An Educational Program to Improve Nursing Staff Attitudes Toward Preventing Urinary Tract Infections Associated with Catheters in Kirkuk City, Iraq

Introduction

Urinary tract infections associated with catheters (UTIAC) are the leading cause of nosocomial infections globally, with the World Health Organization (WHO) reporting 7.1 million cases annually. These infections cause significant morbidity and mortality, with various factors contributing to their prevalence, including the increased frequency of invasive medical procedures and inadequate infection control practices. Urinary tract infections (UTIs) can affect any part of the urinary system, including the urethra, bladder, ureters, and kidneys. Between 70% to 80% of these infections are due to indwelling urethral catheters (IUC), with this percentage rising to 95% in critical care units. Moreover, up to 50% of patients may have catheters inserted without appropriate indications. Risk factors for UTIAC include female gender, extended catheterization, immunocompromised status, advanced age, and prolonged hospital stays. According to the Centers for Disease Control and Prevention (CDC), UTIAC accounts for 32% of all HAIs in the United States, resulting in approximately 449,000 cases annually and costing an estimated $450 million. Despite this, a significant proportion of UTIAC cases and related mortalities can be prevented by adhering to recommended infection control measures.

Nurses play a critical role as primary healthcare providers responsible for inserting and maintaining urinary catheters. Therefore, it is essential that they are knowledgeable and maintain a positive attitude towards UTIAC prevention. This study assesses the effectiveness of an educational program designed to improve nursing staff attitudes towards preventing urinary tract infections associated with catheters at Kirkuk General Hospital.

Methods

A pre-experimental one-group pre- and post-test design was utilized to evaluate the effectiveness of the educational program on nursing staff attitudes towards UTIAC prevention. The study was conducted in the Respiratory Care Unit (RCU), Coronary Care Unit (CCU), and Intensive Care Unit (ICU) at Kirkuk General Hospital.

Study Sample: A purposive sample of 54 nursing staff was selected for the study.

Instrumentation: The tool used in this study was developed by the researcher and consisted of two parts:

1. Demographic Data: This section collected information on age, gender, educational level, years of experience, and training courses received.
2. Nursing Staff Attitudes: This section included 10 items related to UTIAC prevention based on previous studies and CDC guidelines. Responses were rated on a three-point Likert scale: (3) Agree, (2) Neutral, (1) Disagree, with both positive and negative statements included.

Validity and Reliability: A panel of experts reviewed the study tool and educational program for validity. A pilot study involving 5 nurses from Kirkuk General Hospital was conducted to assess the questionnaire's reliability, which yielded a reliability coefficient of 0.72.

Data Analysis: Data were analyzed using SPSS version 22, employing both descriptive and inferential statistical methods.

Results

The study included 54 nursing staff members, with a majority being male (55.6%) and most participants under the age of 25 (51.9%). The mean age of the participants was 24.89 ± 2.95 years. Most of the participants were graduates of a nursing college (83.3%), and the majority had between 1 and 2 years of work experience (40.7%). Only 13% of the nursing staff had received training on UTIAC prevention.

Effectiveness of Educational Programs: The educational program significantly improved nursing staff attitudes towards UTIAC prevention. The mean attitude score increased from 42.41 ± 15.50 before the program to 77.04 ± 9.93 after the program, with a statistically significant mean difference of 34.63 (P = 0.000).

Relationship between Attitudes and Socio-Demographic Characteristics: The ANCOVA analysis revealed no statistically significant relationship between nursing staff attitudes and their demographic characteristics, including gender, age, educational level, years of experience, or previous training.

Table (1): Distribution of the studied socio-demographical characteristics variables (SDCv.) of Nursing Staff (n=54)

Table (2): Descriptive Statistics of effectiveness of educational programs on Attitudes regarding pre/post periods with Comparisons Significant

^(*) HS: Highly Sig. at P<0.01; Testing based on Wilcoxon Signed Ranks test, since the data concerning Knowledge in the pre-period does not follow the normal distribution shape, so used a nonparametric test. Assessments Intervals Scoring Scales: [L: low (0.00 – 33.33)]; [M: Moderate (33.34 – 66.66)]; [H: High (66.67 – 100)].

Table (3): (Analysis of Co-Variance-ANOVA) of Relationships between Knowledge, Attitude, and Practices of the study group and their (SDCv.):

^(*) HS: Highly Sig. at P<0.01; Non-Sig. at P>0.05; Statistical hypothesis based on Analysis of Eight-ways (ANCOVA) of main effects.

Discussion

The study demonstrated a significant improvement in nursing staff attitudes towards UTIAC prevention following the educational program. The findings are consistent with previous studies that have shown similar improvements in attitudes following educational interventions. Despite the positive outcomes, the study also highlighted the critical need for ongoing training, particularly given the low percentage of nurses who had previously received training on UTIAC prevention.

Conclusion

The educational program effectively improved nursing staff attitudes towards UTIAC prevention, highlighting the importance of regular training and adherence to CDC guidelines. The findings suggest a growing trend of males joining the nursing profession in Kirkuk City, challenging the traditional perception of nursing as a female-dominated field in Iraq.

Ethical Considerations

The study was approved by the Scientific Research Ethical Committee at the College of Nursing, University of Kirkuk. Informed consent was obtained from all participants, and they were given the opportunity to learn about the study's objectives and voluntarily participate.

Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author Contributions: All authors contributed to the study's conception, writing, and review of the final manuscript.

Disclosure Statement: The authors declare no conflict of interest.

Acknowledgments: The authors thank the anonymous referees for their valuable suggestions.