Harita Shimpei, Murakami Shutaro, Tagashira Yasuaki, Honda Hitoshi
Teikyo University Graduate School of Public Health, Tokyo, Japan.
Department of Pharmacy, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan; Department of Public Health and Epidemiology, Meiji Pharmaceutical University, Tokyo, Japan.
J Infect Chemother. 2025 Feb;31(2):102479. doi: 10.1016/j.jiac.2024.07.019. Epub 2024 Jul 31.
Few interventional studies of catheter-associated urinary tract infection (CAUTI) have been conducted to optimize indwelling urinary catheter (IUC) use in Japan.
The nurse-led, before-after study was conducted at a tertiary care center from June 2018 through May 2022. The intervention included 1) the provision of appropriate indications for IUC use, 2) prospective feedback to the primary care providers by ward nurses on unnecessary/inappropriate IUC use with two, separate interventional phases, the first involving intensive care units (ICU) only, the second involving ICU and general wards, and 3) proactive feedback by Infectious diseases physicians in the Infection Control department to the primary care providers regarding IUC discontinuation upon discharge from the ICU.
During the first phase involving the implementation of the intervention only in the ICU, the indwelling urinary catheter-device utilization ratio (IUC-DUR) trend in the general wards decreased by 1.5 % (P = 0.01). However, the addition of the intervention to the general wards in the second phase led to a 2 % increase in the trend (P = 0.010). The CAUTI incidence in neither the ICU nor the general wards changed significantly.
Although providing feedback on IUC removal at discharge from the ICU and appropriate indications for urinary catheter insertion can reduce inappropriate urinary catheter use, the nurse-led intervention alone was inadequate for reducing the CAUTI incidence.
在日本，很少有关于导管相关尿路感染（CAUTI）的干预性研究来优化留置导尿管（IUC）的使用。
这项由护士主导的前后对照研究于2018年6月至2022年5月在一家三级医疗中心进行。干预措施包括：1）提供IUC使用的适当指征；2）病房护士就不必要/不适当的IUC使用情况向初级护理人员提供前瞻性反馈，分为两个独立的干预阶段，第一阶段仅涉及重症监护病房（ICU），第二阶段涉及ICU和普通病房；3）感染控制部门的传染病医生就ICU患者出院时IUC的拔除情况向初级护理人员提供主动反馈。
在仅在ICU实施干预的第一阶段，普通病房的留置导尿管设备使用率（IUC-DUR）趋势下降了1.5%（P = 0.01）。然而，在第二阶段将干预扩展到普通病房后，该趋势增加了2%（P = 0.010）。ICU和普通病房的CAUTI发病率均无显著变化。
尽管在ICU患者出院时就IUC拔除情况提供反馈以及提供导尿管插入的适当指征可以减少不适当的导尿管使用，但仅由护士主导的干预不足以降低CAUTI发病率。
