Soundaram Geni Vg, Sundaramurthy Raja, Jeyashree Kathiresan, Ganesan Vithiya, Arunagiri Ramesh, Charles Jhansi
Department of Microbiology, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India.
Department of Epidemiology and Biostatistics, National Institute of Epidemiology, Chennai, Tamil Nadu, India.
Indian J Crit Care Med. 2020 Jul;24(7):544-550. doi: 10.5005/jp-journals-10071-23473.
Implementation of evidence-based infection control practices is the need of the hour for every institute to reduce the device-associated infections, which directly reflects the quality of care. As catheter-associated urinary tract infection (CAUTI) is the most common nosocomial infection, the study was planned to evaluate the impact of the catheter care bundle in reducing CAUTI incidence.
The prospective interventional study before and after the trial study was carried out in adult intensive care units over a period of 9 months (April-June 2017-pre-implementation phase; July-September 2017-training of healthcare worker and implementation of catheter care bundle; October-December 2017-post-implementation phase). Catheter-associated urinary tract infection rates pre- and post-implementation were expressed as incidence rates with Poisson confidence interval.
Statistically significant reduction was found in the incidence of CAUTI (60%-from 10.7 to 4.5 per 1,000 catheter days). The key factors that contributed were significant reduction in device utilization ratio (from 0.71 to 0.56) and average catheter days per patient (from 4.8 to 3.7). This holistic approach has resulted in less incidence of CAUTI even among patients with risk factors and prolonged catheter days. Neuro ICU showed drastic improvement compared to other ICUs due to the poor baseline status of their care practices.
Adherence to all elements of care bundle brought a significant decrease in CAUTI. Implementing care bundle and auditing the adherence to each element should be included as a part of routine hospital infection control committee (HICC) practices.
Hospital-acquired infection directly reflects on the quality care of the hospital. Bundle care is an "all or none" phenomenon. Adherence to each element will have some influence in reducing CAUTI in terms of reducing the device utilization ratio and average catheter days per patient. Auditing the care bundle adherence is having a positive influence on the outcome.
Soundaram GVG, Sundaramurthy R, Jeyashree K, Ganesan V, Arunagiri R, Charles J. Impact of Care Bundle Implementation on Incidence of Catheter-associated Urinary Tract Infection: A Comparative Study in the Intensive Care Units of a Tertiary Care Teaching Hospital in South India. Indian J Crit Care Med 2020;24(7):544-550.
实施循证感染控制措施是每个机构当下的需求，以减少与器械相关的感染，这直接反映了医疗质量。由于导管相关尿路感染（CAUTI）是最常见的医院感染，本研究旨在评估导管护理集束措施对降低CAUTI发生率的影响。
在成人重症监护病房进行了为期9个月的试验性前瞻性干预研究（2017年4月至6月——实施前阶段；2017年7月至9月——医护人员培训及导管护理集束措施实施；2017年10月至12月——实施后阶段）。实施前后的导管相关尿路感染率以泊松置信区间的发病率表示。
CAUTI发病率有统计学意义的降低（60%——从每1000导管日10.7例降至4.5例）。促成这一结果的关键因素是器械使用率显著降低（从0.71降至0.56）以及每位患者的平均导管留置天数减少（从4.8天降至3.7天）。这种整体方法即使在有危险因素和导管留置天数延长的患者中也使CAUTI发病率降低。与其他重症监护病房相比，神经重症监护病房由于其护理措施的基线状况较差，改善更为显著。
坚持护理集束措施的所有要素可使CAUTI显著减少。实施护理集束措施并审核对每个要素的依从性应纳入医院感染控制委员会（HICC）的常规工作。
医院获得性感染直接反映医院的医疗质量。集束护理是一种“全有或全无”的现象。坚持每个要素在降低器械使用率和每位患者的平均导管留置天数方面对减少CAUTI会有一定影响。审核护理集束措施的依从性对结果有积极影响。
Soundaram GVG, Sundaramurthy R, Jeyashree K, Ganesan V, Arunagiri R, Charles J. 护理集束措施实施对导管相关尿路感染发生率的影响：印度南部一家三级护理教学医院重症监护病房的比较研究。《印度重症监护医学杂志》2020年；24(7):544 - 550。
