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Created by:
Nur Hanief M.B
P27220006058
LEGALIZATION SHEET
Legalized on
Date:
Place:
Acknowledge by,
Widodo, MN
NIP.
PREFACE
Thanks to God thats give me chance to finish this proposal research with title
Study Descriptive between Indwelling Urinary Catheter Use and Incidence of
Urinary Tract Infection in Adult Client in Sanglah Hospital 2008. This proposal
is arranged to fulfill the task of research subject in 4th semester.
In this chance, the researcher thanks to every body that helped the researcher
to finishing this proposal. The researcher realizes that without their help the
researcher wouldnt fine difficulties in doing this proposal. This proposal is far
from being perfect; however with the strong and hard working the researcher
could finish the duty.
As this proposal has been completed, the researcher thanks to:
1. Mrs. Rita Benya Adriani, S. Kp. M. Kes
As the director of Polytechnic of Health of Surakarta for giving chance to the
researcher to make the research proposal
2. Mr. Satino, SKM, MScN
As the Chief of Nursing Department of Polytechnic of Health of Surakarta and
as the lecture who had given direction, advice and support to the researcher.
3. Mr. Martono, SKep, Ns,. M. Pd
As the consultant who give guidance and advice to the researcher in making
this proposal
4. Mr. Widodo, MN
As the consultant, for his help, advice well and guide the researcher doing this
research proposal
5. Mr. Sumardino, S. ST, M. Kes
As the consultant, for his help, advice well and guide the researcher doing this
research proposal
6. My Beloved Family
Which give support of this compilation research proposal.
7. All people that helps the researcher in finishing this report that cant be
mentioned one by one
The researcher apologies for some limitations in this research proposal.
Therefore the researcher expects critics and suggestions that can make this
proposal worthy and give benefit for reader and especially the researcher.
Surakarta,
Researcher
2008
CONTENT LIST
LEGALIZATION SHEETi
PREFACE.ii
CONTENT LIST..iv
CHAPTER I: INTRODUCTION.1
A. Research background............1
B. Main problem............3
C. Goal Objective..3
D. Research Scope.4
CHAPTER II: LITERATURE REVIEW.5
A. Definition of Urinary Catheter.5
B. Type of Urinary Catheter.5
1. Indwelling Urinary Catheter5
2. Suprapubic Catheter6
3. External Condom Catheter..7
CHAPTER I
INTRODUCTION
A. Research background
Urinary tract infections (UTIs) are the most common type of nosocomial
(hospital-acquired) infections, accounting for 40% of all infections in hospitals
per year (Burke and Zavasky 1999). Center for Disease Control and National
Nosocomial Infections Study Report (1979) stated that the urinary tract is the
most common site of nosocomial infection, accounting for more than 40% of the
total number reported by acute-care hospitals and affecting an estimated 600,000
patients per year. According to Haley, Hooton, Culver (1975-1976), and Garibaldi,
Burke, Dickman, Smith (1974) Up to 25% of hospitalized patients have a urinary
catheter placed during their stay. The overall incidence of nosocomial UTI among
these patients is 3% to 10% (average, 5%) per day. According to Haley, Culver,
White, Morgan and Emori (1985) urinary tract infections account for up to 40% of
nosocomial infections, and urinary catheterrelated infection accounts for most
nosocomial UTIs.
Bryan and Reynolds (1984) stated that the case-fatality rate from UTIrelated nosocomial bacteremia is approximately 13%, with severely ill patients at
highest risk. Short-term catheterization may also be associated with fevers and
acute pyelonephritis, whereas long-term catheterization may be complicated by
catheter obstruction, urinary tract stones, and chronic renal inflammation.
Urinary Catheter use especially Indwelling Urinary Catheter (IUC) is thought
to be risk factor for developing nosocomial UTIs. One study by Gardam, Amihod,
D. Research scope
1. Setting
This research will be done in Sanglah hospital, Bali.
2. Time
This research will be done on Semester 5th
3. Respondent
This research will include adult client in Sanglah hospital 2008.
4.
Material
This research interrelated with Medical Surgical Nursing II, and Preoperative
Nursing, and Emergency Nursing.
CHAPTER II
LITERATURE REVIEW
A. Definition of Urinary Catheter
Urinary catheter is a plastic tube which is either inserted through a
patient's urinary tract into their bladder or attached to a male patient's penis.
(Wikipedia, the free encyclopedia, 2007). A balloon located at the end of the
catheter is usually inflated with sterile water to prevent the catheter from slipping
out. According to Greeinsten (2007) a urinary catheter is any tube system placed
in the body to drain and collect urine from the bladder.
B. Type of Urinary Catheter
According to Wikipedia, the free encyclopedia, (2007) the most common
type of urinary catheter are indwelling catheter, suprapubic catheter, and external
condom catheter.
1. Indwelling urinary catheters (Long-Term Use)
A catheter that is left in place for a period of time may be attached to a
drainage bag to collect the urine. Indwelling urinary catheters are often needed for
hospitalized patients; however, their use is often in inappropriate because up to
80% of patients with a nosocomial UTI has an indwelling urinary catheter,
(Krieger, Kaiser, and Wenzel, 1983).
