Infection Control in the Use of Urethral Catheters: Knowledge and Practices of Nurses in a Private Hospital in Iloilo City

Asia Pacific Journal of Education, Arts and Sciences | Vol. 1, No. 5 | November 2014 _____________________________________________________________________________________________________________________________ Infection Control in the Use of Urethral Catheters: Knowledge and Practices of Nurses in a Private Hospital in Iloilo City MARK LISTER F. OPINA1 and RYAN MICHAEL F. ODUCADO2 Central Philippine University, Jaro, Iloilo City, Philippines1 West Visayas State University, La Paz, Iloilo City, Philippines2 roducado@yahoo.com Date Received: July 14, 2014; Date Revised: October 20, 2014 Abstract – Catheter Associated Urinary Tract Infections (CAUTI) are the most common type of healthcare-associated infections. This study was conducted to determine the relationship between the level of knowledge and practices of nurses on infection control in the use of urethral catheters in a private hospital in Iloilo City. A total of 30 nurses participated as respondents. The result revealed that nurses have low level of knowledge and poor infection control practices in the use of urethral catheters. The nurses’ level of knowledge has a bearing on their practices on infection control in the use of urethral catheters. In view of the fact that low level of knowledge is related to poor infection control practices, nurses need continuous education and trainings in the use of urethral catheters in order to prevent and decrease incidence of CAUTI. Keywords – Infection control, Urethral Catheters I. INTRODUCTION Basic infection control measures in any healthcare set-up can reduce the rates of healthcare associated infections (Dogra et al, 2012). Most often it is observed that a patient comes to the hospital for treatment of particular ailment, but has acquired infection prolonging his hospital stay sometimes leading to septicaemia, multi system organ failure, and death. Hospital acquired infections are not only the problem of the patients but also the patient’s families, hospital staff, and the community (Aarti et al., 2012). Indwelling urethral catheters are the frequent cause of healthcare associated infections (Pellowe, 2009). Catheter Associated Urinary Tract Infections (CAUTI) are the most common type of healthcare-associated infections, accounting for more than 30 percent of healthcare associated infections reported by acute care hospitals (Center for Disease Control and Prevention [CDC], 2012). Virtually all healthcare-associated urinary tract infections are caused by instrumentations of the urinary tract. CAUTI had been associated with increased morbidity, mortality, hospital cost, and length of stay. Each year, more than 13,000 deaths are associated with Urinary Tract Infections (UTI) (CDC, 2009). Urinary catheter use is associated with a range of adverse outcomes, including death (Pellowe, 2009). Infection control knowledge of nurses in the use of urethral catheters should be sufficient and their practices should adhere to recommended guidelines on infection control in all health care settings. However, many nurses have poor knowledge on infection control, and are not adhering to the recommended guidelines and standards (CDC, 2009). Studies on infection control knowledge vary in some places. In India, Dogra et al. (2012) found in a study among 329 nurses that the nurses’ knowledge on infection control was poor. The nurses’ knowledge regarding the infection control and transmission of blood borne pathogens were uniformly poor and their awareness was significantly less compared to the doctors Moreover, in the United States, in a study conducted by Lewis & Thompson (2009) among 150 nurses, results revealed that nurses’ knowledge on infection control was limited. Nurses did not identify any perceived barriers or possible cues to action to increase the likelihood of engaging in proper infection control practices. Furthermore, findings of Kang et al. (2009) in their study of 306 nurses in South Korea revealed that nurses' knowledge on the basic concepts of infection control and environmental management has remained insufficient. Nurses are relatively non-compliant to the guidelines in the areas of education (staff, patient, family) and communication. Infection control practices of nurses were also found to be poor in some studies. In Pakistan, Saleem (2010) found out in a study of 119 nurses that infection control practices of nurses need to be improved as the frequency of infection control measures were also observed to increase with increasing year in the hospital. Moreover, in a study conducted by Dogra et al. 93 P-ISSN 2362 – 8022 | E-ISSN 2362 – 8030 | www.apjeas.apjmr.com Asia Pacific Journal of Education, Arts and Sciences | Vol. 1, No. 5 | November 2014 _____________________________________________________________________________________________________________________________ (2012) on 400 nurses in India, results revealed that the III. MATERIALS AND METHODS A descriptive relational type of research was nurses’ infection control practices were poor. Less than half of the study group used cap, mask and gown as part utilized, and a researcher-made questionnaire was