Gokula Radha Ramana Murthy, Hickner John A, Smith Mindy A
Sparrow/Michigan State University Family Practice Residency Program, Michigan State University, East Lansing, USA.
Am J Infect Control. 2004 Jun;32(4):196-9. doi: 10.1016/j.ajic.2003.08.007.
An estimated 4 million patients per year in the United States are subjected to urinary catheterization. Approximately 25% of patients who are hospitalized have an indwelling urinary tract catheter placed at some time during their hospital stay and nosocomial urinary tract infections develop in 5% per day, with associated bacteremia in 4% of patients.
We sought to assess the prevalence and the appropriateness of the use of urinary catheters at a community teaching hospital in medical patients age 65 years and older.
We randomly selected 285 charts from a total of 2845 patients admitted during the year 2000 who were 65 years and older and had an indwelling urinary tract catheter inserted during the first 24 hours after admission. We excluded patients who had a urinary catheter placed before admission and patients admitted for operation.
On chart review we found an appropriate indication for catheterization for 46% of these patients. A physician or nurse explicitly documented the reason for catheter placement in only 13%. No order for catheterization was written in 33% of the charts. Mean duration of catheter use was 3 days.
Less than half of urinary catheterizations in this teaching hospital were indicated and even fewer had an explicit indication recorded in the chart. Other investigators have had similar findings at other hospitals. Interventions are needed to decrease the inappropriate use of urinary catheters.
在美国，估计每年有400万患者接受导尿术。约25%的住院患者在住院期间的某个时间会留置导尿管，医院获得性尿路感染每天的发生率为5%，4%的患者会发生相关菌血症。
我们试图评估一家社区教学医院中65岁及以上内科患者使用导尿管的患病率及合理性。
我们从2000年收治的2845名65岁及以上且在入院后24小时内插入留置导尿管的患者中随机抽取285份病历。我们排除了入院前已留置导尿管的患者以及因手术入院的患者。
通过病历审查，我们发现这些患者中有46%有导尿的适当指征。只有13%的病历中有医生或护士明确记录的置管原因。33%的病历中没有导尿医嘱。导尿管的平均使用时间为3天。
在这家教学医院，不到一半的导尿术有指征，病历中明确记录指征的更少。其他研究人员在其他医院也有类似的发现。需要采取干预措施以减少导尿管的不当使用。
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