الفهرس 
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Abstract
Summary
Introduction:
Catheter-associated urinary tract infection (CAUTI) is defined as patients who had a current urinary catheter (UC) in place or had previously inserted a catheter up to 48 hr before the onset of the UTI and who met the clinical, laboratory, and microbiological criteria. Overall, there have been very few studies that focus on understanding CAUTI risk factors, including the indwell time of the catheter (Werneburg, 2022).
Urinary tract infection (UTI) remains one of the most common healthcare-associated infections in the intensive care unit and predominantly occurs in patients with indwelling urinary catheters. Duration of catheterization is the most important risk factor for developing catheter associated urinary tract infection (CAUTI) (Kranz., et al., 2020).
Betadine and normal saline used for indwelling urinary catheter insertion and care in intensive care unit. Betadine 10% Solution is a versatile antiseptic that is used for the treatment and prevention of infection. Normal sterile saline is.9% saline that regarded as the most appropriate and preferred cleansing solution because it is a nontoxic, isotonic solution (Sarani., et al., 2020).
Aim of the study:
This study aims to assess the effect of betadine versus normal saline on urinary tract infection among patients with indwelling urinary catheter through the following:
1. Assess the effect of betadine on urinary tract infection among patients with indwelling urinary catheter.
2. Assess the effect of normal saline on urinary tract infection among patients with indwelling urinary catheter.
3. Compare the presence of urinary tract infection among patients who received urinary catheter care with normal saline and versus urinary catheter care with betadine.
Research Questions:
The current study will answer the following questions:
1. What is the effect of betadine on urinary tract infection among patients with indwelling urinary catheter?
2. What is the effect of normal saline on urinary tract infection among patients with indwelling urinary catheter?
3. Is there a difference between betadine versus normal saline on urinary tract infection among patients with indwelling urinary catheter?
Subjects and Methods:
Research Design:
Quasi experimental research design was utilized in this study.
Setting:
The study was conducted at Intensive Care Unit of Assiut police Hospital, affiliated to the medical services sector at the Ministry of Interior, which contains 10 beds.
Subjects:
The study subjects composed of purposive sample of 70 female patients who were included in this study with indwelling urinary catheter where selected according to certain inclusion criteria.
Tools of data collection
I: Patient Assessment Tool Appendix (I):
It included two parts:
Part I: Patients’ Demographic Data:
It concerned with patients personal data as: age, marital status and educational level, Occupation, and Resident,.
Part 2: Patients’ Clinical Assessment Tool:
It include assessment of patients’ clinical data and health assessment, such as present history (diagnosis, chronic illness, level of consciousness, patient activity level, risk factors for infection, length of stay and date of insertion) and past history (previous experience of catheterization, and previous history of UTI). It was adapted from(Fasugba, et al., 2019).
Part 3: Catheter assessment among the studied patients:
It include assessment of catheter such as(indications for catheterization, catheter type, catheter size, catheter lumen, catheter material, frequency of urinary catheter care provided, duration of catheter insertion, type of fluid used for catheter insertion, type of fluid used for catheter care provided, urinary catheter irrigation, type of fluid used for irrigation, reason for irrigation, vital signs and antibiotic that used).It was adapted from (McNeill., 2017).
II: Urinary Tract Infection Clinical Symptoms Assessment Tool Appendix (II):
Used to assess urinary tract infection symptoms such as (strong smell urine, urine contains blood, painful burning sensation, cramping in the pelvic area or back and discomfort in the lower abdomen, and fever). It was adapted from (Abdel-Hakeim and Hamza., 2018)(Fasugba, et al., 2019).
III: Urine Microbiological Analysis Appendix (III):
It was used to assess the presence of urinary tract infection in urine sample from catheter. It consisted of urine microscopic analysis (pus cell, epithelial cells, bacteria and casts) and urine culture report (colony count, positive/negative) and type of organism. It was adopted from (Public Health England Investigation of Urine, 2014).
Operational design:
The operational design included preparatory phase, tool reliability, pilot study and field work.
Preparatory phase:
It was include reviewing current and past, national and international related literature and theoretical knowledge of various aspects of the study using articles, books, network data base, periodicals, and magazine to develop tools for data collection.
Testing Validity and reliability:
Content validity:
The tools were revised for content validity by a jury of 5 experts in the medical surgical nursing staff at the faculty of nursing, Ain Shams University. Three of them were professors and two assistant professors. Required modifications were done. The jury reevaluated the tool for clarity, relevance, comprehensiveness and applicability and simplicity.
Reliability Test:
Testing reliability of the proposed tools was done by alpha Cronbach test used to measure the consistency of the tools used under study, which was 0.85.
A pilot study:
A pilot study was carried out in the ICU department of Assuit Police Hospital on 10% of the subjects (7 patients) under the study to test the clarity, applicability, feasibility of the tools used in the study and determine the time needed to answer the study tools. Teams which were included in the pilot study were included into the study sample because no modifications were done after conducting pilot study.
