School of Nursing, School of Public Health, Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, MI, United States of America.
School of Nursing, Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, MI, United States of America.
PLoS One. 2019 Jul 10;14(7):e0218755. doi: 10.1371/journal.pone.0218755. eCollection 2019.
Catheter-associated asymptomatic bacteriuria (CAABU) is frequent in intensive care units (ICUs) and contributes to the routine use of antibiotics and to antibiotic-resistant infections. While nurses are responsible for the implementation of CAABU-prevention guidelines, variability in how individual nurses contribute to CAABU-free rates in ICUs has not been previously explored. This study's objective was to examine the variability in CAABU-free outcomes of individual ICU nurses. This observational cross-sectional study used shift-level nurse-patient data from the electronic health records from two ICUs in a tertiary medical center in the US between July 2015 and June 2016. We included all adult (18+) catheterized patients with no prior CAABU during the hospital encounter and nurses who provided their care. The CAABU-free outcome was defined as a 0/1 indicator identifying shifts where a previously CAABU-free patient remained CAABU-free (absence of a confirmed urine sample) 24-48 hours following end of shift. The analytical approach used Value-Added Modeling and a split-sample design to estimate and validate nurse-level CAABU-free rates while adjusting for patient characteristics, shift, and ICU type. The sample included 94 nurses, 2,150 patients with 256 confirmed CAABU cases, and 21,729 patient shifts. Patients were 55% male, average age was 60 years. CAABU-free rates of individual nurses varied between 94 and 100 per 100 shifts (Wald test: 227.88, P<0.001) and were robust in cross-validation analyses (correlation coefficient: 0.66, P<0.001). Learning and disseminating effective CAABU-avoidance strategies from top-performers throughout the nursing teams could improve quality of care in ICUs.
导管相关无症状菌尿症（CAABU）在重症监护病房（ICU）中很常见，这导致抗生素的常规使用和抗生素耐药感染的发生。虽然护士负责执行 CAABU 预防指南，但个体护士对 ICU 中 CAABU 无发生率的贡献的变异性尚未被探索。本研究的目的是检查个体 ICU 护士的 CAABU 无结果的变异性。这项观察性横断面研究使用了美国一家三级医疗中心的两个 ICU 的电子病历中的班次级别的护士-患者数据，时间为 2015 年 7 月至 2016 年 6 月。我们纳入了所有在医院就诊期间没有先前 CAABU 的成年（18 岁以上）置管患者和提供护理的护士。CAABU 无结果定义为 0/1 指标，确定了之前 CAABU 无的患者在班次结束后 24-48 小时内仍然 CAABU 无（没有确认的尿液样本）的班次。分析方法使用增值模型和分割样本设计来估计和验证护士水平的 CAABU 无率，同时调整患者特征、班次和 ICU 类型。样本包括 94 名护士、2150 名患者，其中有 256 例确诊的 CAABU 病例，21729 名患者班次。患者中 55%为男性，平均年龄为 60 岁。个体护士的 CAABU 无率在每 100 班次之间变化为 94-100（Wald 检验：227.88，P<0.001），并且在交叉验证分析中是稳健的（相关系数：0.66，P<0.001）。从护理团队中的顶尖表现者中学习和传播有效的 CAABU 避免策略，可以提高 ICU 的护理质量。
