Department of Internal Medicine, Boston Medical Center, Boston, Massachusetts, USA
Department of Pulmonary, Allergy, Sleep, and Critical Care Medicine, Boston Medical Center, Boston, Massachusetts, USA.
BMJ Open Qual. 2021 Dec;10(4). doi: 10.1136/bmjoq-2021-001534.
Catheter-associated urinary tract infections (CAUTIs) represent approximately 9% of all hospital acquired infections, and approximately 65%-70% of CAUTIs are believed to be preventable. In the spring of 2013, Boston Medical Center (BMC) began an initiative to decrease CAUTI rates within its intensive care units (ICUs). A CAUTI taskforce convened and reviewed process maps and gap analyses. Based on Centers for Disease Control and Prevention (CDC) and Institute for Healthcare Improvement (IHI) guidelines, and delineated by the Healthcare Infection Control Practices Advisory Committee 2009 guidelines, all BMC ICUs sequentially implemented plan-do-study-act cycles based on which measures were most easily adaptable and believed to have the highest impact on CAUTI rates. Implementation of five care bundles spanned 5 years and included (1) processes for insertion and maintenance of foley catheters; (2) indications for indwelling foley catheters; (3) appropriate testing for CAUTIs; (4) alternatives to indwelling devices; and (5) sterilisation techniques. Daily rounds by unit nursing supervisors and inclusion of foley catheter necessity on daily ICU checklists held staff accountable on a daily basis. With these interventions, the total number of CAUTIs at BMC decreased from 53 in 2013 to 9 in 2017 (83% reduction) with a 33.8% reduction in indwelling foley catheter utilisation during the same time period. Adapted protocols showed success in decreasing the CAUTI rate and indwelling foley catheter usage in all of the BMC ICU's. While all interventions had favourable and additive trends towards decreasing the CAUTI rate, the CAUTI awareness education, insertion and removal protocols and implementation of PureWick female incontinence devices had clear and significant effects on decreasing CAUTI rates. Our project provides a framework for improving HAIs using rapid cycle testing and U-chart data monitoring. Targeted education efforts and standardised checklists and protocols adapted sequentially are low-cost and high yield efforts that may decrease CAUTIs in ICU settings.
导管相关尿路感染（CAUTI）约占所有医院获得性感染的 9%，约 65%-70%的 CAUTI 可预防。2013 年春季，波士顿医疗中心（BMC）开始采取措施降低重症监护病房（ICU）的 CAUTI 发生率。一个 CAUTI 工作组召集并审查了流程图和差距分析。根据疾病控制与预防中心（CDC）和医疗保健改进研究所（IHI）的指南，并由医疗保健感染控制实践咨询委员会 2009 年指南划定，所有 BMC ICU 依次实施计划-执行-研究-行动循环，根据最容易适应和认为对 CAUTI 发生率影响最大的措施进行。实施了 5 个护理包，历时 5 年，包括（1） Foley 导管插入和维护流程；（2）留置 Foley 导管的适应证；（3）CAUTI 的适当检测；（4）留置器械的替代品；和（5）消毒技术。单位护理主管的日常查房和在每日 ICU 检查表中列入 Foley 导管必要性，使工作人员每天都承担责任。通过这些干预措施，BMC 的 CAUTI 总数从 2013 年的 53 例减少到 2017 年的 9 例（减少 83%），同时同期留置 Foley 导管的使用率降低了 33.8%。改编后的方案在降低 CAUTI 率和留置 Foley 导管使用率方面在所有 BMC ICU 都取得了成功。虽然所有干预措施都有利于降低 CAUTI 率，但 CAUTI 意识教育、插入和移除方案以及 PureWick 女性失禁装置的实施对降低 CAUTI 率有明显的影响。我们的项目为使用快速循环测试和 U 形图表数据监测来改善 HAI 提供了一个框架。有针对性的教育工作和逐步适应的标准化检查表和方案是低成本、高收益的措施，可以降低 ICU 中的 CAUTI 发生率。
