Division of Colon and Rectal Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Dis Colon Rectum. 2014 Jan;57(1):91-7. doi: 10.1097/DCR.0000000000000019.
Urinary tract infection is associated with increased morbidity, mortality, and healthcare costs. Colon and rectal surgery has been shown to be an independent risk factor for urinary tract infection. Decreased length of the indwelling urinary catheter may play a role in decreasing the rate of urinary tract infection.
The aim of this study was to investigate the effect of standardized indwelling urinary catheter management on urinary tract infection.
This was a prospective cohort study.
This study was conducted in an urban academic tertiary care center.
All of the patients were undergoing colon or rectal resection from 2010 to 2012 at a single National Surgical Quality Improvement Program participating institution.
Intervention 1 (group 1) included implementation of a daily electronic order prompt requiring justification for an indwelling urinary catheter for >24 hours. Intervention 2 (group 2) included intervention 1 plus sterile intraoperative placement of a urinary catheter after the antiseptic preparation and draping of the patient.
The primary outcome measured was urinary tract infection rate.
A total of 811 patients were identified (control = 215; group 1 = 476; group 2 = 120). Patient demographics and comorbidities were similar among the groups. No differences existed in the proportion of proctectomy among the groups. Urinary tract infection rate decreased significantly with the implementation of each intervention (control, 6.9%; group 1, 2.7%; group 2, 0.8%; p = 0.004). The lone urinary tract infection in group 2 involved ureteral reconstruction and stent placement at the time of surgery.
This study was limited by its small sample size and single institution design.
The implementation of 2 low-cost practice interventions was associated with a statistically significant decrease in urinary tract infection in patients undergoing colorectal surgery at an academic tertiary care center.
尿路感染与发病率、死亡率和医疗保健成本增加有关。结肠和直肠手术已被证明是尿路感染的独立危险因素。留置导尿管的长度减少可能在降低尿路感染率方面发挥作用。
本研究旨在探讨标准化留置导尿管管理对尿路感染的影响。
这是一项前瞻性队列研究。
本研究在一家城市学术三级保健中心进行。
所有患者均于 2010 年至 2012 年在一家全国外科质量改进计划参与机构接受结肠或直肠切除术。
干预 1（组 1）包括实施每日电子医嘱提示，要求对留置导尿管超过 24 小时的患者进行留置导尿管的理由进行说明。干预 2（组 2）包括干预 1 加上在患者消毒准备和铺单后无菌性术中放置导尿管。
主要观察指标为尿路感染率。
共确定了 811 例患者（对照组=215 例；组 1=476 例；组 2=120 例）。组间患者的人口统计学和合并症相似。各组间直肠切除术的比例无差异。随着每一项干预措施的实施，尿路感染率显著下降（对照组 6.9%；组 1 2.7%；组 2 0.8%；p=0.004）。组 2 中唯一的尿路感染发生在手术时进行输尿管重建和支架放置。
本研究受到其小样本量和单一机构设计的限制。
在学术性三级保健中心对接受结肠直肠手术的患者实施 2 项低成本实践干预措施与尿路感染发生率的统计学显著降低相关。
