Frödin Maria, Ahlstrom Linda, Gillespie Brigid M, Rogmark Cecilia, Nellgård Bengt, Wikström Ewa, Erichsen Andersson Annette
Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
J Infect Prev. 2022 Mar;23(2):41-48. doi: 10.1177/17571774211060417. Epub 2022 Feb 15.
Urinary catheter (UC)-associated infections are one of the most common preventable healthcare-associated infections (HAIs) and they frequently occur in older, frail populations.
The study aim was to describe the incidence of UC-associated infection in elderly patients undergoing hip fracture surgery after implementing a preventive care bundle.
A longitudinal prospective study using a before-and-after design. The bundle was theory driven and involved the co-creation of a standard operational procedure, education and practical training sessions. Prospectively collected registry data were analysed. Univariable statistics and multivariable logistic regressions were used for analyses.
2,408 patients with an acute hip fracture were included into the study. There was an overall reduction in UC catheter associated-associated urinary tract infections, from 18.5% ( = 75/406) over time to 4.2% ( = 27/647). When adjusting for all identified confounders, patients in phase 4 were 74% less likely to contract an UC-associated infection (OR, 0.26; 95% CI, 0.15-0.45, < 0.0001).
Bundled interventions can reduce UC-associated infections substantially, even in elderly frail patients. Partnership and co-creation as implementation strategies appear to be promising in the fight against HAI.
导尿管（UC）相关感染是最常见的可预防医疗相关感染（HAIs）之一，且经常发生在老年体弱人群中。
本研究旨在描述实施预防性护理包后，接受髋部骨折手术的老年患者中UC相关感染的发生率。
采用前后设计的纵向前瞻性研究。该护理包以理论为驱动，涉及共同制定标准操作程序、开展教育和实践培训课程。对前瞻性收集的登记数据进行分析。采用单变量统计和多变量逻辑回归进行分析。
2408例急性髋部骨折患者纳入研究。UC相关尿路感染总体有所减少，从最初的18.5%（n = 75/406）降至4.2%（n = 27/647）。在对所有已识别的混杂因素进行调整后，第4阶段的患者发生UC相关感染的可能性降低了74%（OR，0.26；95%CI，0.15 - 0.45，P < 0.0001）。
即使在老年体弱患者中，综合干预措施也能大幅减少UC相关感染。作为实施策略的伙伴关系和共同制定在对抗医疗相关感染方面似乎很有前景。