During long-term use, the catheter may be left in place during the entire
time, or a patient may be instructed on a procedure for placing a catheter just long
enough to empty the bladder and then removing it (known as clean intermittent
self-catheterization). If temporary or long-term urinary collection is required,
options other than indwelling catheterization should be considered. Intermittent
catheterization, ie, inserting and removing a sterile or clean urinary catheter
several times daily, may reduce the risk of bacteriuria compared with an
indwelling catheter. Because the incidence of bacteriuria is about 1% to 3% per
insertion, however, most patients become bacteriuric within a few weeks.
Intermittent catheterization may also be associated with a lower risk of local and
systemic complications of bacteriuria, but further studies are needed to assess
these issues (Warren, 1997).
2. Suprapubic Catheters
A suprapubic catheter is basically an indwelling catheter that is placed
directly into the bladder through the abdomen. The catheter is inserted above the
pubic bone. This catheter must be placed by an urologist during an outpatient
surgery or office procedure (Greenstein, 2007). A suprapubic catheter may be
recommended in people who require long term catheterization, after some
gynecological surgeries, and in people with urethral injury or obstruction
(Greenstein, 2007).
3. External Condom Catheters
A condom catheter, which fits on the outside of the penis using adhesive,
can be used for short-term catheterizations in males. However, long-term
catheterization is not recommended because chronic use carries a significant risk
of urinary tract infection (Wikipedia, 2007).
Hirsh, Vainstein, Musher (1979) found that the risk of developing
bacteriuria in men wearing a condom catheter was approximately 12% per month.
The rate was substantially higher, however, in those who frequently manipulated
their catheters. In 2 parallel cohort studies that are Ouslanders, Greengold, Chen
(1987) in a Department of Veterans Affairs nursing home, the incidence of
symptomatic UTI was about 2.5 times greater in men with a long-term indwelling
catheter compared with those wearing a condom catheter. On the other hand,
Zimakoff, Stickler, Pontoppidan, Larsen (1996) in Denmark reported that the risk
of UTI was higher in hospitalized patients wearing condom catheters than in those
using indwelling catheters. In light of these conflicting data, a randomized trial
comparing the safety and efficacy of these 2 devices is much needed.
C. Indwelling Urinary Catheter Use In Hospitalized Client
referred to as acute uncomplicated UTI. It occurs in the lower urinary tract (the
bladder and urethra) and nearly always in women. When infection spreads to the
upper tract (the ureters and kidneys) it is called pyelonephritis , or more
commonly, kidney infection.
When infection is limited only to the urethra, the infection is known as
urethritis. This is a common sexually transmitted disease in men.
2. Risk Factors
Sex
Hazelett, Tsai, Gareri and Allen (2006) found that female elderly
patients were more susceptible to inappropriate IUC use than
their male. Only 25% male patients who developed a nosocomial
UTI had an IUC placed inappropriately, while 50% female
patients developed a nosocomial UTI associated with an
inappropriately placed IUC. UTIs are more rare in boys and
young men. In adult women, though, the rate of UTIs gradually
increases with age. Scientists are not sure why women have more
urinary infections than men. One factor may be that a woman's
urethra is short, allowing bacteria quick access to the bladder.
Also, a woman's urethral opening is near sources of bacteria from
the anus and vagina. Infections in Men
UTIs in men are often a result of an obstructionfor example, a
urinary stone or enlarged prostateor from a medical procedure
involving a catheter. The first step is to identify the infecting organism
and the drugs to which it is sensitive. Usually, doctors recommend
lengthier therapy in men than in women, in part to pevent infections of
the prostate gland.
Prostate infections (chronic bacterial prostatitis) are harder to cure
because antibiotics are unable to penetrate infected prostate tissue
effectively. For this reason, men with prostatitis often need long-term
treatment with a carefully selected antibiotic. UTIs in older men are
frequently associated with acute bacterial prostatitis, which can have
serious consequences if not treated urgently.
Age
Age is a significant factor for bacteriuria with older age being associated
with bacteriuria than the younger age, without regard to the sex, the risk of
catheter-associated
bacteriuria
increase
with
age,
(http://www.psmid.org.ph/vol22/vol22num2topic5.pdf.)
b.
Severe disease
ODonnel and Hofmann (2002) point out that 20-50% of nursing home residents
have asymptomatic UTIs, and this rises to 100% in patients with IUC. Several
factors predispose the elderly to UTIs including malfunction (e. g., enlarged
prostate gland, obstructions), chronic diseases (e. g., diabetes, cerebrovascular
disease, parkinsons disease and multiple sclerosis), and certain medications.
g. Nutrition
3. Symptoms & Signs of UTIs from Wikipedia (2007)
For Bladder Infections
Frequent urination along with the feeling of having to urinate even though
little or
Night Sweats.
Extreme Fatigue.
4. Complications
Untreated UTIs can lead to acute or chronic kidney infections
(pyelonephritis), which could permanently damage your kidneys. Young children
and older adults are at the greatest risk of kidney damage due to UTIs because
their symptoms are often overlooked or mistaken for other conditions. Women
who have UTIs while pregnant may also have an increased risk of delivering low
birth weight or premature infants (Greinstein, 2007).