used of the maximal barrier precautions. Nurses used these for data collection. Complete enumeration was used in maximal barrier precautions less in comparison to the study. All nurses who were assigned in units where doctors. Also, Succhitra & Lakshmi (2007) in their catheter insertions were done, and who were able to do study of 50 nurses in India found out that the nurses’ urethral catheter insertions for the past 30 days were practices on infection control remained low. Even the included in the study. A total of 30 nurses participated spread of multi-drug resistant pathogens has not as respondents. Frequency distributions, means, and percentages compelled nurses to adopt the recommended practices. Nurses’ stated multiple reasons for the poor practice were used to describe the data while Gamma test, was which include skin irritation, being too busy, employed to test the relationship between variables set understaffing, inconvenient location of sinks, lack of at 0.05 level of significance, and interpreted using the institutional guidelines, lack of knowledge and Garrett’s scale of interpretation. experience, lack of a role model, and lack of rewards. Furthermore, in another study conducted by Animesh et IV. RESULTS AND DISCUSSION al. (2012) among 120 nurses in India, they found out Table 1 shows that majority of the respondents that infection control practices of nurses were poor. were young with a computed mean age of 25.20 years Overall, nurses were observed to have poor practices on old. Specifically, it can be seen that almost all (90 standard precautions, immunizations, and barrier percent) of the respondents belonged to age group 21 precautions. There is a need for improvement in the 29 years old, single. More than half (56.7 percent) were perception and practice of infection control measures males, while the rest (43.4 percent) were females. among nurses for both self and patient's protection. Alittle more than three-fourths (76.7 percent) were only The International Nosocomial Infection Control Bachelor’s degree holder, while the rest (23.3 percent) Consortium (INICC) used a sampling of Philippine have masteral units. More than half (56.7 percent; 53.3 Hospitals to track infection rates. The prevalence was percent; 53.3 percent respectively) were regular monitored on 1.9% on catheter associated urinary tract employees; were assigned in the wards and have more infection (Rosenthal, 2008). In the Philippines, no than 24 months of clinical experience, with a mean studies have been done showing a successful length of 25. 367 months. A little more than a quarter intervention to reduce CAUTI rates (Berba, 2010). (26.7 percent) had only 1 – 11 months of clinical Despite collaborative efforts, programs, policies, experience, while the rest (20 percent) had 12 – 23 standards, and advances in the health care setting, there months of clinical experience. is still an alarming increased CAUTI cases among varied health care settings. This prompted the conduct Table 1. Distribution of respondents according to of this study. their personal characteristics II. OBJECTIVES OF THE STUDY This study was conducted to determine the knowledge and practices of nurses on infection control in the use of urethral catheters in a private hospital in Iloilo City. It specifically aimed to: determine the personal characteristics of the nurses in terms of age, sex, civil status, educational attainment, employment status, area of assignment, and length of service; determine the nurses level of knowledge on infection control in the use of indwelling urethral catheters; determine the practices on infection control in the use of indwelling urethral catheters; and determine if there is a relationship between the nurses’ level of knowledge and practices on infection control in the use of indwelling urethral catheters. Personal Characteristics Age 21 to 29 years old 30 to 39 years old Mean Age = 25.20 years old ; SD = 3.782 Sex Male Female Civil Status Single Married Educational Attainment Bachelor’s Degree With Masteral Units Employment Status Regular Contractual Area of Assignment Wards Special Area 94 P-ISSN 2362 – 8022 | E-ISSN 2362 – 8030 | www.apjeas.apjmr.com % 90.0 10.0 56.7 43.3 90.0 10.0 76.7 23.3 56.7 43.3 53.3 46.7 Asia Pacific Journal of Education, Arts and Sciences | Vol. 1, No. 5 | November 2014 _____________________________________________________________________________________________________________________________ materials to reduce the risk of encrustination (CDC, Table 1. (cont.) Distribution of respondents 2012). Majority (80 percent) have mistakenly identified according to their personal characteristics Personal Characteristics % antiseptic lubricants to be more beneficial than nonantiseptic lubricants in reducing the risk of (CAUTI). Length of Experience 1 to 11 months 26.7 Several studies comparing antiseptic lubricant to non12 to 23 months 20.0 antiseptic lubricants found no significant differences 24 months and 53.3 (CDC, 2012). A little less than three fourths (70 above percent) have mistakenly considered antimicrobial Mean Clinical Experience = 25.367 months; SD = 17.345 prophylaxis to offer greater benefit in reducing the Knowledge on infection control in the use of urethral