Snyder Megan D, Priestley Margaret A, Weiss Michelle, Hoegg Cindy L, Plachter Natalie, Ardire Sarah, Thompson Allison
Megan D. Snyder is the Director of Nursing Professional Practice at the Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Margaret A. Priestley is an associate professor of clinical anesthesiology and critical care medicine at the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Crit Care Nurse. 2020 Feb 1;40(1):e12-e17. doi: 10.4037/ccn2020438.
Catheter-associated urinary tract infections are common health care-associated infections and have been associated with increased mortality, morbidity, length of stay, and cost. Prevention strategies are grouped into bundles focused on reducing unnecessary catheter use and promptly removing urinary catheters. Before intervention in the study institution, no urinary catheters were unnecessarily used and compliance with the catheter-associated urinary tract infection bundle was 84%.
To increase bundle compliance by using targeted rounds specifically focused on eliminating dependent loops in drainage tubing and ensuring appropriate catheter use to reduce the incidence of catheter-associated urinary tract infections.
A multidisciplinary team was formed to identify misperceptions, highlight best practices, and eliminate barriers to success over 1 year in a single pediatric intensive care unit. The team completed a quality improvement project of daily targeted rounding for patients with an indwelling urinary catheter. The goals were to assess appropriateness of catheterization, increase bundle compliance, and decrease catheter-associated urinary tract infection risk. Targeted rounds were conducted in addition to the medical team rounds.
Bundle compliance supported by targeted rounding increased from 84% to 93% and helped reduce the overall catheter-associated urinary tract infection rate from 2.7 infections per 1000 catheter-days at baseline to 0. This change was sustained for 1 year.
Targeted rounding for pediatric patients with an indwelling urinary catheter is an effective and sustainable strategy to reduce catheter-associated urinary tract infections. The ease of implementation for this intervention lends itself to generalizability to other patient populations.
导尿管相关尿路感染是常见的医疗保健相关感染，与死亡率增加、发病率上升、住院时间延长及成本增加有关。预防策略分为若干组合，重点是减少不必要的导尿管使用并及时拔除导尿管。在研究机构进行干预之前，未出现不必要使用导尿管的情况，导尿管相关尿路感染组合的依从率为84%。
通过开展有针对性的查房，特别关注消除引流管中的依赖环路并确保导尿管的正确使用，以提高组合依从率，降低导尿管相关尿路感染的发生率。
组建了一个多学科团队，在一个儿科重症监护病房内，用1年时间识别误解、突出最佳实践并消除成功的障碍。该团队针对留置导尿管的患者完成了一项每日有针对性查房的质量改进项目。目标是评估导尿的适宜性、提高组合依从率并降低导尿管相关尿路感染风险。除了医疗团队查房外，还进行了有针对性的查房。
有针对性查房支持下的组合依从率从84%提高到93%，并有助于将导尿管相关尿路感染的总体发生率从基线时的每1000导尿日2.7次感染降至0。这一变化持续了1年。
对留置导尿管的儿科患者进行有针对性的查房是降低导尿管相关尿路感染的一种有效且可持续的策略。这种干预措施易于实施，可推广至其他患者群体。
