI [2].

The global burden of Hospital-Acquired Infection (HAI) is underestimated in developing countries due to lack of surveillance systems, The Association for Professionals in Infection Control and Epidemiology in the United States also reported that CAUTI is accounting for 25.6% of all HAIs [2]. CAUTI remains an expensive complication, though the additional cost to a hospitalization varies by assessment method from a few hundred dollars to thousands of dollars [6]. The National Healthcare Safety Network in 2013 reported that CAUTI pooled means were ranged from 1.2 to 4.1 per 1000 urinary catheter days in medical-surgical and burn intensive care units. While for Non-ICU rates ranged from 1.3 to 1.5 per 1000 urinary catheter days in medical-surgical units [3]. CAUTI can lead to such complications as prostatitis, epididymitis, and orchitis in males, and cystitis, pyelonephritis, gram-negative bacteremia, endocarditis, vertebral osteomyelitis, septic arthritis, endophthalmitis, and meningitis in patients. Complications associated with CAUTI cause discomfort to the patient, prolonged hospital stay, and increased cost and mortality. It has been estimated that each year, more than 13,000 deaths are associated with UTIs [7].

The significance of this study, from a researcher it will provide baseline information on nurses’ knowledge level and practice on prevention of CAUTI. Health care professionals must be skillful and competent enough with their knowledge and skills to prevent UTI among the hospitalized patient under indwelling catheter and give adequate knowledge to patients regarding the prevention of CAUTI [2]. Therefore, this study aimed to assess the nurse’s knowledge toward the prevention of catheter-associated urinary tract infection in public hospitals at Amran City.

1) Do nurses have knowledge about prevention of CAUTI?

2) What is the relationship between demographic characteristics of nurses and their knowledge level regarding about prevention of CAUTI?

Table 1 shows the demographic characteristics of the ICU nurses, the most (65.6%) of nurses were female belonged age group between 25 to <30 years old (43.0%), and more than half (51.6%) of them were single, followed by the majority of nurses (88.2%) were had diploma degree on belonged experience years between (1 - 5 years) 81.7%. Whereas, slightly more than half (51%) of them were had training courses in the prevention catheter-associated urinary tract infection.

Table 2 showed the vast majority of nurses (97%) were knew that antimicrobial prophylaxis offers are not greater benefit in reducing the incidence of CAUTI, followed by the majority (90%) of nurses knew that antiseptic meatal

cleaning before catheter insertion is necessary for reducing the incidence of catheter-associated urinary tract infection, collecting bag should be kept below the level of the bladder, and Regular educational training regarding basic urinary catheter care is from preventive measures of CAUTI. While only (13%) of nurses knew that routine use of antiseptic lubricants to decrease the risk of infection is necessary for urinary catheter insertion don’t from preventive measures of CAUTI.

Figure 1 showed that, more than two third of nurses had moderate knowledge regarding prevention of CAUTI (72%), (18.3%) of nurses were had good knowledge regarding prevention of CAUTI. Whereas only (9.7%) of nurses had poor knowledge regarding prevention of CAUTI with mean ± SD (14.17 ± 2.51).

Figure 1 showed that, more than two third (72%) of nurses had fair knowledge level, (18.3%) of nurses were had good knowledge level regarding prevention of CAUTI. Whereas only (9.7%) of nurses had poor knowledge level regarding prevention of CAUTI with mean ± SD (14.17 ± 2.51).

Table 3 showed a significant association between knowledge level regarding preventive of CAUTI, and demographic characteristics of nurses regarding sex at (P-value = 0.042). No statistically significant association between overall knowledge and other demographic characteristics of nurses (P-value ≥ 0.05).

One of the most prevalent health-care–associated infections is CAUTI. One of the causes is that urinary catheters that have been placed in hospitalized patients stay in place long after the rationale for their usage has expired. The most essential preventative approach in reducing the occurrence of CAUTI is to limit catheter usage. Assessing health care professionals’ knowledge of catheterization and UTI, particularly nurses’ knowledge, would aid in the management of problems linked to CAUTI and improper catheterization [2]. The aim of this study was to assess the knowledge levels of nurses toward the prevention of catheter-associated urinary tract infection at major hospitals in Amran City Yemen.

The results of this study were based on the primary data gathered from ninety-three nurses to assess the knowledge. The prevention of CAUTI is primarily the responsibility of the nurse whose knowledge and practice influence the health outcome of patients. Nurses are considered as the primary health care providers who are responsible for inserting and maintain urinary catheters, as well as the production of desired outcomes.