incidence of CAUTI for patients requiring long-term catheterization. CDC (2012) suggests that there is no catheters The knowledge on infection control in the use of benefit in using antimicrobial prophylaxis for patients urethral catheters of the respondents is classified undergoing both short and long term catheterizations. according to the considerations and techniques for Moreover, two thirds (66.7 percent) did not know that catheter insertion, the different approaches for routine use of antiseptic lubricants were not necessary catheterization and specimen collecting methods, and in preventing infection caused by urinary catheter proper urethral catheter maintenance. In general, insertion. Routine use of antiseptic lubricants in catheter respondents had a very poor knowledge on infection insertion is not necessary (CDC, 2012). More than half control in the use of urethral catheters. The respondents (63.3 percent) failed to recognize that antiseptic meatal were least knowledgeable about the different cleansing before catheter insertion is not necessary in approaches to catheterization and specimen collecting reducing the incidence of CAUTI. According to CDC methods followed by proper urethral catheter (2012), there is no benefit of antiseptic meatal cleansing maintenance and lastly, on considerations and regimens before, during or after catheterization to prevent CAUTI. Routine hygiene is appropriate. Two techniques for catheter insertion. As shown in table 2, it is alarming to note that a fifths (60 percent) did not know that using alcohol hand little more than two thirds (70 percent) had low level of sanitizer is comparable to hand washing in preventing knowledge. Although some (30 percent) of the nurses CAUTI incidence. Studies have shown that alcohol have average level of knowledge on infection control, hand sanitizer and hand washing have no significant there is still a huge number of nurses who are not aware differences in reducing CAUTI incidence (CDC, 2012). In terms of different approaches for catheterization or knowledgeable about infection control on CAUTI and specimen collecting methods, more than half (60 prevention which in turn may lead to errors, and lapses percent) knew that when obtaining small urine volume that may posed a great risk for patients in acquiring for examination, one should aspirate the urine from the CAUTI during their hospital stay. This is congruent with the findings of Dogra et al. (2012) in a study in needleless sampling port with a sterile syringe after India, of Lewis & Thompson (2009) in the United cleansing the port with a disinfectant. On the other States and of Kang et al. (2009) in South Korea that hand, more than half (53.3 percent) did not know that revealed insufficient or poor knowledge on infection they will obtain large volume of urine for special analysis (not culture) aseptically from the drainage bag. control. According to CDC (2012), when a small volume of fresh urine is needed for examination, aspirate the urine Table 2. Overall level of knowledge on the infection from the needleless sampling port with a sterile control in the use of urethral catheters syringe/cannula adapter after cleansing the port with a Level of Knowledge % High 0.0 disinfectant, so as to avoid entry of bacteria to the Average 30.0 sterile environment inside the catheter. On the other Low 70.0 hand, large volumes of urine for special analyses should be obtained aseptically from the drainage bag. Further, With regards to considerations and techniques for a little less than two thirds (63.3 percent) mistakenly catheter insertion, table 3 shows that two thirds (66.7 identified that meatal cleansing solution postpercent) knew that Silicone is preferable than Teflon catheterization offers greater advantage in preventing and latex-coated materials in reducing the risk of the incidence of CAUTI. For CDC (2012), there is no encrustination for long term catheterized patients who benefit of antiseptic meatal cleansing regimens before, have frequent obstruction. Silicone is preferable to other during or after catheterization to prevent CAUTI. 95 P-ISSN 2362 – 8022 | E-ISSN 2362 – 8030 | www.apjeas.apjmr.com Asia Pacific Journal of Education, Arts and Sciences | Vol. 1, No. 5 | November 2014 _____________________________________________________________________________________________________________________________ Table 3. Distribution according to itemize knowledge on the infection control in the use of urethral catheters Items (Overall Mean = 2.600) Considerations and Techniques for Cathether Insertion (Mean = 2.2667) 1. Silicone is preferable than Teflon-coated and latex catheter materials in reducing the risk of encrustation for long term catheterized patients who have frequent obstruction. 2. Using alcohol hand sanitizer is comparable to hand washing in preventing CAUTI incidence. 3. Antiseptic meatal cleansing before catheter insertion is necessary in reducing the incidence of CAUTI. 4. Routine use of antiseptic lubricants to decrease the risk of infection is necessary for urinary catheter insertion. 5. Antimicrobial prophylaxis offers greater benefit in reducing the incidence of CAUTI for patients requiring long-term catheterization. 