The quality of critical care in relation to the incidence of nosocomial urinary tract infections: Kenyatta National Hospital - Intensive Care Unit

Abstract

Urinary tract infections (UTls) are the most common nosocomial infections in both acute care settings and long-term care facilities. In the acute care settings a vast majority of UTls occur in patients with temporary urinary catheters. Nosocomial catheter-associated urinary tract infections have been one of the major problems in the Intensive care unit and have contributed to the mortality and morbidity of the patients. Efforts to contain the problem have resulted in the introduction of guidelines to reduced the incidence and prevalence of the nosocomial UTI. Such measures have·been implemented in the developed world; unfortunately the developing countries have not duplicated the same. This descriptive cross-sectional study aimed at determining the quality of critical care in relation to the incidence of nosocomial catheter-associated urinary tract infection (NCAUTI) at Kenyatta National Hospital's, Intensive Care Unit. Through participant observation, doctors and nurses were observed as they managed patients with temporary indwelling urinary catheters and questionnaires administered to them. Urine specimens were collected and analyzed in the laboratory for growth of microorganisms to determine the incidence of NCAUTls. Key informants were interviewed to determine the role of the Quality assurance and the Infection Control committees. The findings of the study indicate that a majority of the healthcare personnel had not attended an update course in Infedion control. The practice level on the care of an indwelling catheter in the ICU/HDU was inadequately done as compared to the internationally accepted standards. The Incidence of NCAUTI was determined to be 18% with the common isolated microorganism being Escherichia coli. Based on the findings, it is therefore recommended that; a standard for urinary catheter care should be developed and made available for use in the ICU. There should be updatel refresher courses on the care of an indwelling urethral catheter for the health personnel in the Intensive care Unit. There should be regular audits by QAP and ICP of the care given. Studies should be done covering other areas of the hospital to get a more generalizable picture.