Our study result, two thirds of nurses were female, and more than half of them were single, belonged on the age group between 20 to less than 25 years old (40.9%). Because most of the old nursing quit work and went to other hospitals because government hospitals do not have salaries in them, and this is because of the wars in our country. The majority of nurses were had diploma degree and had years’ experience group between one to five years. The half of nurses (51%) had training courses in CAUTI. This might be related to the fact that the majority of them hold a nursing diploma and all of the nursing books are written in English and they are learning in Arabic. In addition, another causes for a lack of knowledge. This finding agrees with a study was conducted in India by Balu et al. [8] who reported that ranged between 21 to more Köse et al. [9] who found that (81.7%) of Istanbul were female. than 30 years age of nurses. In addition, our finding agrees with a study was conducted by Algarni et al. [3] who found that more than two-thirds of nurses were female (68.6%). Moreover, our results agreement with the study by Abdulmalek and Majeed [10] whose found that the highest percentage (51.6%) of the study participants had a diploma.

The current results agree with the study was conducted by Kose et al. [9] who reported in his study that (53.2%) had training about CAUTI. Also, it agrees with the study reported by Mukakamanzi [11] who found that (79.2%) had training on infection control.

Our results this disagreement with other results reported by Opina and Oducado [12] who found that more than half (56.7%) were males, furthermore more than three-fourths (76.7%) had bachelor’s degree.

The current study showed that the preventive measures of the catheter-associated urinary tract infection showed that (72%) of the nurses knew that antimicrobial prophylaxis offers are not greater benefit in reducing the incidence of CAUTI. This finding disagrees with the study was conducted by Algarni et al. [3] who found that more than half of nurses (60.6%) mistakenly considered that antimicrobial prophylaxis offers greater benefit in reducing the incidence of CAUTI.

The current study showed the knowledge level of nurses toward prevention of CAUTI was more than two-third (72%) of nurses were had fair knowledge might be due to the inadequacy of in-service refreshing training’ courses or because hospitals have not a clear and updated guideline protocol that nurses can access and adhere to at work. Our result conformity with study by Tobin et al. [13] the majority, 76.7% had fair knowledge of CAUTI.

Furthermore, our result of the study accepted with Rashmi and Dhakal [14] who found that, the most 59.37% of nurses had a moderate level of knowledge and only 16.25% had an adequate level of knowledge towards the prevention of CAUTI. In the line, the results of our study relative similar with Benny et al. [2] who reported that, majority of nurses (80.85%) had fair knowledge on prevention of CAUTI. In the same line, Abdelmoaty et al. [15] who mentioned that, more than half (54.2%) of nurses had moderate knowledge regarding prevention methods of CAUTI.

Moreover, this finding is disagreement with the study was conducted in India by Zachariah [16] who reported that more than two third (73%) of the staff nurses in the pretest were had good knowledge regarding the prevention of urinary tract infections in patients with an indwelling catheter. Furthermore, our study was unaccepted with the study that was conducted by Mukakamanzi [11] who reported that the majority of ICU nurses (64.52%) have a low level of knowledge regarding CAUTI prevention. On the other hand, Mong et al. [17] who reported that, nurses were found to have good knowledge, a positive attitude and good perceived practice regarding CAUTI prevention. On the line, our result not compatible with Balu et al. [8] who mentioned that, more than one quarter (28.4%) of health care professionals had moderately adequate knowledge on CAUTI. Moreover, this result unconformity with Algarni et al. [3] who’s revealed that, more than half of nurses (62.77%) had a low level of knowledge.

The current study showed there was no statistically significant association between overall knowledge and demographic characteristics of nurses regarding age, material statue, educational level, years’ experience, and training courses because (P-value ≥ 0.05). Our result accepted with study by Tobin et al. [13] who mentioned that there was no association between previous training and knowledge of CAUTI prevention. The result of this study disagreed with Rashmi and Dhakal [14] who revealed that, all socio-demographic variables were statistically significant with the level of knowledge about CAUTI prevention.

Based on the results, we conclude that:

1) More two-thirds of nurses were had fair knowledge regarding preventive of CAUTI, while only (18.3%) of them had good knowledge.

2) There is a statistically significant difference between knowledge level for preventive measures of CAUTI and demographic characteristics of nurses toward sex only (P-value = 0.042).

Based on the results of the present study, the following can be recommended:

1) Provide written updated guidelines based on evidence to promote urinary catheterization with enough knowledge, and high safe nursing practice to ensure the reduction of the CAUTI rate.

2) Future researchers should compile an evidence-based guideline of CAUTI prevention and catheter care, specifically for nurses.

3) Replication of the study on a larger probability sample acquired from the different geographical areas in a general and private hospitals to figure out the main aspects of these problems.

The authors would like to sincerely thank all those who collaborated in this research, especially the deputy of research of the Public Hospitals at Amran City. We also thank the staff of educational and medical centers and the nurses who participated in this project.

The authors declare no conflicts of interest regarding the publication of this paper.

Haza’a, A.A., Al-Jaradi, A. and Odhah, M.A. (2021) Knowledge of Nurses toward Prevention for Catheter-Associated Urinary Tract Infection in Public Hospitals at Amran City, Yemen. Open Journal of Nursing, 11, 933-946. https://doi.org/10.4236/ojn.2021.1111076

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