6. Antiseptic lubricants are more beneficial than non-antiseptic lubricants in reducing the incidence of Catheter Associated Urinary Tract Infection (CAUTI). Different Approaches to Catheterization and Specimens Collecting Methods (Mean = 1.8667) 7. When obtaining small urine volume for examination, aspirate the urine form the needless sampling port with a sterile syringe after cleansing the port with a disinfectant. 8. If obstruction is anticipated, close continuous irrigation is suggested to prevent obstruction. 9. Obtain large volume of urine for special analysis aseptically from the drainage bag. 10. Meatal cleansing with antiseptic solution post-catheterization offers greater advantage in preventing the incidence of CAUTI. Proper Urethral Catheter Maintenance (Mean = 2.1481) 11. Adding microbial solutions to drainage bags reduce the incidence of acquiring infection. 12. Silver coated catheters increase the risk of urethral irritation and antimicrobial resistance among catheterized patients. 13. There is no benefit of clamping versus free drainage before catheter removal in reducing the risk of bacteriuria in catheterized patients. 14. Bladder irrigation, instillation, or washout using antiseptic or antimicrobial agent is beneficial in preventing CAUTI. 15. Changing indwelling catheters or drainage bags at routine, fixed intervals is recommended for proper catheter maintenance. More than half (53.3 percent) mistakenly identified that close continuous irrigation is not suggested to prevent obstruction. According to CDC (2012), there is a benefit of using a closed rather than open urinary drainage system. In terms of proper urethral catheter maintenance, two thirds (66.7 percent) knew that adding microbial solutions to drainage bags does not reduce the incidence of acquiring infection. There is no benefit of antiseptic instillation in urinary drainage bags according to CDC (2012). More than three fourths (76.7 percent) mistakenly identified that changing indwelling catheters or drainage bags at routine, fixed interval is recommended for proper catheter maintenance. According to CDC (2012), there is no benefit of routine catheter or drainage bag changes to prevent CAUTI. This was based on no difference or an increased risk of symptomatic urinary tract infection and no difference in bacteriuria with routine change compared to as-needed changes or with more frequent changing intervals. Moreover, an alarming less than three fourths (73.3 percent) of the respondents answered incorrectly that bladder irrigation, instillation, or washout using % 66.7 40.0 36.7 33.3 30.0 20.0 60.0 46.7 43.3 36.7 66.7 46.7 30.0 26.7 23.3 antiseptic or antimicrobial agent is beneficial in preventing CAUTI. There is no benefit of antiseptic or antimicrobial bladder irrigation, instillation or washouts in patients with indwelling or intermittent catheters (CDC, 2012). A little less than three fourths (70 percent) mistakenly identified that there is no benefit of clamping versus free drainage before catheter removal in reducing the risk of bacteriuria in catheterized patients. According to CDC (2012), there is no benefit of clamping versus free drainage before catheter removal. More than half (53.3 percent) failed to identify that silver coated catheters do not increase the risk of urethral irritation and antimicrobial resistance among catheterized patients. According to CDC (2012), silvercoated catheters are preferable over standard latex catheters. Practices on Infection Control in the Use of Urethral Catheters The practices on infection control for the use of indwelling urethral catheters of the respondents were classified in three parts: before, during, and after catheter insertion. 96 P-ISSN 2362 – 8022 | E-ISSN 2362 – 8030 | www.apjeas.apjmr.com Asia Pacific Journal of Education, Arts and Sciences | Vol. 1, No. 5 | November 2014 _____________________________________________________________________________________________________________________________ Majority (83.3 percent) used sterile gloves when Table 4. Distribution according overall practice on inserting a catheter which is a good practice. Also, most infection control in the use of urethral catheters of the respondents (80.0 percent) handled and opened Practice (N = 30) % the indwelling catheter correctly and aseptically from its Good 33.3 packaging before catheter insertion. However, it is Poor 66.7 alarming that one sixth (16.7 percent) only used clean As shown in table 4, it is very alarming to note that gloves in catheter insertion while one fifth (20.0 two thirds (66.7 percent) of the respondents had poor percent) opened the indwelling catheter from its practices on infection control. Although some (33.3 packaging incorrectly. Urinary catheter insertions percent) of the nurses had good practices, there is still a should be done in aseptic technique and sterile huge number of nurses prone to making mistakes which equipment should be used (CDC, 2012). Moreover, posed a risk for patients to develop CAUTI. The although two thirds (66.7 percent) had good practices in findings of this study is congruent to the findings of the number of times of using a single pack lubricant Animesh et al. (2012), Dogra et al. (2012), Saleem jelly in their catheter