基于证据的干预对导尿管使用、相关过程指标以及感染和非感染结果的影响。

Impact of an evidence-based intervention on urinary catheter utilization, associated process indicators, and infectious and non-infectious outcomes.

机构信息

Swissnoso, National Centre for Infection Control, Bern, Switzerland; Department of Infectious Diseases and Hospital Epidemiology, Basel University Hospital, Basel, Switzerland; Zug Cantonal Hospital, Zug, Switzerland.

Swissnoso, National Centre for Infection Control, Bern, Switzerland; Division of Infectious Diseases and Hospital Epidemiology, University and University Hospital Zurich, Zurich, Switzerland.

出版信息

J Hosp Infect. 2020 Oct;106(2):364-371. doi: 10.1016/j.jhin.2020.07.002. Epub 2020 Jul 10.

DOI:10.1016/j.jhin.2020.07.002

PMID:32653433

Abstract

BACKGROUND

Multi-centre intervention studies tackling urinary catheterization and its infectious and non-infectious complications are lacking.

AIM

To decrease urinary catheterization and, consequently, catheter-associated urinary tract infections (CAUTIs) and non-infectious complications.

METHODS

Before/after non-randomized multi-centre intervention study in seven hospitals in Switzerland. Intervention bundle consisting of: (1) a concise list of indications for urinary catheterization; (2) daily evaluation of the need for ongoing catheterization; and (3) education on proper insertion and maintenance of urinary catheters. The primary outcome was urinary catheter utilization. Secondary outcomes were CAUTIs, non-infectious complications and process indicators (proportion of indicated catheters and frequency of catheter evaluation).

FINDINGS

In total, 25,880 patients were included in this study [13,171 at baseline (August-October 2016) and 12,709 post intervention (August-October 2017)]. Catheter utilization decreased from 23.7% to 21.0% (P=0.001), and catheter-days per 100 patient-days decreased from 17.4 to 13.5 (P=0.167). CAUTIs remained stable at a low level with 0.02 infections per 100 patient-days (baseline) and 0.02 infections (post intervention) (P=0.98). Measuring infections per 1000 catheter-days, the rate was 1.02 (baseline) and 1.33 (post intervention) (P=0.60). Non-infectious complications decreased significantly, from 0.79 to 0.56 events per 100 patient-days (P<0.001), and from 39.4 to 35.4 events per 1000 catheter-days (P=0.23). Indicated catheters increased from 74.5% to 90.0% (P<0.001). Re-evaluations increased from 168 to 624 per 1000 catheter-days (P<0.001).

CONCLUSION

A straightforward bundle of three evidence-based measures reduced catheter utilization and non-infectious complications, whereas the proportion of indicated urinary catheters and daily evaluations increased. The CAUTI rate remained unchanged, albeit at a very low level.

摘要

背景

缺乏多中心干预研究来解决导尿及其感染和非感染并发症问题。

目的

减少导尿，从而减少导尿管相关尿路感染（CAUTI）和非感染性并发症。

方法

在瑞士的七家医院进行了非随机多中心干预研究之前/之后。干预措施包括：（1）简明的导尿适应证清单；（2）每天评估继续导尿的必要性；（3）导尿管正确插入和维护的教育。主要结果是导尿利用情况。次要结果是 CAUTI、非感染性并发症和过程指标（指征性导尿管的比例和导尿管评估频率）。

结果

本研究共纳入 25880 例患者[基线时 13171 例（2016 年 8 月至 10 月），干预后 12709 例（2017 年 8 月至 10 月）]。导尿管使用率从 23.7%降至 21.0%（P=0.001），每 100 患者日的导尿管天数从 17.4 天降至 13.5 天（P=0.167）。CAUTI 保持在低水平，每 100 患者日感染率为 0.02（基线）和 0.02（干预后）（P=0.98）。以每 1000 导尿管日感染率计算，发病率为 1.02（基线）和 1.33（干预后）（P=0.60）。非感染性并发症显著减少，从每 100 患者日 0.79 降至 0.56 例（P<0.001），从每 1000 导尿管日 39.4 降至 35.4 例（P=0.23）。指征性导尿管从 74.5%增至 90.0%（P<0.001）。每 1000 导尿管日重新评估次数从 168 次增加至 624 次（P<0.001）。