Urinary catheterisation among nurses in Sweden: A survey on routines and guideline adherence

Introduction and Objectives

Bladder catheterisation is a common and invasive procedure with guidelines that can prevent or minimize associated complications. However, healthcare workers often do not follow these guidelines. Healthcare systems' strategies, policies and practices which support quality of care could affect the level of guideline adherence. This could be explored by studying adherence in a high-performing healthcare system with extensive monitoring of health outcomes, such as Sweden. Moreover, there is a lack of relevant literature about the knowledge, attitudes and practices of healthcare workers regarding CAUTI. This study therefore aims to investigate how nurses in Sweden perform bladder catheterisation and identify potential ways to improve adherence to guidelines in order to decrease complications.

Materials and Methods

A cross-sectional survey was performed between the 21st and 29th of May 2020. A survey including questions on supervision during bladder catheterisation, maintenance of sterility, accidental urine spillage, and potential advantages of a urinary catheter with an integrated valve was distributed through social media channels to Swedish nurses. Participants were anonymous and no personal data was collected. The data was tabulated and analysed using descriptive statistics (Microsoft Excel).

Results

A total of 910 nurses responded to the survey. Respondents worked across several settings, and 76.1% worked within surgical, internal medicine, prehospital, geriatrics or primary care clinics. Respondents had various levels of experience in placing catheters, with 40.3% having inserted less than 50 catheters, and 31.5% having inserted more than 100.

54.9% reported that someone had checked that they followed guidelines during catheter insertion. A majority (66.5%) either often or sometimes received assistance during insertion, with only 9.3% always receiving help. Only 9.9% reported always being able to maintain sterility during insertion.

58.6% reported inadvertently spilling urine on the material (protective sheet, diaper) 1–5 times during their last 10 catheter insertions, 24.8% reported spilling on the bed or linen, and 15.7% on themselves, the patient or other healthcare staff.

When asked about the potential advantages of a urinary catheter with an integrated valve, the most significant advantage cited was the reduced risk of urine leakage (63%), followed by the absence of stress from not having to connect a urine bag or plug (52.1%). 96% of respondents see at least one advantage in such a device.

Conclusions

Nearly half of nurses have not been audited concerning guideline adherence during bladder catheterisation. Only 10% are able to always maintain sterility, and it is common to spill urine during the catheterization process. Virtually all nurses see at least one advantage in a urinary catheter with an integrated valve.