Field work:
An approval was obtained from the director of Assuit Police Hospital. The researcher first met the patients as the previously mentioned sitting and explained the aim and nature of the study after introducing himself. The questionnaire tool filled by the researchers who interviewed the patients individually.This study was carried out through a period of three months(from August2022 to October 2022). This study was carried out 3 times per week (Saturday-Tuesday-Thursday) in morning and afternoon shifts. The average time required to fill full the questionnaire tool was (25- 35) minutes. Purposive sample of 70 female patients with indwelling urinary catheter. They was selected according to certain inclusion criteria.
Administrative design:
An official letter was issued from the faculty of nursing / Ain shams University explaining the aim of the study to obtain the permission for collecting of the data; this letter was submitted to the hospital directors at Assiut Police Hospital.
Ethical consideration:
• The research proposal was approved from Ethical Committee in the Faculty of Nursing Ain Shams University.
• There was no risk for the study subjects during application of the research.
• The study followed common ethical principles in the clinical research.
• Confidentiality and anonymity were assured.
• Patients had the right to agree or disagree to participate in the study and to withdraw them from the study at any time without any effect on the care provided for their patients.
• Study subjects privacy was considered during the collection of data.
Statistical Design:
The collected data were organized, tabulated and statistically analyzed using SPSS software (Statistical Package for the Social Sciences, version 23, SPSS Inc. Chicago, IL, USA). The categorical variables were represented as frequency and percentage. Friedman test was used to test differences related categorical variables in related groups. Chi-square test was used to test the differences between categorical variables. Statistically significant was considered at p-value ≤ 0.05 &0.01.
Result of the study:
The important findings that were obtained from the study can be summarized as follows:
• Demographic characteristics of the studied patients revealed that their mean age was 37.76+ 10.9 years. Also, 52.9% of them were married and 38.6% of them were housewife. Additionally, 45.7% of the studied patients had secondary education and 54.3% of the studied patients were from urban residence.
• Regarding to their present health history that, 44.3% of the studied patients had neurological diagnosis and 38.6% of them were oriented. Also, regarding activity level, 60.0% of them were mobile. Additionally, 67.1% of them had hospitalized for 1-4 days with mean length of stay 4.20+1.90 days
• The most common chronic disease revealed 31.4% of the studied patients were diabetes mellitus among both groups, 84.3% of the studied patients were the most common risk factors inadequate fluid intake among both groups respectively
• Regarding to their past health history that 84.3% of the studied patients had previous history of UTI and previous experience of catheterization among both groups respectively.
• Urinary catheter care provided twice daily among 41.4% of the studied patients. Additionally, urinary catheter irrigation was done among 75.7% of the studied patients.
• Regarding to their urine analysis findings, 82.9% of the studied patients in betadine group had bacteria in urine analysis, 77.1% in normal saline group had bacteria in urine analysis. While, 80.0% of the studied patients in betadine group had no casts in urine analysis, while the majority 88.6% in normal saline group had no casts in urine analysis.
• 85.7% of the studied patients in betadine group had pus cells in urine analysis. 57.1% of the studied patients in normal saline group had pus cells in urine analysis. While, 88.6% and 80.0% of the studied patients in betadine group and normal saline group had no epithelial cell in urine analysis respectively.
• According to relationship between studied patient’s length of hospital stay and type of fluid used for catheter care there was length of hospital stay has no significant statistical relation with type of fluid used for catheter care and growth of microorganism in urine culture at P-value=> 0.05.
• Significant statistical relation with pus cells in urine analysis at P-value=≤ 0.05. While, type of fluid used for catheter has no significant statistical relation with bacteria, casts and epithelial cell in urine analysis at P-value= > 0.05.
Conclusion:
Based on findings of the current study, it can be concluded that, Regarding to effect of betadine and normal saline on urinary tract infection, about three quarters of the studied patients in betadine group had positive growth of microorganism in urine culture. Regarding to effect of normal saline on urinary tract infection, the majority of the studied patients in normal saline group had positive growth of microorganism in urine culture.
Concerning the difference between betadine and normal saline on urinary tract infection, there was no statistically significant difference between betadine and normal saline in relation to urinary tract infection among patients with indwelling urinary catheter.
Recommendations:
On the light of the present study, the following recommendations are made:
• Replication of the study on alarger probability sample acquire from different geographical areas to achieve more generalized results.
• Further researches have to be carried out in order to determine best practice regarding management of urethral care.
• Further studies regarding knowledge gap concerning early predictions to prevent infection for catheter care.
• Develop plan for health education program about proper screening and prevention of infection for catheter.
• The need for further multidisciplinary collaboration between nurses, physicians, patient’relatives to increase awareness of early signs and symptoms, management to prevent catheter infection.
• Further study is also recommended to be done to compare the efficacy of normal saline or betadine with other antiseptic solutions as cholorhexidine.