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Physicians' Perceptions and Practice Regarding the Prevention of Catheter-Associated Urinary Tract Infections in the ICU Marilyn Keng-Nasang Mbi Feh Walden University

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Physicians' Perceptions and Practice Regarding the Prevention of Catheter-Associated Urinary Tract Infections in the ICU Marilyn Keng-Nasang Mbi Feh Walden University Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2015 Physicians' Perceptions and Practice Regarding the Prevention of Catheter-Associated Urinary Tract Infections in the ICU Marilyn Keng-Nasang Mbi Feh Walden University Follow this and additional works at: https://scholarworks.waldenu.edu/dissertations Part of the Epidemiology Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please contact [email protected]. Walden University College of Health Sciences This is to certify that the doctoral dissertation by Marilyn Keng-Nasang Mbi Feh has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Ji Shen, Committee Chairperson, Public Health Faculty Dr. Pamela Gross, Committee Member, Public Health Faculty Dr. Scott McDoniel, University Reviewer, Public Health Faculty Chief Academic Officer Eric Riedel, Ph.D. Walden University 2015 Abstract Physicians’ Perceptions and Practice Regarding the Prevention of Catheter-Associated Urinary Tract Infections in the ICU by Marilyn Keng-Nasang Mbi Feh MD Candidate, Windsor University School of Medicine, 2016 BSIT, Clayton State University, 2008 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University October 2015 Abstract Catheter associated urinary tract infection (CAUTI) incidence continue to rise despite all prevention efforts. The state of Georgia incidence of CAUTI between 2012 and 2013 showed an increase by 350 cases. The challenge is translating CAUTI prevention knowledge into practice by all physicians. The purpose of this correlational study was to improve the epidemiological understanding of CAUTI. Looking at physicians’ perception and practice of CAUTI preventions was necessary. A total of 336 physicians from the state of Georgia completed a 26-item survey. Additionally, a pilot study was conducted on a small sample of participants. The result of the Cronbach alpha for the pilot study analysis of the 26-item survey instrument indicated excellent reliability. The analysis revealed that participants’ frequency of training on proper catheterization and their perception of CAUTI risk factors and effective implementation of CAUTI prevention bundle elements, varied significantly. It also resulted that many of the participants were not knowledgeable of certain important CAUTI prevention elements. Only a few made changes in their practice despite knowledge of the Center for Medicare and Medicaid Services reimbursement policy. Results of the Pearson’s chi-square test for independence indicated a significant correlation (p < .05) between physicians’ perception and practice of CAUTI prevention elements and CAUTI incidence. The results of this study suggest that current CAUTI prevention practice may be inefficient without the effective implementation of proven bundled element. Improved understanding of CAUTI and its relation to effective implementation of bundled prevention elements may result in improved prevention efforts, decreased morbidity, mortality, and overall healthcare cost. Physicians’ Perceptions and Practice Regarding the Prevention of Catheter-Associated Urinary Tract Infections in the ICU by Marilyn Keng-Nasang Mbi Feh MD Candidate, Windsor University School of Medicine, 2016 BSIT, Clayton State University, 2008 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University October 2015 Dedication I dedicate my dissertation to my entire family. A special sentiment of gratitude to my beloved parents, Mr. & Mrs. Feh Henry Baaboh, Esq. and Ms. Immaculate N. Ntinglet-Mbi whose continuous financial and moral support and words of encouragement to always shoot for the “star” keeps resonating in my ears. My other dad, Mr. Sonny Mbi who agreed to support me when I decided to pursue my doctoral degree, I thank you for everything dad. My brother Conrad Feh and his wife Christy who have always been there for me and never stopped believing in me. My sisters, Ashley, Yasmine, Betina, Camilla, Vanessa and Maheva are my motivation. My beautiful nieces Theresia, Amyrah and Cailah are very special to me; they give me the reason to not give up. I also dedicate this dissertation to my grandparents, Mr. Christopher and Mrs. Regina Musongong who contributed enormously in making me to be the woman that I am today. My aunty Dr. Emelda S. Ntinglet who is my role model and my other many aunties and uncles who are like parents to me and whose continuous support aided me to get to this point. To all my cousins who have continuously given me words of encouragement, I appreciate you all. I dedicate this work and give special thank to my husband, Leland Gosha for being so understanding, for supporting me throughout this process and for always having a listening ear when I had to talk about my research findings. My entire family has been my cheerleaders throughout my doctoral educational process and I am very grateful and blessed. I thank you all. Acknowledgement I will like to acknowledge my committee members for their unwavering support in helping me get to this level. A special thank you to Dr. Ji Shen, my committee chair, for being my mentor throughout my dissertation process, for the countless hours spent evaluating and proof reading my work and most of all for being patient with me especially when I had setbacks. Thank you Dr. Pamela Gross for agreeing to serve on my committee as my content member and for all your support. Thank you Dr. Scott McDoniel, my university research reviewer, for your help in reviewing my work and helping me achieve a scholastic voice. I will also like to acknowledge my dissertation editor, Ms. Jenny Martel for the hours spent proof reading my work and for the great input and suggestions which added strength to my writing. I am forever grateful to have crossed the path of all my committee members. I would never have gotten to this point if it wasn’t for great scholars like you. I thank you all from the bottom of my heart. I will also like to acknowledge and thank my colleagues Dr. Salome Kapella- Mshigeni and Dr. Valere Bekolo for your continuous advice and motivation throughout my writing process. I will like to acknowledge my primary mentor Dr. Joyce Akwe for spear-heading me in the right direction and advising me to focus my research on a problem that she sees daily as a hospitalist. Most importantly, I will like to acknowledge my Almighty God, Jehovah for continuously blessing and providing all that I need and for giving me the strength to get to this point. Table of Contents List of Tables .......................................................................................................................v Chapter 1: Introduction to the Study ....................................................................................1 Introduction ....................................................................................................................1 Background ....................................................................................................................3 Statement of the Problem ...............................................................................................8 Purpose of the Study ....................................................................................................10 Research Question and Hypothesis ..............................................................................11 Theoretical Framework for the Study ..........................................................................13 Nature of Study ............................................................................................................18 Definition of Terms......................................................................................................20 Assumptions and Limitations ......................................................................................23 Assumptions .......................................................................................................... 23 Scope & Delimitations .......................................................................................... 24 Limitations ............................................................................................................ 25 Significance of the Research ........................................................................................26 Summary ......................................................................................................................27 Chapter 2: Literature Review .............................................................................................30 Introduction ..................................................................................................................30 Theoretical Foundation ................................................................................................31 Literature Search Strategies .........................................................................................32 Incidence of CAUTI ....................................................................................................33
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