Christ-Libertin Cheryl, Black Sharon, Latacki Theresa, Bair Tina
From the *Akron Children's Hospital, Ohio; and †Walsh University, North Canton, Ohio.
J Burn Care Res. 2015 Jan-Feb;36(1):e1-6. doi: 10.1097/BCR.0000000000000193.
The objective of this pilot study was to describe effectiveness of an evidence-based guideline designed to prevent catheter-associated urinary tract infection (CA-UTI) in reducing CA-UTI in the burn-injured patient population. The study used a pre- and post-bundle implementation comparison design. Inclusion criteria included burn-injured patients of all ages with an indwelling urinary catheter. Patient demographic data were collected by medical record review when informed of a CA-UTI. The Rosswurm-Larrabee Model six-step process model guided implementation of practice change. The sample included eight burn-injured patients (7-88 years). Catheter day range was 1 to 27 days. Each patient had a clear indication for an indwelling urinary catheter; the need for accurate urinary output measurement in a critically injured patient. Four patients had a catheter placed twice during the stay. Nurses reported using a bladder scanner to assess bladder volume for post-operative patients with urinary retention avoiding use of an indwelling urinary catheter in some cases. Integration of evidence-based guidelines in practice resulted in a reduced CA-UTI rate, reduced catheter days, increased days between CA-UTI, and outperformance of the national benchmark statistic. In 2013, the burn unit reduced catheter days by about 75% and reduced infection incidence by >90% in three quarters after implementation of the practice changes. The unit was able to sustain a CA-UTI rate of zero for 248 days.
这项初步研究的目的是描述一项旨在预防导管相关尿路感染（CA-UTI）的循证指南在降低烧伤患者群体中CA-UTI发生率方面的有效性。该研究采用了捆绑式措施实施前后对比设计。纳入标准包括所有年龄的留置导尿管的烧伤患者。当得知发生CA-UTI时，通过病历审查收集患者人口统计学数据。罗斯沃姆-拉腊比模型的六步流程模型指导了实践变革的实施。样本包括8名烧伤患者（7至88岁）。导尿天数范围为1至27天。每位患者都有明确的留置导尿管指征；在重伤患者中需要准确测量尿量。4名患者在住院期间导尿管放置了两次。护士报告称，他们使用膀胱扫描仪评估术后尿潴留患者的膀胱容量，在某些情况下避免使用留置导尿管。在实践中整合循证指南导致CA-UTI发生率降低、导尿天数减少、CA-UTI发生间隔天数增加，并且超过了国家基准统计数据。2013年，烧伤科在实施实践变革后的三个季度内，将导尿天数减少了约75%，感染发生率降低了90%以上。该科室能够维持248天的CA-UTI发生率为零。
