Urinary Catheterisation Practices: A Survey of Italian Healthcare Workers

Abstract

1 Introduction and Objectives: Bladder catheterisation is a high-risk procedure linked to complications like catheter-associated urinary tract infections. Guidelines aim to reduce these risks, but adherence is challenged by factors such as workload and training. Studies among Spanish and Swedish nurses identified barriers like understaffing and lack of supervision, suggesting the potential influence of systemic factors on this procedure. This study aims to explore the behaviour of nurses in Italy regarding bladder catheterisation.

2 Material and Methods: A cross-sectional survey was distributed among Italian nurses between June and November 2024. The anonymity of the participants was maintained, and the survey included questions regarding the professional area, experience in bladder catheterisation, supervision and assistance received, sterility of the procedure, use of the urine collection bag and other accessories, occupational risks and stress felt during the procedure. The data was tabulated and analysed using descriptive statistics.

3 Results: Of the 131 participants, the vast majority were nurses (85.2%) mainly from surgical (35.1%), medical (11.8%) and emergency areas (13.7%). 61.1% of respondents had extensive experience in urinary catheterisation (more than 100 insertions) and only 16% had performed fewer than 50 insertions. Fifty-eight percent indicated that they were never or rarely supervised during the procedure and only 17.6% indicated they always had help, which generated a lot or moderate stress in 17.5%. The main causes of this stress were the time available to perform the procedure (18.1%), the risk of inflating the balloon in the urethra (10.8%) and maintaining sterility when collecting the urine sample (10.8%).

Just over half of the participants (53.4%) asserted to always be able to maintain sterility. 38.2% of participants admitted to soiling the material with urine 1–5 times, 29.8% the patient's clothes or sheets, and 18.3% the patient or themselves. However, only 36.6% of participants reported urine contamination but 58.4% would report it after knowing that Ebola, SARS and Covid-19 can be transmitted through urine.

When asked about the potential advantages of a urinary catheter with an integrated valve, the most significant advantage cited was a greater ease in obtaining a sterile urine sample (48.1%), followed by the reduced risk of urine leakage (43.5%) and the absence of stress from not having to connect a urine bag or plug (35.9%). 95.4% would recommend using it in their hospital/clinic.

4 Conclusion: This study reveals significant challenges for Italian nurses in performing bladder catheterisation, including limited supervision, lack of assistance and associated occupational stress. These findings align with those from other countries, underscoring a need for systemic improvements in catheterisation practices. Device innovations may help improve compliance with safety protocols, enhancing patient safety and reducing occupational risks.