insertions,it is startling that one (2010), and Succhitra and Lakshmi (2007). third (33.3 percent) had poor practices. CDC (2012) In terms of the procedures done before catheter recommends use of single pack lubricant jelly strictly insertion as revealed in table 5, it is disturbing that for single-use. It is also alarming that more than one almost all (96.7 percent) had poor practices in cleaning third (40 percent) of the respondents did not perform the urethra with an antiseptic solution before inserting hand washing prior to catheter insertion and donning of the catheter. According to CDC (2012), there is no sterile gloves which is a poor practice, while only more benefit of antiseptic meatal cleansing regimens before, than half (60 percent) of the respondents performed during or after catheterization to prevent CAUTI. hand washing before insertion. Routine hand hygiene immediately before and after insertion or any Table 5. Correct practices on infection control in the manipulation of the catheter device or site is strictly use of urethral catheters (N = 30) suggested by the CDC (2012). Before Catheter Insertion % In terms of practices during catheter insertion, a 1. Using a pair of sterile gloves for catheter 83.3 little less than three fourths (73.3 percent) had good insertion practices in maintaining an unobstructed urine flow for 2. Opening and handling of indwelling catheter 80.0 the urethral catheter. Good practice includes keeping from its packaging the collecting bag and tube free from kinking to 3. Number of times using a single pack lubricant 66.7 maintain an unobstructed urine flow for the indwelling jelly 4. Washing of hands before catheter insertion 60.0 catheter, while some of the respondents alarmingly 5. Cleaning the urethra with an antiseptic 3.3 pushed 5 mL of sterile water in the needleless port to solution before inserting the catheter maintain an unobstructed urine flow which is an During Catheter Insertion incorrect practice. According to CDC (2012), making 1. Maintaining an unobstructed urine flow for the 73.3 sure that the collecting bag and tube are free from indwelling catheter kinking is the most important and basic way of 2. Amount of sterile water injected in the 53.3 maintaining an unobstructed urine flow for the needleless port to inflate the balloon indwelling catheter because obstruction increases After Catheter Insertion urinary bladder tension, and bacterial colonization. 1. Placement of collecting bag after insertion 100 Three fourths (74.3 percent) injected no larger than 10 2. Ratio of collecting container used per patient 100 milliliters of sterile water in the needleless port to in emptying the collecting bag 3. Use of clean gloves when draining the 80.0 inflate the balloon which is a good practice. No larger collecting bag than 10 ml of sterile water but not lesser than 5 ml is the 4. Pulling out of catheter 56.7 suggested amount to anchor a balloon in the urinary 5. Draining the collecting bag in the collecting 13.3 bladder (CDC, 2012). container In terms of the practices after catheter insertion, all 6. Proper sequence of things to do post-catheter 6.7 (100 percent) had good practices on the placement of insertion the collecting bag after insertion. Collecting bags 7. Implementing Quality Improvement strategies 3.3 should be placed below the bladder at all times and to reduce CAUTI should not touch the floor (CDC, 2012). All (100 8. Wearing of gown when manipulating the 0.0 percent) also had good practices when it comes to the indwelling catheter’s collecting bag 97 P-ISSN 2362 – 8022 | E-ISSN 2362 – 8030 | www.apjeas.apjmr.com Asia Pacific Journal of Education, Arts and Sciences | Vol. 1, No. 5 | November 2014 _____________________________________________________________________________________________________________________________ ratio of collecting container used per patient in (2012), there is no benefit of clamping versus free emptying the collecting bag of the indwelling catheter. drainage before catheter removal. Majority (86.7 This may also attributed to the fact that the hospital percent) had poor practices when they drained the implemented that all admitted patients should have an catheter. According to CDC (2012), when draining the admission kit which contains individual necessity items catheter, contents of the collecting bag should not have for each patient which are needed for his admission any contact with the collecting container through the which also includes a container for draining the drainage spigot as it may serve as a portal of entry for catheter. According to CDC (2012), one container for bacteria colonization. It is also alarming to note that draining the catheter should be utilized by one and the right after catheter insertion, almost all (93.3 percent) same patient all throughout the hospital stay so as to had poor practices on the proper sequence of things to prevent infection transmission. It is however, alarming do post catheter insertion. According to CDC (2012), to know that all 100 percent) had poor practices on accurate documentation had been proven to reduce the wearing of gown during any manipulation of the risk of CAUTI because of system implementation, chart indwelling catheter’s collecting