Department of Health Informatics, School of Public Health, Kyoto University, Kyoto, Japan.
Department of Infectious Diseases, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan.
J Eval Clin Pract. 2022 Aug;28(4):542-549. doi: 10.1111/jep.13626. Epub 2021 Oct 10.
Since patients with stroke frequently develop bladder dysfunction, a careful approach is required to reduce unnecessary indwelling urinary catheter (IUC) for preventing catheter-associated urinary tract infection (CAUTI). This study aimed to assess the effectiveness and safety of a program to promote appropriate IUC use in stroke care.
We conducted a prospective interrupted time series study in three tertiary care hospitals in Japan. Adult patients with acute stroke were eligible. The study consisted of three phases: baseline, education and implementation. Our program included an assessment of IUC indications, educational meetings among healthcare professionals, reminders for removal of inappropriate IUC and a urinary retention protocol. The primary outcome was the proportion of inappropriate IUC use to assess effectiveness. The device utilization ratio and incidence of CAUTI were examined to assess effectiveness, and incidences of urinary retention and all symptomatic urinary tract infection (UTI) were examined to assess safety.
Among 976 patients who met the inclusion criteria, 738 were analysed. Inappropriate IUC use decreased from 50.1% in the baseline phase to 22.5% in the implementation phase (absolute risk reduction in interrupted time series analysis 42.4% [95% confidence interval, 19.2%-65.6%]). The device utilization ratio decreased from 0.302 to 0.194 (p < 0.001), whereas CAUTI did not change significantly (from 8.81 to 8.28 per 1000 catheter-days; incidence rate ratio 0.95 [0.44-1.94]). All symptomatic UTI decreased from 9.5% to 4.9% (p = 0.015), with no increase in urinary retention.
Our program improved the appropriateness of IUC use in stroke care while ensuring safety.
由于中风患者常出现膀胱功能障碍，因此需要谨慎处理，以减少不必要的留置导尿管（IUC），从而预防导管相关性尿路感染（CAUTI）。本研究旨在评估促进中风护理中适当使用 IUC 的方案的有效性和安全性。
我们在日本的三家三级护理医院进行了一项前瞻性中断时间序列研究。符合条件的成年急性中风患者纳入研究。研究包括三个阶段：基线期、教育和实施期。我们的方案包括对 IUC 适应证的评估、医护人员教育会议、对不合适的 IUC 去除的提醒以及尿潴留方案。主要结局是评估有效性的不合适 IUC 使用比例。还评估了设备使用率和 CAUTI 发生率以评估有效性，以及尿潴留和所有有症状的尿路感染（UTI）发生率以评估安全性。
在符合纳入标准的 976 名患者中，有 738 名患者纳入分析。在基线期，不合适的 IUC 使用比例为 50.1%，在实施期降至 22.5%（中断时间序列分析的绝对风险降低 42.4%[95%置信区间，19.2%-65.6%]）。设备使用率从 0.302 降至 0.194（p<0.001），而 CAUTI 无显著变化（每 1000 个导管日从 8.81 例降至 8.28 例；发病率比 0.95[0.44-1.94]）。所有有症状的 UTI 从 9.5%降至 4.9%（p=0.015），且尿潴留无增加。
我们的方案在确保安全性的同时，提高了中风护理中 IUC 使用的适当性。
