Department of Internal Medicine, University of Michigan, and 3Ann Arbor VA Medical Center, Ann Arbor, Michigan 48109-0429, USA.
Clin Infect Dis. 2010 Sep 1;51(5):550-60. doi: 10.1086/655133.
Prolonged catheterization is the primary risk factor for catheter-associated urinary tract infection (CAUTI). Reminder systems are interventions used to prompt the removal of unnecessary urinary catheters. To summarize the effect of urinary catheter reminder systems on the rate of CAUTI, urinary catheter use, and the need for recatheterization, we performed a systematic review and meta-analysis.
Studies were identified in MEDLINE, the Cochrane Library, Biosis, the Web of Science, EMBASE, and CINAHL through August 2008. Only interventional studies that used reminders to physicians or nurses that a urinary catheter was in use or stop orders to prompt catheter removal in hospitalized adults were included. A total of 6679 citations were identified; 118 articles were reviewed, and 14 articles met the selection criteria.
The rate of CAUTI (episodes per 1000 catheter-days) was reduced by 52% (P < .001) with use of a reminder or stop order. The mean duration of catheterization decreased by 37%, resulting in 2.61 fewer days of catheterization per patient in the intervention versus control groups; the pooled standardized mean difference (SMD) in the duration of catheterization was -1.11 overall (P = 070), including a statistically significant decrease in studies that used a stop order (SMD, -0.30; P = .001) but not in those that used a reminder (SMD, -1.54; P = .071). Recatheterization rates were similar in control and intervention groups.
Urinary catheter reminders and stop orders appear to reduce the rate of CAUTI and should be strongly considered to enhance the safety of hospitalized patients.
长时间留置导尿管是导致导尿管相关性尿路感染（CAUTI）的主要危险因素。提醒系统是一种干预措施，用于提示去除不必要的导尿管。为了总结导尿管提醒系统对 CAUTI 发生率、导尿管使用和再置管需求的影响，我们进行了系统评价和荟萃分析。
我们在 MEDLINE、Cochrane 图书馆、Biosis、Web of Science、EMBASE 和 CINAHL 中检索了截至 2008 年 8 月的研究。仅纳入使用提醒系统通知医生或护士导尿管正在使用或下达停置导尿管医嘱以提示去除导尿管的干预性研究。共确定了 6679 篇引文，经评价后有 118 篇文章被纳入，其中 14 篇符合入选标准。
使用提醒或停置医嘱可使 CAUTI 发生率（每 1000 个导管日感染例数）降低 52%（P<0.001）。留置导尿管的平均时间缩短了 37%，与对照组相比，干预组每位患者的导尿管留置时间减少了 2.61 天；总体上，导管留置时间的标准化均数差值（SMD）为-1.11（P=0.70），其中使用停置医嘱的研究差异有统计学意义（SMD，-0.30；P=0.001），而使用提醒系统的研究差异无统计学意义（SMD，-1.54；P=0.071）。对照组和干预组的再置管率相似。
导尿管提醒和停置医嘱似乎可以降低 CAUTI 发生率，应强烈考虑使用这些措施来增强住院患者的安全性。
