University of Colorado Hospital, Aurora, CO, 80045, USA.
Am J Infect Control. 2012 Aug;40(6):548-53. doi: 10.1016/j.ajic.2011.07.018. Epub 2011 Nov 1.
Catheter-associated urinary tract infections (CAUTIs) are common, morbid, and costly. Nearly 25% of hospitalized patients are catheterized yearly, and 10% develop urinary tract infections. Evidence-based guidelines exist for indwelling urinary catheter management but are not consistently followed.
A pre/post intervention design was used in this quality improvement project to test the impact of nurse-driven interventions based on current evidence to reduce CAUTIs in hospitalized patients on 2 medical/surgical units. Interventions consisted of hospital-wide strategies including policy and product improvements and unit-specific strategies that focused on a review of current evidence to guide practice.
The number of catheter days decreased from 3.01 to 2.2 (P = .018) on the surgery unit and from 3.53 to 2.7 (P = .076) on the medical unit. CAUTI rates were too low to achieve significant reduction. Product cost savings were estimated at $52,000/year.
Guidelines derived from research and other sources of evidence can successfully improve patient outcomes. Nurse-driven interventions, combined with system-wide product changes, and patient and family involvement may be effective strategies that reduce CAUTI.
与导尿管相关的尿路感染（CAUTIs）很常见，且病情严重，花费巨大。每年将近 25%的住院患者需要置管，其中 10%会发生尿路感染。留置导尿管管理的循证指南已经存在，但并未得到一致遵循。
本质量改进项目采用了预/后干预设计，以检验基于现有证据的护士主导干预措施对 2 个内科/外科病房住院患者 CAUTIs 的影响。干预措施包括全院范围的策略，包括政策和产品改进，以及针对特定科室的策略，重点是审查现有证据以指导实践。
外科病房的导尿管使用天数从 3.01 天减少到 2.2 天（P =.018），内科病房从 3.53 天减少到 2.7 天（P =.076）。CAUTI 发生率太低，无法实现显著降低。产品成本节约估计为每年 52,000 美元。
源自研究和其他证据来源的指南可以成功改善患者结局。护士主导的干预措施，结合系统范围的产品变更以及患者和家属的参与，可能是降低 CAUTI 的有效策略。
