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A prospective study of nosocomial urinary tract infection in hip fracture patients
Department of Orthopaedics, Örebro University Hospital, Örebro, Sweden.ORCID iD: 0000-0003-0460-3864
Department of Urology, Örebro University Hospital, Örebro, Sweden.
Örebro University, School of Health and Medical Sciences.
Örebro University, School of Health and Medical Sciences.ORCID iD: 0000-0002-8658-3360
2011 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 17-18, p. 2531-2539Article in journal (Refereed) Published
Abstract [en]

Aim.  To investigate risk factors and consequences of nosocomial urinary tract infection in hip fracture patients. Background.  Nosocomial urinary tract infection is a well-known problem in hip fracture patients. There are several risk factors for nosocomial urinary tract infection described in the literature.

Design.  Prospective observational study with a descriptive and comparative design.

Methods.  Hip fracture patients were included consecutively between April 2006-March 2007. Excluded were those under 50, having an indwelling urinary catheter, signs of cognitive impairment or additional severe physical problems at the time of admission. To verify nosocomial urinary tract infection, a urine specimen was taken at admission and discharge. Patients with and without nosocomial urinary tract infection were compared.

Results.  The study included 86 hip fracture patients, of whom 45 (52·3%) contracted nosocomial urinary tract infection in hospital. Earlier reported risk factors for nosocomial urinary tract infection were not confirmed in this study, with one exception: diabetes. All diabetic patients in the study contracted urinary tract infections. Patients receiving cloxacillin as antibiotic prophylaxis for wound infection contracted UTI less often than other patients. There were no statistical differences between groups with regard to urinary tract infection frequency four months after fracture or with regard to mortality after one year.

Conclusion.  Diabetes was the only previously known risk factor for nosocomial urinary tract infection confirmed among hip fracture patients in this study. Cloxacillin as antibiotic prophylaxis for surgery seemed to offer a certain protection against nosocomial urinary tract infection. Relevance to clinical practice.  Nurses in clinical practice should be aware of the risk of urinary tract infections in hip fracture patients and especially in hip fracture patients with diabetes. Patients given cloxacillin as antibiotic prophylaxis seem less likely to contract nosocomial urinary tract infection.

Place, publisher, year, edition, pages
2011. Vol. 20, no 17-18, p. 2531-2539
Keywords [en]
hip fracture, nosocomial urinary tract infection, nurses, nursing, risk factors, urinary catheterisation
National Category
Nursing
Research subject
Nursing Science
Identifiers
URN: urn:nbn:se:oru:diva-16578DOI: 10.1111/j.1365-2702.2011.03769.xISI: 000293748900015PubMedID: 21733026Scopus ID: 2-s2.0-80051575875OAI: oai:DiVA.org:oru-16578DiVA, id: diva2:434411
Available from: 2011-08-15 Created: 2011-08-15 Last updated: 2017-12-08Bibliographically approved
In thesis
1. Urinary catheter policies for short-term bladder drainage in hip surgery patients
Open this publication in new window or tab >>Urinary catheter policies for short-term bladder drainage in hip surgery patients
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to evaluate methods for urinary catheter handling in patients undergoing hip surgery. The intention was to gain knowledge in order to provide optimal and cost- effective care regarding urinary catheterisation in this group of patients.

In Study I , 45 of the 86 catheterised patients (52%) contracted nosocomial urinary tract infections (UTIs). Diabetes was a risk factor for developing UTI, and cloxacillin as a perioperative antibiotic prophylaxis seemed to offer a certain protection. Study II was a randomised controlled trial on the effect of clamping (n = 55) or not (n = 58) of the indwelling urinary catheter before removal. No significant differences were found between the groups with respect to time to normal bladder function, need for recatheterisation, or length of hospital stay. Study III was a randomised controlled trial among patients with hip fracture and hip arthroplasty, in which the patients were randomised to intermittent (n = 85) or indwelling (n = 85) urinary catheterisation. No significant differences in nosocomial UTIs (9% vs. 12%) or cost-effectiveness were shown. The patients in the intermittent group regained normal bladder function significantly sooner after surgery. Fourteen percent of the patients in the intermittent group did not need any catheterisation. In Study IV , 30 patients were interviewed about their experiences of bladder emptying and urinary catheterisation. The patients’ views were described through the main category ‘An issue but of varying impact’. Both bladder emptying through micturition and bladder emptying through catheterisation were described as convenient, but also as uncomfortable and an intrusion on dignity. The patients were aware of risks and complications of urinary catheterisation.

In conclusion, this thesis indicates that UTI is common in hip surgery patients. Clamping of indwelling catheters seems not necessary. There is no preference for either intermittent or indwelling urinary catheterisation according to the results of this thesis, either for the development of nosocomial UTI or, for cost-effectiveness, or from the patient perspective. Nurses should be aware that catheterisation might make the patients feel exposed, and it is essential that their practice reflect the best available evidence.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2012. p. 75
Series
Örebro Studies in Care Sciences, ISSN 1652-1153 ; 38
Keywords
Urinary catheterisation, nosocomial urinary tract infection, hip fracture, hip arthroplasty, nursing, patient experiences, clamping
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-22505 (URN)978-91-7668-870-0 (ISBN)
Public defence
2012-06-01, Wilandersalen, Universitetssjukhuset, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2012-04-12 Created: 2012-04-12 Last updated: 2017-10-17Bibliographically approved

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Hälleberg-Nyman, MariaJohansson, Jan-ErikPersson, KatarinaGustafsson, Margareta

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