University of Pennsylvania School of Nursing, Philadelphia Pennsylvania; Department of Nursing, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and.
Department of Nursing, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and.
Pediatrics. 2014 Sep;134(3):e857-64. doi: 10.1542/peds.2013-3470. Epub 2014 Aug 11.
Catheter-associated urinary tract infections (CAUTIs) are among the most common health care-associated infections in the United States, yet little is known about the prevention and epidemiology of pediatric CAUTIs.
An observational study was conducted to assess the impact of a CAUTI quality improvement prevention bundle that included institution-wide standardization of and training on urinary catheter insertion and maintenance practices, daily review of catheter necessity, and rapid review of all CAUTIs. Poisson regression was used to determine the impact of the bundle on CAUTI rates. A retrospective cohort study was performed to describe the epidemiology of incident pediatric CAUTIs at a tertiary care children's hospital over a 3-year period (June 2009 to June 2012).
Implementation of the CAUTI prevention bundle was associated with a 50% reduction in the mean monthly CAUTI rate (95% confidence interval: -1.28 to -0.12; P = .02) from 5.41 to 2.49 per 1000 catheter-days. The median monthly catheter utilization ratio remained unchanged; ∼90% of patients had an indication for urinary catheterization. Forty-four patients experienced 57 CAUTIs over the study period. Most patients with CAUTIs were female (75%), received care in the pediatric or cardiac ICUs (70%), and had at least 1 complex chronic condition (98%). Nearly 90% of patients who developed a CAUTI had a recognized indication for initial catheter placement.
CAUTI is a common pediatric health care-associated infection. Implementation of a prevention bundle can significantly reduce CAUTI rates in children.
在美国，导管相关尿路感染（CAUTI）是最常见的与医疗保健相关的感染之一，但对于儿科 CAUTI 的预防和流行病学知之甚少。
进行了一项观察性研究，以评估包括在整个机构范围内标准化和培训导尿管插入和维护实践、每日审查导管必要性以及快速审查所有 CAUTI 在内的 CAUTI 质量改进预防包对预防 CAUTI 率的影响。使用泊松回归来确定该预防包对 CAUTI 率的影响。进行了一项回顾性队列研究，以描述在 3 年期间（2009 年 6 月至 2012 年 6 月）在一家三级保健儿童医院中发生的儿科 CAUTI 的流行病学。
CAUTI 预防包的实施与平均每月 CAUTI 率降低 50%相关（95%置信区间：-1.28 至-0.12；P=.02），从每 1000 个导尿管日 5.41 降至 2.49。每月导尿管使用率中位数保持不变；约 90%的患者有导尿适应证。研究期间有 44 名患者发生了 57 例 CAUTI。大多数 CAUTI 患者为女性（75%），在儿科或心脏 ICU 接受治疗（70%），并且至少有 1 种复杂的慢性疾病（98%）。近 90%发生 CAUTI 的患者有初始放置导管的明确适应证。
CAUTI 是一种常见的儿科医疗保健相关感染。预防包的实施可以显著降低儿童 CAUTI 的发生率。
