在一家急性护理医院实施限制使用导尿管的方案。

A program to limit urinary catheter use at an acute care hospital.

机构信息

Hollywood Presbyterian Medical Center, Los Angeles, CA, USA.

出版信息

Am J Infect Control. 2010 Sep;38(7):568-71. doi: 10.1016/j.ajic.2009.12.017. Epub 2010 Apr 9.

DOI:10.1016/j.ajic.2009.12.017

PMID:20381918

Abstract

BACKGROUND

Urinary catheters are the major cause of catheter-associated urinary tract infections (CAUTIs) and often may be unnecessary. We attempted to reduce the number of CAUTIs by limiting the use of urinary catheters.

METHODS

The number of catheters and CAUTIs were recorded during a control period of 7 months. A program was implemented limiting these catheters to patients who had urinary tract obstruction, orders for hourly output measurements, breakdown of skin in areas exposed to urine in patients with documented urinary tract infections, or urine- associated skin irritation that was unresponsive to barrier measures. In patients who did not meet these criteria, the physician was asked for a catheter removal order, and superabsorbent pads or diapers were used. Urinary catheter use and CAUTIs were then recorded during a subsequent 5-month intervention period. Nursing personnel were queried regarding their experience after 4 months of the intervention period.

RESULTS

Urinary catheter use decreased by 42% (P < .01), and the incidence of CAUTIs decreased by 57% (P < .05). There was some improvement in nursing satisfaction.

CONCLUSION

Limiting urinary catheter use can reduce the incidence of CAUTI with no deterioration in nursing satisfaction.

摘要

背景

导尿管是导致导管相关性尿路感染（CAUTI）的主要原因，而且往往可能是不必要的。我们试图通过限制导尿管的使用来减少 CAUTI 的发生。

方法

在 7 个月的对照期内记录导尿管数量和 CAUTI 的发生情况。实施了一项方案，将导尿管限制用于有尿路梗阻、需要每小时测量尿量的医嘱、有记录的尿路感染患者暴露于尿液的皮肤破损、或对屏障措施无反应的与尿液相关的皮肤刺激的患者。对于不符合这些标准的患者，医生会下达拔除导尿管的医嘱，并使用超强吸水性垫或尿布。随后在接下来的 5 个月干预期内记录导尿管使用和 CAUTI 的发生情况。在干预期进行 4 个月后，向护理人员询问他们的经验。