E. Theoretical framework
Improperly procedure
Nutrition
Surgery
Symptoms of infection
Disease
Nosocomial infection
Signs of infection
F. Conceptual Framework
Age
Urinary Tract Infections
Sex
G. Operational Definition
Definition operational variable represent the guide of how variables in
research will give the illustrations manifestly more instructing phenomenon at
problems to be checked.
No Variable Operational Parameter Instrument
Definition
1
Scoring
Measureme
Urinary
A urinary tract-Symptoms
nt
-Symptoms Urinary
Tract
infection
of
Infections (UTI)
of UTIs
is
a-
bacterial
Signs
ofQuestionnair Infections is
UTIs
valued with
-Signs
affects
any
UTIs:
the
Observation -Symptoms
of
Nominal
UTIs:Tract
infection that
part
Scale
urinary tract.
sheet
ofthe
statement:
of UTIs:
Yes: 1
No: 0
- Signs of
UTIs:
Yes: 1
No: 0
Age
Period since a
20-30 yearMedical
20-30 year:ordinal
people
31-40 yearrecord
was
born until now
31-40 year:
41-90 year
2
3
Sex
Gender
Male
Medical
41-90: 3
Male: 1
differences
Female
record
Female: 0
Nominal
based
on
genital
CHAPTER III
METHODOLOGY RESEARCH
A. Research Design
This research uses Quantitative Research. The quantitative approach is
measure of phenomena use numerical data test and examine cause and effect
relationship to produce the findings, (Burns and Grove, 1997). According to Carr,
1994 Quantitative research is more objective view and more reliable, because its
use questionnaire or measurement that have been tested for validity and reliability.
This research will use survey research method, which is take sample from
one population and use questionnaire and observation sheet as primer
measurement. (Singarimbun and Sofian, 1989). This research analyzes by using
cross sectional methods.
C. Research Variable
Variable is a criteria that is possessed by member of group (people, things,
situation) and different with possessing of this group (Rafli, 1985). This research
use one variable, which is Incidence of Urinary Tract Infection (UTI) that can
influenced by age and sex category.
D. Instrument Measurement
Instrument measurement of this research is questionnaire, that consist of 8
question based on signs and symptoms of Urinary Tract Infection. Questions in
questionnaire use closed question and checklist. Before that, the respondent was
given explanation and statement and was informed the way to answer or fill up
questionnaire sheet. The respondent is questioned to identification of answer: yes
or no toward the statements. The respondent just put sign on the each printed
column at the question item.
Formula: C =
X2
N X2
X2 =
i 1
j 1
OP
ij
Eij
EPij
Note: O (Observation) = fo
E (Expactation) = fh
To make measurement easily, data can be placed in this table:
Var. B
Var. A total
Total
B1
(A1B1)
(A2B2)
(AkBk)
B2
(A2B2)
(A3B3)
(AkBk)
..
Br
(A1Br)
(A2Br)
(AkBk)
Total
3. Measure variable A related to variable B
4. Measure fh (Hoped frequency)
5. Measure chi square with formula above
6. Measure Contingency Coefficient with formula above
7. Test measurement result chi quadrate with table chi quadrate,
include dk and significant error
-
significant error = 0, 05
st 2 piqi
st 2
Note:
ri
pi
qi
: 1 pi
No. Item
Res
Xt
Xt2
Total x
(Total x)2
..
..
..............
Total
Total
Total
(Total Np)2
no.1
no.2
n
Np
Total Np
no.x
0, total 0, total .
0, total
no.1
no.2
no.x
1-p
1-p
...
1-p
pq
pq
..
..
pq
pq = ..
X=
xt
xt
n
; n = total of respondent
x2
St2 = n
3. Result of St2 converts to formula KR-20
R1 =
2
k St p1 q1
k 1
St 2
REFERENCE
Center for Disease Control. (1979). National Nosocomial Infections Study Report,
Atlanta: Center for Disease Control. 2-14.
Gardam
MA,
Amihod
B,
Oreinstein
P, Consolacion
N,
Miller
M.
The
Respondent Agreement
Surakarta,..2008
To: Research Respondent
In Sanglah hospital,
Surakarta
By respectful
Im sincerely on this letter:
Name
: Nur Hanief M. B
Institution
NIM
: P27220006058
Address
Sincerely Yours
(Nur Hanief M. B)
Surakarta,
2008
Respondent
QUESTIONNAIRE
Study Descriptive Between Indwelling Urinary Catheter Use and Incidence
Of Urinary Tract Infection in Adult Client in Sanglah Hospital 2008
Instruction:
1. Read identity of respondent and fill the data completely
2. Read question and answer it by put sign (check list) on the each printed
column at the question item
A. Respondents Identity:
Initial of respondent:
Age
Address
Marital status
Occupation
Educational level
Sex
Date of admission
B. Observation Sheet
NO
1.
OBSERVATION
The respondent feels dysuria (burning or pain on urination)
YES
NO
2.
3.
4.
5.
6.
7.
8.