Izzo Ilaria, Lania Donatella, Bella Daniele, Formaini Marioni Cesare, Coccaglio Romana, Colombini Paolo
Unità Operativa di Medicina Generale.
Gruppo operativo per il controllo delle infezioni ospedaliere.
Infez Med. 2015 Sep;23(3):243-6.
Catheter-associated urinary tract infections (CA-UTI) are estimated to be the most frequent nosocomial infections (40%). A catheter is introduced to 10-25% of inpatients, and is often left on site for a long period of time. We carried out a prospective study on inpatients of our Internal Medicine ward to assess the incidence of CA-UTI under the implementation of corrective action. All inpatients who underwent introduction of a urinary catheter upon or after admission to our ward were included in the study. Patients with bacteriuria or positive urine culture before catheterization, others with less than 24 hours catheterism, or bearing a catheter on admission were all excluded from the study. CA-UTI diagnosis was assessed on the basis of CDC 2009 guidelines. The investigation was held between June 2010 and March 2013 in five steps or phases. In the first phase open circuit drainage catheterism was used, in the second phase close circuit drainage catheterism was introduced, while in the third phase disposable lubrification was added to closed circuit drainage catheterism. In the next step (phase 4) we introduced number of days of catheterism control and nurse training; in the last phase (5) emptying urine collection bags on a container was added. In phase 1 we estimated six UTIs out of 18 patients (incidence 33%), in phase 2 we had four infections out of 10 patients (40%). Given the results, we had to reflect on the quality of the procedures of catheter positioning and management . Where feasible, we improved technical practices and during follow-up there was evidence of CA-UTI in 10 patients over 25 (phase 3, 40%), and eight infections over 25 (phase 4, 32%). Once all these steps had been implemented, in phase 5 we determined a sharp reduction in CA-UTI (2 patients over 27, or 7.5%, p=0.025). This improvement was particularly evident in the rate of infection per days of catheter, which was reduced from 43.4/1000 to 13.6/1000. Although the statistical power of the present study has its limitations, we attained a significant reduction in catheter-associated UTIs through the implementation of close circuit catheterism and improvements in care practices.
据估计，导尿管相关尿路感染（CA-UTI）是最常见的医院感染（占40%）。10%至25%的住院患者会插入导尿管，且导尿管常常会留置很长时间。我们对内科病房的住院患者进行了一项前瞻性研究，以评估在采取纠正措施后CA-UTI的发生率。所有在我院病房入院时或入院后接受导尿管插入的住院患者均纳入研究。导尿术前有菌尿或尿培养阳性的患者、导尿时间少于24小时的患者或入院时已留置导尿管的患者均被排除在研究之外。CA-UTI的诊断依据美国疾病控制与预防中心（CDC）2009年的指南进行评估。该调查于2010年6月至2013年3月分五个步骤或阶段进行。在第一阶段使用开路引流导尿术，第二阶段引入闭路引流导尿术，而在第三阶段在闭路引流导尿术中增加一次性润滑措施。在接下来的步骤（第四阶段），我们引入了导尿天数控制和护士培训；在最后阶段（第五阶段），增加了将尿液收集袋倒空至容器中的操作。在第一阶段，18名患者中有6例发生UTI（发生率33%），在第二阶段，10名患者中有4例感染（40%）。鉴于这些结果，我们不得不反思导尿管放置和管理程序的质量。在可行的情况下，我们改进了技术操作，在随访期间，25名以上患者中有10例出现CA-UTI迹象（第三阶段，40%），25名以上患者中有8例感染（第四阶段，32%）。一旦实施了所有这些步骤，在第五阶段，我们确定CA-UTI大幅减少（27名以上患者中有2例，即7.5%，p = 0.025）。这种改善在导尿管每日感染率方面尤为明显，该感染率从43.4/1000降至13.6/1000。尽管本研究的统计效力存在局限性，但通过实施闭路导尿术和改进护理措施，我们使导尿管相关UTI显著减少。
