预防导尿管相关尿路感染临床实践指南的质量评价与内容分析

Quality assessment of clinical practice guidelines for preventing catheter-associated urinary tract infection and its content analysis

目的评价国内外导尿管相关尿路感染(CAUTI)预防临床实践指南的质量,分析指南特点及推荐内容。方法系统检索国内外数据库、指南网站及相关专业学会网站中包含CAUTI预防内容的相关指南,检索时限自建库至2022年5月30日,由2名评价员按照纳入排除标准筛选出指南后,3名评价员采用临床指南研究与评价系统Ⅱ(AGREEⅡ)对指南进行质量评价。结果共纳入CAUTI预防指南12部,其中国外11部,国内1部。12部指南在AGREEⅡ6个领域平均得分由高到低依次为:清晰性(91.05%)、范围和目的(82.87%)、编写独立性(72.22%)、参与人员(67.75%)、严谨性(59.26%)、应用性(44.21%)。总体质量评价为A级4部,B级7部,C级1部。推荐内容主要包括尿管留置必要性评估、尿管留置护理、置管后维护、教育与培训等。结论本研究纳入的CAUTI预防指南总体质量中等,高质量指南较少;纳入指南的应用性领域得分最低,建议未来可组建多学科专业团队,立足国内实际,参照循证指南编制过程,考虑推荐建议应用时的阻碍/促进因素,编制出高质量的CAUTI预防循证指南。

Objective To evaluate the quality of clinical practice guidelines for preventing catheter-associated urinary tract infection(CAUTI)at home and abroad,and analyze the characteristics and recommended contents of the guidelines.Methods Relevant guidelines for prevention of CAUTI in domestic and foreign databases,guideline websites and websites of relevant professional societies were systematically searched from the establishment of the database to May 30,2022.After the guidelines were selected by 2 evaluators according to the inclusion and exclusion criteria,3 evaluators the quality of guidelines by using the Appraisal of Guidelines for Research&EvaluationⅡ(AGREEⅡ).Results A total of 12 guidelines for prevention of CAUTI were included,including 11 foreign guidelines and 1 domestic guidelines.The average scores of the 12 guidelines in the 6 domains of AGREEⅡfrom high to low were:Clarity of presentation(91.05%),scope and purpose(82.87%),editorial independence(72.22%),stakeholder involvement(67.75%),rigour of development(59.26%),and applicability(44.21%).The overall quality evaluation was A grade for 4 departments,B grade for 7 departments,C grade for 1 departments.The recommended contents mainly included the necessity evaluation of urinary catheter indwelling,urinary catheter indwelling nursing,maintenance after catheterization,education and training,etc.Conclusion The overall quality of CAUTI prevention guidelines includes in this study was medium,and there were few high-quality guidelines.Scores of the domain of applicability were the lowest.It is suggested that a multidisciplinary professional team should be established in the future to formulate high-quality evidence-based guidelines for CAUTI prevention based on domestic reality,refer to the development process of evidence-based guidelines,and consider the obstacles/promoting factors in the application of recommendations.