The Impact of a Nurse-Led Protocol on Reducing Urinary Catheter Complications in Orthopedic Surgery Patients

Background: Indwelling urinary catheters (IUCs) are frequently used in orthopedic surgery patients, particularly those undergoing hip fracture repair. Their use is associated with significant complications, primarily catheter-associated urinary tract infections (CAUTIs) and urethral trauma, which increase morbidity, length of stay, and healthcare costs. Traditional management often requires a physician's order for removal, leading to unnecessary delays. Aim: This study aimed to evaluate the impact of a nurse-led protocol for urinary catheter complications in orthopedic surgery patients. Methods: A quasi-experimental, pre-post intervention design was utilized in the orthopedic unit at Sohag university hospitals. A convenience sample of 50 nurses and 100 patients was recruited within six months: 50 patients received standard care (control group), and 50 patients were managed under a new nurse-led protocol (experimental group). Data collection tools included; 1. Patient Data Collection Form (Medical Record Abstraction Tool), 2. Nurse Adherence and Protocol Checklist (The HOUDINI Protocol)3, Nurse Knowledge and Attitude Questionnaire. Results: The educational component of the nurse-led protocol was highly effective in improving the theoretical knowledge of the nursing staff. The average knowledge score increased dramatically from a moderate 12.1 to a high 18.5 out of 20 possible points (P < 0.001). Also, The data clearly illustrates the positive impact of Nurse-Led Protocol on reducing the incidence of Catheter-Associated Urinary Tract Infections, the rate per 1,000 catheter-days was also significantly reduced (1.8 vs. 7.7). Reductions were also noted in the catheter reinsertion rate and mean length of stay for the experimental group. Conclusion: The implementation of a nurse-led protocol for urinary catheter management and removal in orthopedic surgery patients significantly reduces the duration of catheterization and lowers the incidence of complications such as CAUTIs and trauma. This approach empowers nursing staff, improves patient safety outcomes, and demonstrates a cost-effective quality improvement initiative.