Quality Improvement and Patient Safety, Hamad Medical Corporation, Doha, Qatar
Department of Nursing and Midwifery Education and Research, Hamad Medical Corporation, Doha, Qatar.
BMJ Open Qual. 2023 May;12(2). doi: 10.1136/bmjoq-2022-002214.
Catheter-associated urinary tract infection (CAUTI) is one of the most common hospital-acquired infections. The use of urinary catheters is associated with several complications and increased mortality and morbidity. At the coronary intensive care unit (CICU) of a tertiary cardiac care facility, the CAUTI rate was 7.6/1000 catheter days in January 2017. In collaboration with the Institute for Healthcare Improvement, we implemented evidence-based practices in the form of bundles based on the value improvement methodology to eliminate CAUTIs in the CICU.
This initiative aimed to reduce the CAUTI rate using a multifaceted approach. The key interventions were empowering front-line nurses for automatic stop orders and ensuring compliance to the catheter insertion and maintenance bundles. We used a model for improvement and tested the changes using small plan-do-study-act cycles. Surveillance methods and CAUTI definitions proposed by the National Healthcare Safety Network were used to monitor the outcomes. Monthly rates of CAUTIs 24 months before the intervention were compared with those 44 months after the intervention using an independent t-test. Statistical significance was set at p<0.05.
The rate of CAUTIs dropped from 7.6 per 1000 catheter days in January 2017 to 0 from October 2021 to August 2022. The unit had achieved 280 calendar days free of CAUTI untill August 2022.
Behavioural changes, including empowerment of nurses and adherence to all elements of the care bundle, led to significant and sustained improvement in reducing the CAUTI rate in the adult CICU.
导管相关尿路感染（CAUTI）是最常见的医院获得性感染之一。使用导尿管会导致多种并发症，并增加死亡率和发病率。在一家三级心脏护理机构的冠心病加强护理病房（CICU），2017 年 1 月 CAUTI 发生率为每 1000 个导管日 7.6 例。我们与医疗改进研究所合作，采用基于价值改进方法的基于捆绑包的循证实践，以消除 CICU 中的 CAUTI。
该倡议旨在通过多方面的方法降低 CAUTI 发生率。主要干预措施是授权一线护士自动下达停止医嘱，并确保遵守导管插入和维护捆绑包。我们使用改进模型，并使用小计划-执行-研究-行动循环来测试更改。使用国家医疗保健安全网络提出的监测方法和 CAUTI 定义来监测结果。使用独立 t 检验比较干预前 24 个月和干预后 44 个月的 CAUTI 每月发生率。统计显著性设置为 p<0.05。
CAUTI 发生率从 2017 年 1 月每 1000 个导管日 7.6 例降至 2021 年 10 月至 2022 年 8 月的 0 例。截至 2022 年 8 月，该病房已实现 280 天无 CAUTI。
行为改变，包括护士的赋权和遵守护理捆绑包的所有要素，导致成人 CICU 中 CAUTI 发生率显著且持续降低。
