Tominaga Gail T, Dhupa Achal, McAllister Sonja M, Calara Robin, Peters Stacie A, Stuck Amy
Trauma Service, Scripps Memorial Hospital La Jolla, 9888 Genesee Avenue, LJ601, La Jolla, CA 92037, USA.
Critical Care Service, Scripps Memorial Hospital La Jolla, 9888 Genesee Avenue, LJ601, La Jolla, CA 92037, USA.
Am J Surg. 2014 Dec;208(6):1065-70; discussion 1069-70. doi: 10.1016/j.amjsurg.2014.08.013. Epub 2014 Sep 28.
Purpose of this study is to determine strategies to decrease catheter-associated urinary tract infection (CAUTI) in intensive care unit (ICU) patients.
ICU patients with an indwelling urinary catheter (UC) in one tertiary hospital were monitored for CAUTI. Interventions were implemented sequentially with quarterly data collection. Outcome measures were infection ratio (IR = number of infections/catheter days [CD] × 1000) and device utilization rate (DUR = catheter days/patient days).
CDs and DUR decreased (fiscal year 2008: CD, 11,414; DUR, .85 vs fiscal year 2013: CD, 8,144; DUR, .70). IR increased with suspension of prepackaged baths (IR, 3.2 to 3.5 to 4.9 to 5.0), twice daily UC care (IR, 4.8 to 6.7), emptying UC bags at 400 mL (IR, 6.7 to 9.2). Two-person UC placement (IR, 5.6 to 4.8), physician notification of CAUTI (IR, 6.1 to 4.8), and reinstitution of prepackaged baths and daily UC care (IR, 4.8 to 3.7) decreased CAUTI rates.
Decreasing CAUTI in the ICU requires diligent monitoring and constant practice re-evaluation. Elimination of CAUTI in the ICU may not be possible.
本研究的目的是确定降低重症监护病房（ICU）患者导管相关尿路感染（CAUTI）的策略。
对一家三级医院中留置导尿管（UC）的ICU患者进行CAUTI监测。依次实施干预措施并每季度收集数据。结果指标为感染率（IR = 感染例数/导尿管使用天数[CD]×1000）和器械使用率（DUR = 导尿管使用天数/患者住院天数）。
导尿管使用天数和器械使用率下降（2008财年：导尿管使用天数，11414；器械使用率，0.85； vs 2013财年：导尿管使用天数，8144；器械使用率，0.70）。随着预包装沐浴液停用（感染率，从3.2升至3.5再升至4.9再升至5.0）、每日两次的导尿管护理（感染率，从4.8升至6.7）、导尿管集尿袋在400毫升时排空（感染率，从6.7升至9.2），感染率上升。两人操作放置导尿管（感染率，从5.6降至4.8）、医生通报CAUTI情况（感染率，从6.1降至4.8）以及恢复使用预包装沐浴液和每日导尿管护理（感染率，从4.8降至3.7）使CAUTI发生率降低。
降低ICU中的CAUTI需要进行认真监测并不断重新评估实践。在ICU中消除CAUTI可能无法实现。
