Duffy L M, Cleary J, Ahern S, Kuskowski M A, West M, Wheeler L, Mortimer J A
Geriatric Research, Education, and Clinical Center (GRECC), VA Medical Center, Minneapolis, Minnesota 55417, USA.
J Am Geriatr Soc. 1995 Aug;43(8):865-70. doi: 10.1111/j.1532-5415.1995.tb05528.x.
To compare the safety and cost of clean versus sterile intermittent bladder catheterization in male nursing home residents. To provide evidence to support the hypothesis that intermittent catheterization is a valid, alternative method of bladder management in male residents of long-term care in whom urinary retention is a documented problem.
Randomized clinical trial.
Three long-term care sites having predominantly male populations.
Eighty male veterans, residents of three long-term care facilities, ranging in age from 36 to 96 years with a mean age of 72.
Standardized procedures for clean and sterile intermittent catheterization (IC) were implemented by staff nurses at each site. Patients were randomized into clean and sterile IC groups. Nursing time and catheterization equipment usage were recorded using bar code readers. Clinical data were collected from the medical chart. Treatment of urinary tract infection was prescribed by the medical personnel responsible for each individual resident.
We compared the number of treatment episodes for symptomatic bacteriuria between groups randomized to receive either clean or sterile intermittent catheterization. Laboratory analysis of blood and urine was done on predetermined days. Control variables were research site and patient history of urinary tract infection within the last 6 months. A cost comparison of nursing time and equipment usage for the two catheterization techniques was also performed.
No significant differences were found between clean and sterile groups with regard to number of treatment episodes, time to first infection, type of organism cultured, or cost of antibiotic treatment. The cost of sterile technique was considerably higher both in terms of nursing time and supplies.
Findings from this study demonstrate that clean technique intermittent catheterization is a safe and cost-effective bladder management technique with male, nursing home residents, despite the frailty of this high risk population. An annual savings of approximately $1460 per patient in nursing time and catheterization supplies could be anticipated if a patient were catheterized an average of four times per day substituting clean IC technique for sterile IC technique.
比较男性疗养院居民进行清洁间歇性膀胱导尿与无菌间歇性膀胱导尿的安全性和成本。为支持以下假设提供证据：对于有尿潴留记录问题的长期护理男性居民，间歇性导尿是一种有效的膀胱管理替代方法。
随机临床试验。
三个主要为男性人群的长期护理机构。
80名男性退伍军人，来自三个长期护理机构，年龄在36至96岁之间，平均年龄为72岁。
每个机构的护士执行清洁和无菌间歇性导尿（IC）的标准化程序。患者被随机分为清洁导尿组和无菌导尿组。使用条形码阅读器记录护理时间和导尿设备使用情况。从病历中收集临床数据。由负责每位居民的医务人员开出处治尿路感染的药方。
我们比较了随机接受清洁或无菌间歇性导尿组之间有症状菌尿的治疗次数。在预定日期进行血液和尿液的实验室分析。控制变量为研究机构和患者过去6个月内的尿路感染病史。还对两种导尿技术的护理时间和设备使用进行了成本比较。
在治疗次数、首次感染时间、培养出的生物体类型或抗生素治疗成本方面，清洁组和无菌组之间未发现显著差异。无菌技术在护理时间和用品方面的成本都要高得多。
本研究结果表明，对于男性疗养院居民，清洁技术间歇性导尿是一种安全且具有成本效益的膀胱管理技术，尽管该高危人群身体虚弱。如果患者每天平均导尿4次，用清洁导尿技术替代无菌导尿技术，预计每位患者每年在护理时间和导尿用品方面可节省约1460美元。
