Division of Health Care Policy Research, University of Colorado Denver, School of Medicine, Denver, Colorado, USA.
J Hosp Med. 2011 Apr;6(4):183-9. doi: 10.1002/jhm.846.
Indwelling urinary catheter duration is an important risk factor for catheter-associated urinary tract infections (CAUTIs).
To audit patient-level postoperative catheter duration and measure the impact of its feedback to nursing staff on postoperative catheter duration and CAUTI rates.
Preobservational and postobservational study.
Two surgical units at an urban academic medical center.
Postoperative patients with indwelling urinary catheters.
Audit and feedback of postoperative urinary catheter duration to nurses during an educational session.
Patient-level postoperative catheter duration obtained from electronic clinical documentation. Mean catheter duration and proportion of patients with postoperative catheter duration <3 days were determined.
Following the intervention, the mean postoperative catheter duration decreased (1.7-1.4 days [P = 0.01] on orthopedic surgery, and 2.6 to 2.2 days [P = 0.01] on general surgery). The proportion of patients with catheter duration <3 days increased significantly on orthopedic surgery (86-92% [P = 0.04]), and nonsignificantly on general surgery (56-63% [P = 0.14]). When adjusted for length of stay differences, the odds of catheter duration <3 days on general surgery increased from 1.38 (P = 0.14) to 1.69 (P = 0.02). The CAUTI rates did not significantly decrease. The rate on orthopedic surgery dropped from 8.9 infections per 1000 device-days to 0 (confidence interval [CI], -1.1 to 18.3); on general surgery the rate was constant at 7 infections per 1000 device-days (CI, -12.1 to 10.8).
Audit and feedback of aggregated patient-level urinary catheter duration determined from electronic documentation may prove effective in improving urinary catheter management for surgical patients.
留置导尿管时间是导尿管相关性尿路感染（CAUTI）的一个重要危险因素。
审核患者术后导尿管留置时间，并衡量将其反馈给护理人员对术后导尿管留置时间和 CAUTI 发生率的影响。
预观察和观察后研究。
城市学术医疗中心的两个外科病房。
留置导尿管的术后患者。
在教育会议上对护士进行术后导尿管留置时间的审核和反馈。
从电子临床文档中获取患者水平的术后导尿管留置时间。确定平均导尿管留置时间和术后导尿管留置时间<3 天的患者比例。
干预后，平均术后导尿管留置时间缩短（骨科手术从 1.7 天降至 1.4 天[P = 0.01]，普外科手术从 2.6 天降至 2.2 天[P = 0.01]）。骨科手术中，留置导尿管时间<3 天的患者比例显著增加（86-92%[P = 0.04]），普外科手术中无显著增加（56-63%[P = 0.14]）。调整住院时间差异后，普外科手术中<3 天留置导尿管的可能性从 1.38（P = 0.14）增加到 1.69（P = 0.02）。CAUTI 发生率无显著下降。骨科手术的感染率从每 1000 个装置日 8.9 例降至 0（置信区间[CI]，-1.1 至 18.3）；普外科手术的感染率保持在每 1000 个装置日 7 例（CI，-12.1 至 10.8）。
从电子文档中确定的汇总患者水平导尿管留置时间的审核和反馈可能在改善外科患者导尿管管理方面有效。