bag. CDC (2012) audit, and correct surveillance. suggested that Standard Precautions, including the use of gloves and gowns, during any manipulation of the Level of Knowledge and Practices on the Infection catheter or collecting system is necessary in preventing Control in the use of Indwelling Urethral Catheters CAUTI because spillage of urine to the nurses’ uniform Table 6 shows that most respondents (77.8 percent) may lead to infection transmission from the nurse to who had an average level of knowledge on infection another patient. Further, although most (80 percent) had control had poor infection control practices. On the good practices in using a pair of clean gloves when other hand, more than half (61.9 percent) of the draining the catheter, it is alarming to know that one respondents who had low level of knowledge had poor fifth (20 percent) had poor practices. Likewise, almost infection control practices. It can be seen that 66.7 all (96.7 percent) had poor practices on implementing percent of all insertions were poorly performed. It was Quality Improvement strategies to prevent CAUTI. noted that there exist a positive very high correlation According to CDC (2012), quality improvement (QI) between the respondent’s level of knowledge and their programs or strategies to enhance appropriate use of practices. The result of this study is congruent to the indwelling catheters and to reduce the risk of CAUTI findings of Aarti et al., (2012), Mohamed (2012) and based on a facility risk assessment should be Paudyal (2008) who found that there is a significant implemented. Less than half (43.3 percent) had poor relationship between level of knowledge and practice. practices in pulling out a catheter. According to CDC Table 6. Relationship between level of knowledge and practices on the infection control in the use of urethral catheters Good Level of Knowledge Average Low Total Gamma = 0.366 f % 2 22.2 8 38.1 10 33.3 r = 0.862 In a study conducted by Aarti et al. (2012) in India among 50 nurses, findings stated that there exist a positive relationship between knowledge and practice. Thus, the persons with requisite knowledge will be better performers in their professional practice in preventing and controlling hospital acquired infections. In addition, Paudyal (2008) also found in a study conducted in Nepal among 166 staff nurses that there exist a positive relationship between infection control f 7 13 20 Practice Poor % f 77.8 9 61.9 21 66.7 30 very high correlation Total % 100.0 100.0 100.0 knowledge and practices. Similarly, Mohamed (2012) found out in a study among 50 nurses in Saudi Arabia that there is a significant relationship between level of knowledge and practice regarding infection control. V. CONCLUSIONS, AND RECOMMENDATIONS Most of the staff nurses are young. This may be because the older nurses are already occupying the managerial positions. This statistics shows that over the 98 P-ISSN 2362 – 8022 | E-ISSN 2362 – 8030 | www.apjeas.apjmr.com Asia Pacific Journal of Education, Arts and Sciences | Vol. 1, No. 5 | November 2014 _____________________________________________________________________________________________________________________________ years, men have been observed to enter the nursing infection rates in six intensive care units of two profession which was traditionally a female dominated cities of Philippines: Findings of the job. Married nurses are already handling managerial international nosocomial infection control and supervisory positions, while single nurses are consortium. Retrieved on March 17, 2010 from handling staff nurses position. Most nurses have not http://shea.confex.com/shea/2010/webprogram/ pursued advance studies in the field of nursing. Center for Disease Control and Prevention. (2009). Majority of the nurses have already been regularized. CAUTI guideline fast facts. Retrieved on July 2, Staff nurses are predominantly working in the general 2012, from http://www.cdc.gov/hicpac/CAUTI wards. Being a young hospital, most of the staff nurses Center for Disease Control and Prevention. (2012). have only just more than 24 months of experience. It is Catheter associated urinary tract infection alarming to know that the nurses had low level of event. Retrieved July 5, 2012 from knowledge and poor practices on infection control in the use of urethral catheters. This indicates that nurses http://www.cdc.gov/nhsn/pdfs need to be educated and trained more on infection Dogra, V., Mishra, B., Jain, M., Thakur, A., & control in the use of urethral catheters. The nurses’ level Loomba, P.S. (2012). Infection control practices of knowledge had a bearing on their practices on among doctors and nurses in a tertiary care infection control in the use of urethral catheters. It is hospital. Annals of Tropical Medicine and highly recommended that the Administration, together Public Health, 5(1):28-33. Retrieved on July 2, with the Continuous Quality Improvement Department, 2012,from http://atmph.org/article.asp the Nursing Service Office, the Training Division, the Infection Control Department, and the Human Resource Kang, J., Cho, J., Kim, J., Kim, D.H., Lee, J., Park, H.K., . . . Lee, E.N. (2009). 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