Effectiveness and safety of a simple catheter securement device aimed at preventing catheter-associated urinary tract infection in intensive care unit patients: A randomized controlled trial.

BACKGROUND: Clinical practice guidelines for the prevention of catheter associated urinary tract infection (CAUTI) recommend urinary catheter securement in critical patients although there is scant research on its effectiveness. AIM: To analyse whether securement of an indwelling urinary catheter (IUC) reduces the risk of CAUTI and meatal pressure injury among intensive care unit (ICU) patients and assess medical adhesive-related skin injury (MARSI) associated with the securement device. STUDY DESIGN: Open randomized controlled trial involving patients admitted to two ICUs in Spain. In the intervention group (n = 169 patients), the IUC was secured to the thigh using an in-house device piloted as part of this trial. Controls (n = 181) received standard care, including non-securement of the IUC. Barrier film spray was applied to the securement site with the aim of preventing MARSI. The definitions of the main outcomes were: CAUTI was diagnosed according to the criteria of the European Centre for Disease Prevention and Control, meatal pressure injury was categorized into four grades and MARSI was classified as either erythema or skin tears. Bivariate analysis and multivariate logistic regression were performed. Log-rank and Cox regressions were used to compare risk over time to CAUTI and meatal pressure injury in the two groups. RESULTS: Data from 350 patients were analysed, 169 (48.29%) from IG and 181 (51.71%) from CG. In the multiple logistic regression analysis, IUC securement was an independent protective factor against both CAUTI (RR = 0.2, 95% CI [0.05, 0.67]) and meatal pressure injury (RR = 0.31, 95% CI [0.15, 0.58]). The incidence of MARSI was 7.1%. CONCLUSION: Effective IUC securement significantly reduces the risk of CAUTI and meatal pressure injury among ICU patients. The in-house device piloted in the present trial is simple for nurses to use, and the incidence of MARSI was low. These results underline the benefits of IUC securement. RELEVANCE TO CLINICAL PRACTICE: Indwelling urinary catheter (IUC) securement reduces the risk of urinary tract infection. IUC securement helps prevent meatal pressure injury. IUC securement with in-house devices is safe and effective.

Knowledge and beliefs of intensive care nurses about urinary catheter securement: Results of a national survey.

OBJECTIVE: To explore the knowledge and beliefs of intensive care nurses about urinary catheter securement. METHOD AND SETTING: A self-report survey tool comprising 19 questions (15 closed, 4 open-ended) was developed through consultation with a panel of experts and then disseminated electronically to nurse members of two societies for critical care medicine and nursing in Spain. Responses were analysed by calculating descriptive statistics and through qualitative analysis. MAIN OUTCOME MEASURES: Nurses' self-reported knowledge and beliefs about urinary catheter securement in the intensive care patient. RESULTS: Responses of 333 nurses were analysed. Most respondents considered that urinary catheter securement was beneficial for patients (n = 261, 78.4 %) and that it reduced the risk of both meatal pressure injury (n = 266, 79.9 %) and accidental tugging (n = 304, 91.3 %). Regarding the securement procedure, less than a quarter of nurses mentioned the use of barrier film to protect the skin at the securement site (n = 62, 18.6 %) or the need to leave slack in the tube to avoid tugging (n = 45, 13.5 %). Qualitative analysis of responses to open-ended questions revealed that some nurses believed that catheter securement was contraindicated due to the risk of skin injury, or that it interfered with some aspects of basic care, thus increasing their workload. CONCLUSIONS: There appears to be a lack of knowledge among Spanish intensive care nurses about recommended procedures for securing a urinary catheter. Clear and concise guidelines for the intensive care setting are required to ensure safe and standardised practice without creating additional burden for nurses. IMPLICATIONS FOR CLINICAL PRACTICE: Lack of knowledge among intensive care nurses about how to secure urinary catheters may pose certain risks to patients, therefore specific training in how to secure a urinary catheter is needed.

Related factors to semi-recumbent position compliance and pressure ulcers in patients with invasive mechanical ventilation: An observational study (CAPCRI study).

BACKGROUND: Semi-recumbent position is recommended to prevent ventilator-associated pneumonia. Its implementation, however, is below optimal. OBJECTIVES: We aimed to assess real semi-recumbent position compliance and the degree of head-of-bed elevation in Spanish intensive care units, along with factors determining compliance and head-of-bed elevation and their relationship with the development of pressure ulcers. Finally, we investigated the impact that might have the diagnosis of pressure ulcers in the attitude toward head-of-bed elevation. METHODS: We performed a prospective, multicenter, observational study in 6 intensive care units. Inclusion criteria were patients ≥18 years old and expected to remain under mechanical ventilator for ≥48h. Exclusion criteria were patients with contraindications for semi-recumbent position from admission, mechanical ventilation during the previous 7 days and prehospital intubation. Head-of-bed elevation was measured 3 times/day for a maximum of 28 days using the BOSCH GLM80(®) device. The variables collected related to patient admission, risk of pressure ulcers and the measurements themselves. Bivariate and multivariate analyses were carried out using multiple binary logistic regression and linear regression as appropriate. Statistical significance was set at p<0.05. All analyses were performed with IBM SPSS for Windows Version 20.0. RESULTS: 276 patients were included (6894 measurements). 45.9% of the measurements were <30.0°. The mean head-of-bed elevation was 30.1 (SD 6.7)° and mean patient compliance was 53.6 (SD 26.1)%. The main reasons for non-compliance according to the staff nurses were those related to the patient's care followed by clinical reasons. The factors independently related to semi-recumbent position compliance were intensive care unit, ventilation mode, nurse belonging to the research team, intracranial pressure catheter, beds with head-of-bed elevation device, type of pathology, lateral position, renal replacement therapy, nursing shift, open abdomen, abdominal vacuum therapy and agitation. Twenty-five patients (9.1%) developed a total of 34 pressure ulcers. The diagnosis of pressure ulcers did not affect the head-of-bed elevation. In the multivariate analysis, head-of-bed elevation was not identified as an independent risk factor for pressure ulcers. CONCLUSIONS: Semi-recumbent position compliance is below optimal despite the fact that it seems achievable most of the time. Factors that affect semi-recumbent position include the particular intensive care unit, abdominal conditions, renal replacement therapy, agitation and bed type. Head-of-bed elevation was not related to the risk of pressure ulcers. Efforts should be made to clarify semi-recumbent position contraindications and further analysis of its safety profile should be carried out.