Healthcare Workers’ Knowledge, Attitudes, and Practices on Catheter-Associated Urinary Tract Infection Prevention in a Tertiary General Hospital: A Cross-Sectional Study

Background Catheter-associated urinary tract infections (CAUTIs) remain among the most common healthcare-associated infections (HAIs) and are largely preventable through adherence to evidence-based infection prevention measures. Healthcare workers’ (HCWs) knowledge, attitudes, and practices (KAP) play a critical role in the effective implementation of these strategies. However, there is no evidence regarding HCWs’ KAP on CAUTI prevention in Greek healthcare settings. This study aimed to evaluate HCWs’ knowledge, attitudes, and practices related to CAUTI prevention in a tertiary care hospital in Greece. Methods An analytical cross-sectional study was conducted between September 2023 and September 2024 at a tertiary hospital in Athens. Nurses, nursing assistants, and physicians working in departments with high urinary catheter utilization were invited to participate. Data were collected using a structured questionnaire developed in accordance with international CAUTI prevention guidelines. Descriptive statistics were calculated, and non-parametric test methods were employed. The Mann-Whitney U test was used for two-group comparisons, the Kruskal-Wallis test was used for comparisons across multiple groups, and Spearman’s rank correlation coefficient was applied to examine associations with continuous variables. Logistic regression analyses were performed to identify factors associated with selected preventive practices. Results A total of 260 HCWs participated (response rate: 72. 8%). Overall knowledge levels were moderate to high (mean score: 20. 7 ± 2. 1 out of 25). While most participants correctly identified key preventive measures, notable misconceptions were observed regarding prophylactic antimicrobial use after catheter insertion and appropriate catheter fixation techniques. Attitudes toward CAUTI prevention were generally positive, with the majority recognizing the importance of education and appropriate catheter management. Despite the high level of knowledge, a clear knowledge-practice gap was identified. Although the participants correctly identified key preventive measures, adherence to routine maintenance practices was markedly lower, particularly for hand hygiene before catheter manipulation (26. 2%) and the maintenance of a continuously closed drainage system (66. 5%). Greater professional experience (adjusted odds ratio aOR, 2. 22; 95% confidence interval CI, 1. 08-4. 56) and higher knowledge scores (aOR, 1. 18 per point; 95% CI, 1. 02-1. 37) were independently associated with correct catheter fixation. Additionally, positive perceptions regarding the role of catheter management in reducing morbidity were strongly associated with maintaining a closed drainage system (aOR, 6. 65; 95% CI, 1. 72-25. 66). Conclusions Although HCWs demonstrated adequate knowledge and favorable attitudes toward CAUTI prevention, important gaps remain in the consistent implementation of recommended practices. Targeted educational initiatives and organizational strategies focusing on catheter maintenance and adherence to prevention guidelines may improve clinical practice and reduce CAUTI risk.