Columbia University College of Physicians and Surgeons, New York, NY; Department of Infectious Diseases and Infection Prevention, Stamford Hospital, Stamford, CT.
Am J Infect Control. 2013 Dec;41(12):1178-81. doi: 10.1016/j.ajic.2013.03.296. Epub 2013 Jun 13.
Despite using sterile technique for catheter insertion, closed drainage systems, and structured daily care plans, catheter-associated urinary tract infections (CAUTIs) regularly occur in acute care hospitals. We believe that meaningful reduction in CAUTI rates can only be achieved by reducing urinary catheter use.
We used an interventional study of a hospital-wide, multidisciplinary program to reduce urinary catheter use and CAUTIs on all patient care units in a 300-bed, community teaching hospital in Connecticut. Our primary focus was the implementation of a nurse-directed urinary catheter removal protocol. This protocol was linked to the physician's catheter insertion order. Three additional elements included physician documentation of catheter insertion criteria, a device-specific charting module added to physician electronic progress notes, and biweekly unit-specific feedback on catheter use rates and CAUTI rates in a multidisciplinary forum.
We achieved a 50% hospital-wide reduction in catheter use and a 70% reduction in CAUTIs over a 36-month period, although there was wide variation from unit to unit in catheter reduction efforts, ranging from 4% (maternity) to 74% (telemetry).
Urinary catheter use, and ultimately CAUTI rates, can be effectively reduced by the diligent application of relatively few evidence-based interventions. Aggressive implementation of the nurse-directed catheter removal protocol was associated with lower catheter use rates and reduced infection rates.
尽管在插入导尿管时采用了无菌技术、使用密闭引流系统以及制定了日常护理计划，但在急性护理医院中，导管相关性尿路感染（CAUTI）仍时有发生。我们认为，只有减少导尿管的使用，才能显著降低 CAUTI 发生率。
我们采用了一项在康涅狄格州一家 300 床位的社区教学医院内所有护理单元实施的、多学科参与的、针对减少导尿管使用和 CAUTI 的干预性研究。我们的主要关注点是实施一项由护士主导的导尿管拔除方案。该方案与医生的导尿管插入医嘱相关联。另外还包括三个要素：医生记录导尿管插入标准、在医生电子病历中添加特定设备的图表模块、以及在多学科论坛上每两周对各单元的导尿管使用率和 CAUTI 率进行反馈。
在 36 个月的时间里，我们实现了全院范围内导尿管使用率降低 50%，CAUTI 降低 70%。尽管各单元在减少导尿管方面的努力程度存在很大差异，从 4%（产科）到 74%（遥测），但导尿管使用率的降低是显著的。
通过应用少数几项基于证据的干预措施，可以有效地降低导尿管使用率，最终降低 CAUTI 发生率。积极实施由护士主导的导尿管拔除方案与较低的导尿管使用率和较低的感染率相关。
