The effect of developing nursing practice guidelines to prevent hospital-acquired urinary tract infections in pediatrics with indwelling urinary catheters

Abstract

Objective : To develop nursing guidelines and assess the outcomes of implementing these guidelines to prevent urinary tract infections associated with catheterization at Mahasarakham Hospital.

Methods: The study utilized a nursing practice development model based on the Iowa Model, developed by Tiler et al. (2001), and applied it to a group of 23 professional nurses and 20 patients. The tools used in the study included nursing manuals and guidelines for preventing urinary system infections in pediatric patients with indwelling catheters, as well as a practice flowchart, an evaluation form for nursing practice, and a satisfaction survey for nurses regarding the guidelines. The nursing guidelines for preventing hospital-acquired urinary system infections in pediatric patients with catheters were validated for content accuracy by three experts. Data were analyzed using frequency, percentage, mean, standard deviation, the Chi-square test, and Fisher’s exact probability test.

Results : The majority of the sample, both before and after the intervention, were male (67.0% and 70.0%, respectively) and aged between 10-15 years (52.3% and 54.8%). The first catheterization site at the hospital, both before and after the implementation of the nursing guidelines to prevent urinary tract infections in pediatric patients, was primarily in the pediatric intensive care unit (68.7% and 71.4%). Most patients presented with severe lung infections (63.5% and 68.8%, respectively). Professional nurses working in the pediatric ward and pediatric intensive care unit adhered to the nursing guidelines to prevent urinary tract infections in pediatric patients. Overall, 87.8% of the practices were correct, and 12.3% were not performed. The urinary tract infection rate in patients with indwelling catheters decreased from 10.6 to 0.9 per 1,000 catheter days after implementing the nursing guidelines, with a statistically significant difference at the 0.05 level. Overall, nurses' satisfaction with the nursing guidelines was high (X̅=3.5).

Conclusion : Nursing administrators should establish guidelines and policies for healthcare personnel to effectively follow measures to prevent urinary tract infections associated with catheterization in pediatric patients. Additionally, clear nursing standards should be developed for use as a reference.