Liang Ching-Chuan, Huang Tzyy-Jen, Yang Shu-Hua, Su Jui Yuan, Mu Pei-Fan, Curia Marianne
Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan.
Department of Nursing, National Yang-Ming University. Taipei, Taiwan.
JBI Database System Rev Implement Rep. 2019 Jun;17(6):1256-1267. doi: 10.11124/JBISRIR-2017-003945.
The objective of this evidence based implementation project was to promote evidence based practice in the prevention of catheter-associated urinary tract infection (CAUTI) in the neurology and neurosurgery units of a Taipei hospital.
Catheter-associated urinary tract infection has been associated with increased morbidity, mortality, hospital costs and length of stay. Urinary drainage systems are often reservoirs of infection in patients, thus effective prevention of CAUTI requires an evidence-based approach. The CAUTI incidence in the neurosurgery units of the hospital was 1.86-2.69% urinary catheter days, which ranked as medium when compared to the entire hospital.
A clinical audit was undertaken using the Joanna Briggs Institute Practical Application of Clinical Evidence System tool, based on eight audit criteria that represented best practice recommendations for CAUTI. A baseline audit of the neurology and neurosurgery units was performed, followed by the implementation of multiple strategies throughout a 20-week period. A follow-up audit was undertaken after this to assess changes in practice.
The post strategy implementation audit results indicated that compliance with clinical guideline recommendations improved considerably. Proper utilization of an appropriate closed drainage system and training of persons maintaining catheters achieved 100% compliance. The guideline recommendation that catheter and drainage bags be changed only when clinically indicated reached 94% compliance. Catheters removed within 24 hours postoperatively improved by more than 50% compliance. Compliance with systemic antimicrobials being clinically indicated and their use justified improved by 25% and documentation on a clinically appropriate indication for ongoing urinary catheterization improved by almost 33.3%.
The implementation project was successful in improving nurses' knowledge and skills related to the prevention of CAUTI. A variety of strategies, such as an education program, simple and clear instruments, collaboration with physicians in caring for patients with a high risk of CAUTI, and multiple educational materials can facilitate implementation of evidence based procedures in clinical practice.
本循证实施项目的目的是在台北一家医院的神经内科和神经外科促进预防导尿管相关尿路感染（CAUTI）的循证实践。
导尿管相关尿路感染与发病率、死亡率、医院成本和住院时间增加有关。尿液引流系统通常是患者感染的源头，因此有效预防CAUTI需要循证方法。该医院神经外科的CAUTI发病率为每导尿管日1.86%-2.69%，与全院相比排名中等。
使用乔安娜·布里格斯循证实践应用系统工具进行临床审核，该工具基于代表CAUTI最佳实践建议的八项审核标准。对神经内科和神经外科进行了基线审核，随后在20周内实施了多种策略。在此之后进行了随访审核，以评估实践中的变化。
策略实施后的审核结果表明，对临床指南建议的依从性有了显著提高。正确使用适当的密闭引流系统以及对维护导尿管人员的培训达到了100%的依从性。仅在临床指征明确时更换导尿管和引流袋的指南建议依从率达到了94%。术后24小时内拔除导尿管的依从性提高了50%以上。临床指征明确且使用合理的全身抗菌药物的依从性提高了25%，持续导尿临床适当指征的记录改善了近33.3%。
该实施项目成功提高了护士预防CAUTI的知识和技能。多种策略，如教育项目、简单明了的工具、与医生合作护理CAUTI高风险患者以及多种教育材料，可以促进循证程序在临床实践中的实施。
