Public Health England, Gloucester, UK.
University of the West of England, Bristol, UK.
J Hosp Infect. 2019 Jun;102(2):200-218. doi: 10.1016/j.jhin.2018.10.013. Epub 2018 Oct 22.
Escherichia coli bacteraemia rates in the UK have risen; rates are highest among older adults. Previous urinary tract infections (UTIs) and catheterization are risk factors.
To examine effectiveness of behavioural interventions to reduce E. coli bacteraemia and/or symptomatic UTIs for older adults.
Sixteen databases, grey literature, and reference lists were searched. Titles and/or abstracts were scanned and selected papers were read fully to confirm suitability. Quality was assessed using Critical Appraisal Skills Programme guidelines and Scottish Intercollegiate Guidelines Network grading.
Twenty-one studies were reviewed, and all lacked methodological quality. Six multi-faceted hospital interventions including education, with audit and feedback or reminders reduced UTIs but only three supplied statements of significance. One study reported decreasing catheter-associated UTI (CAUTI) by 88% (F (1,20) = 7.25). Another study reported reductions in CAUTI from 11.17 to 10.53 during Phase I and by 0.39 during Phase II (χ = 254). A third study reported fewer UTIs per patient week (risk ratio = 0.39). Two hospital studies of online training and catheter insertion and care simulations decreased CAUTIs from 33 to 14 and from 10.40 to 0. Increasing nursing staff, community continence nurses, and catheter removal reminder stickers reduced infection. There were no studies examining prevention of E. coli bacteraemias.
The heterogeneity of studies means that one effective intervention cannot be recommended. We suggest that feedback should be considered because it facilitated reductions in UTI when used alone or in multi-faceted interventions including education, audit or catheter removal protocols. Multi-faceted education is likely to be effective. Catheter removal protocols, increased staffing, and patient education require further evaluation.
英国的大肠杆菌菌血症发生率有所上升；发生率在老年人中最高。既往尿路感染（UTI）和导尿是危险因素。
研究行为干预措施在降低老年人大肠杆菌菌血症和/或有症状尿路感染方面的有效性。
检索了 16 个数据库、灰色文献和参考文献列表。扫描标题和/或摘要，并阅读全文以确认适宜性。使用批判性评价技能计划指南和苏格兰校际指南网络分级对质量进行评估。
共综述了 21 项研究，所有研究均缺乏方法学质量。6 项多方面的医院干预措施包括教育，结合审核和反馈或提醒，可减少 UTI，但只有 3 项提供了有统计学意义的结果。一项研究报告称，通过 88%（F（1，20）=7.25）降低了与导管相关的尿路感染（CAUTI）。另一项研究报告称，在第 I 阶段，CAUTI 从 11.17 降至 10.53，在第 II 阶段减少了 0.39（χ=254）。第三项研究报告称，每位患者每周的尿路感染减少（风险比=0.39）。两项关于在线培训和导管插入及护理模拟的医院研究将 CAUTI 从 33 例减少至 14 例，从 10.40 例减少至 0 例。增加护理人员、社区控尿护士和导管移除提醒贴纸可减少感染。没有研究检测预防大肠杆菌菌血症的措施。
研究的异质性意味着无法推荐一种有效的干预措施。我们建议应考虑反馈，因为单独使用或在包括教育、审核或导管移除方案在内的多方面干预措施中，反馈都有助于减少 UTI。多方面的教育可能是有效的。导管移除方案、增加人员配备和患者教育需要进一步评估。
