Dawson Carolyn H, Gallo Melanie, Prevc Kate
Infection Prevention and Control Team, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
J Infect Prev. 2017 Mar;18(2):57-64. doi: 10.1177/1757177416668584. Epub 2016 Nov 1.
Urinary tract infections (UTI) are the second-largest group of healthcare-associated infections (HCAI). The Saving Lives Urinary Catheter Care Bundle was introduced to reduce catheter-associated urinary tract infections (CAUTI). In response, we implemented a catheter care group to examine ways to improve catheter care in an acute hospital NHS Trust.
We adopted a multimodal approach, revolving around four components: (1) Catheter Care Pathway; (2) HOUDINI checklist; (3) catheter magnets; and (4) use of bladder ultrasound scanners.
The yearly CAUTI prevalence survey showed an annual reduction in CAUTI from 2012-2013 to 2014-2015 (3.5% to 2.4%). Evaluations of the multimodal approach have highlighted limitations, leading to priorities being established around provision of tools, education, and use of measurement and feedback.
Our multimodal approach demonstrates CAUTI rate improvements are achievable, directly benefiting patients. However, long-term maintenance of multimodal components is required to ensure sustained benefit. Engagement and accountability have emerged as significant challenges to the effectiveness and longevity of the catheter care group. We suggest greater emphasis on such challenges if long-term national or international improvement is to be achieved.
尿路感染（UTI）是医疗保健相关感染（HCAI）的第二大类型。为减少导尿管相关尿路感染（CAUTI），引入了“拯救生命的导尿管护理包”。作为回应，我们成立了一个导尿管护理小组，以研究在一家急性医院国民保健服务信托机构中改善导尿管护理的方法。
我们采用了一种多模式方法，围绕四个组成部分展开：（1）导尿管护理路径；（2）HOUDINI检查表；（3）导尿管磁铁；（4）膀胱超声扫描仪的使用。
年度CAUTI患病率调查显示，从2012 - 2013年到2014 - 2015年，CAUTI逐年下降（从3.5%降至2.4%）。对多模式方法的评估突出了局限性，从而确定了围绕提供工具、教育以及测量和反馈使用的优先事项。
我们的多模式方法表明，CAUTI率的提高是可以实现的，这直接使患者受益。然而，需要长期维持多模式组成部分以确保持续受益。参与度和问责制已成为导尿管护理小组有效性和持久性的重大挑战。我们建议，如果要实现长期的国家或国际层面的改善，应更加重视这些挑战。
