Willson Margaret, Wilde Mary, Webb Marilyn-Lu, Thompson Donna, Parker Diana, Harwood Judith, Callan Laurie, Gray Mikel
Columbia Hospital, Milwaukee, Wisconsin, USA.
J Wound Ostomy Continence Nurs. 2009 Mar-Apr;36(2):137-54. doi: 10.1097/01.WON.0000347655.56851.04.
The US Centers for Medicare & Medicaid Services has enacted 2 policies that have focused considerable attention on the optimal use of indwelling catheters in the acute and long-term care settings and the prevention of complications including catheter-associated urinary tract infection (CAUTI).
This is the second of a 2-part Evidence-Based Report Card reviewing current evidence pertaining to nursing actions for prevention of CAUTI in patients with short- and long-term indwelling catheters. Part 2 reviews multiple interventions for CAUTI prevention including staff education, monitoring of catheter use and CAUTI incidence, insertion technique, urethral meatal care, securement, use of a closed drainage system, bladder irrigation, frequency of catheter change, and antiseptic solutions in the drainage bag.
Nursing actions for prevention of CAUTI were identified based on search of electronic databases and Web-based search engines for national or international clinical practice guidelines focusing on this topic. Evidence related to the above nursing interventions was identified by searching electronic databases MEDLINE, CINAHL, the Cochrane Library, the ancestry of articles identified in these searches and Google scholar.
Limited evidence suggests that the following interventions reduce the incidence of CAUTI in patients managed by short-term indwelling catheterization: (1) staff education about catheter management, combined with regular monitoring of CAUTI incidence, (2) a facility-wide program to ensure catheterization only when indicated and prompt removal of indwelling catheters, (3) daily cleansing of the urethral meatus using soap and water or perineal cleanser, and (4) maintenance of a closed urinary drainage system. Mixed evidence suggests that use of a preconnected system reduces inadvertent interruption of a closed urinary drainage system and may prevent CAUTI. Limited evidence suggests that routine catheter changes every 4 to 6 weeks reduce CAUTI incidence in patients managed by long-term catheterization. Existed evidence suggests that the following interventions are not effective for reducing CAUTI incidence: (1) use of sterile technique for catheter insertion, (2) use of antiseptic solutions or ointments during routine meatal care, (3) use of a 2-chambered urinary drainage bag, (4) use of antiseptic filters incorporated into a urinary drainage bag, (5) bladder or catheter irrigation, (6) frequent changes of the urinary drainage bag, and (7) placement of an antiseptic solution in the urinary drainage bag.
Evidence from parts 1 and 2 of this Evidence-Based Report Card provides a sound basis for designing an evidence-based program to prevent CAUTI. Essential elements of a CAUTI prevention program include staff education, ongoing monitoring of CAUTI incidence, monitoring catheter insertion and ensuring prompt removal, and careful attention to techniques for catheterization and catheter care.
美国医疗保险和医疗补助服务中心已颁布两项政策，这两项政策极大地关注了急性和长期护理环境中留置导管的最佳使用以及包括导管相关尿路感染（CAUTI）在内的并发症的预防。
这是一份分为两部分的循证报告卡中的第二部分，回顾了有关预防短期和长期留置导管患者CAUTI的护理措施的当前证据。第二部分回顾了多种预防CAUTI的干预措施，包括工作人员教育、导管使用和CAUTI发生率监测、插入技术、尿道口护理、固定、使用密闭引流系统、膀胱冲洗、更换导管的频率以及引流袋中的抗菌溶液。
通过检索电子数据库和基于网络的搜索引擎，查找关注该主题的国家或国际临床实践指南，从而确定预防CAUTI的护理措施。通过检索电子数据库MEDLINE、CINAHL、Cochrane图书馆、这些检索中所识别文章的参考文献以及谷歌学术，确定与上述护理干预措施相关的证据。
有限的证据表明，以下干预措施可降低短期留置导尿患者的CAUTI发生率：（1）对工作人员进行导管管理教育，并定期监测CAUTI发生率；（2）开展全机构范围的项目，确保仅在有指征时进行导尿，并及时拔除留置导管；（3）每天使用肥皂和水或会阴部清洁剂清洁尿道口；（4）维持密闭尿液引流系统。有混合证据表明，使用预连接系统可减少密闭尿液引流系统的意外中断，并可能预防CAUTI。有限的证据表明，每4至6周定期更换导管可降低长期导尿患者的CAUTI发生率。现有证据表明，以下干预措施对降低CAUTI发生率无效：（1）导管插入时使用无菌技术；（2）在常规尿道口护理期间使用抗菌溶液或软膏；（3）使用双腔尿液引流袋；（4）使用内置在尿液引流袋中的抗菌过滤器；（5）膀胱或导管冲洗；（6）频繁更换尿液引流袋；（7）在尿液引流袋中放置抗菌溶液。
本循证报告卡第1部分和第2部分的证据为设计预防CAUTI的循证项目提供了坚实基础。CAUTI预防项目的基本要素包括工作人员教育、持续监测CAUTI发生率、监测导管插入并确保及时拔除，以及密切关注导尿和导管护理技术。
