Knowledge and practice skills on home-based urinary catheter care among parents of under-five children with urinary catheter

Objectives:The objectives of this study were to assess the knowledge and practice skills on home-based urinary catheter care among parents of under-five children with urinary catheter.Materials and Methods:This cross-sectional study was conducted from June 1,2021,to September 11,2021,in a tertiary hospital in north India.Purposive sampling was used to select 50 participants.Three instruments were employed for data collection after fulfilling sample criteria;for baseline information demographic tool,knowledge questionnaires,and a practice checklist.Data were analyzed using descriptive and inferential statistics.Results:On assessment of 50 participants,the majority of parents aged above 30 years(74%).Most of the participants were male(82%),graduated(38%),and working in the private sector(58%).Similarly,two-thirds of participants were residing in a nuclear family(64%)with a single child 32(64%)and family income<5000 rupees per month(60%).The mean score of knowledge was 1.94±0.81 and that of practice skills was 1.98±0.85 on home-based care.Regression analysis showed that knowledge of parents was significantly associated with qualification(β:1.821,P=0.002).Similarly,association of practice skills of parents with gender(β:1.235,P=0.050)and qualification(β:1.889,P=0.00)was significant.Conclusion:The general findings of our study showed that parents’education and occupation played a significant role in a child’s care.Parental education and catheter care skills positively affect the child and reduce readmission rates.

Analysis of the Nursing Effect of Hierarchical Extended Nursing Based on The Guidance of Orem’s Theory in Patients with PICC Catheterization

Objective:To analyze the nursing effect of hierarchical extended nursing based on the guidance of Orem’s theory in patients with peripherally inserted central(PICC)catheterization.Methods:Ninety-one patients with PICC catheterization admitted to the hospital from May 2021 to May 2023 were selected and divided into a control group and an observation group,with 45 and 46 cases,respectively.The control group received routine nursing care,while the observation group received routine nursing care combined with hierarchical extended nursing based on the guidance of Orem’s theory for 3 months.Relevant indicators between the two groups were compared.Results:The improvement degree of various indicators in the observation group after nursing was better than that of the control group(P<0.05).Conclusion:Graded extended nursing based on the guidance of Orem’s theory improved the knowledge,belief,behavior,and self-efficacy of patients with PICC catheterization,and relieved their anxiety,depression,and other negative emotions.The nursing effect was deemed to be significant.

Central venous catheterization-related complications in a cohort of 100 hospitalized patients:An observational study

Objective:To evaluate the complications of central venous catheterization(CVC).Methods:A prospective,observational study was conducted at a tertiary care center in India from December 2018 to September 2020.Critically ill patients(aged≥18 years)in the intensive care unit undergoing CVC procedures were included in the study.Baseline demographics and detailed medical history were recorded.Chest X-rays and electrocardiography were performed on all the patients.Complications associated with CVC were recorded.Results:A total of 100 patients with the indication for central venous catheter insertion were included.The majority(81%)of the patients were inserted with CVC at the right internal jugular vein.Complications such as arterial puncture(2%),hematoma(4%),blood clot formation(4%),catheter kinking(3%),thoracic injury(1%),thrombophlebitis(6%),sepsis(9%)and nerve injury(1%)were reported.Conclusions:Though central venous access is preferred in management of critically ill patients,it has its risks.However,early recognition and prompt management of complications may reduce mortality and morbidity.Physicians and intensive care unit intensivists should be vigilant for central venous catheter-related complications.Suitable site selection,operator experience,and proper catheter maintenance are associated with optimal outcomes.

Point of care ultrasonography as the new“Laennec Sthetoscope”

Point of care ultrasonography(POCUS)has evolved to become the fifth pillar of the conventional physical examination,and use of POCUS protocols have significantly decreased procedure complications and time to diagnose.However,lack of experience in POCUS by preceptors in medical schools and nephrology residency programs are significant barriers to implement a broader use.In rural and low-income areas POCUS may have a transformative effect on health care management.

Focus on peripherally inserted central catheters in critically ill patients

Venous access devices are of pivotal importance for an increasing number of critically ill patients in a variety of disease states and in a variety of clinical settings(emergency, intensive care, surgery) and for different purposes(fluids or drugs infusions, parenteral nutrition, antibiotic therapy, hemodynamic monitoring, procedures of dialysis/apheresis). However, healthcare professionals are commonly worried about the possible consequences that may result using a central venous access device(CVAD)(mainly, bloodstream infections and thrombosis), both peripherally inserted central catheters(PICCs) and centrally inserted central catheters(CICCs). This review aims to discuss indications, insertion techniques, and care of PICCs in critically ill patients. PICCs have many advantages over standard CICCs. First of all, their insertion is easy and safe-due to their placement into peripheral veins of the armand the advantage of a central location of catheter tip suitable for all osmolarity and p H solutions. Using the ultrasound-guidance for the PICC insertion, the risk of hemothorax and pneumothorax can be avoided, as wellas the possibility of primary malposition is very low. PICC placement is also appropriate to avoid post-procedural hemorrhage in patients with an abnormal coagulative state who need a CVAD. Some limits previously ascribed to PICCs(i.e., low flow rates, difficult central venous pressure monitoring, lack of safety for radio-diagnostic procedures, single-lumen) have delayed their start up in the intensive care units as common practice. Though, the recent development of power-injectable PICCs overcomes these technical limitations and PICCs have started to spread in critical care settings. Two important take-home messages may be drawn from this review. First, the incidence of complications varies depending on venous accesses and healthcare professionals should be aware of the different clinical performance as well as of the different risks associated with each type of CVAD(CICCs or PICCs). Second, an inappropriate CVAD choice and, particularly, an inadequate insertion technique are relevant-and often not recognized-potential risk factors for complications in critically ill patients. We strongly believe that all healthcare professionals involved in the choice, insertion or management of CVADs in critically ill patients should know all potential risk factors of complications. This knowledge may minimize complications and guarantee longevity to the CVAD optimizing the risk/benefit ratio of CVAD insertion and use. Proper management of CVADs in critical care saves lines and lives. Much evidence from the medical literature and from the clinical practice supports our belief that, compared to CICCs, the so-called power-injectable peripherally inserted central catheters are a good alternative choice in critical care.

Clinical analysis of central venous catheter-related infections in patients in the emergency ICU

BACKGROUND:Catheter-related infection(CRI)of the central vein is a common cause of nosocomial infection.This study was undertaken to investigate the pathogen culturing and risk factors of CRI in emergency intensive care unit(EICU)in order to provide the beneficial reference.METHODS:From January 2008 to December 2010,a total of 1 363 patients were subjected to catheterization.In these patients,the peak CRI rate of the patients was determined by bacterial cultivation and blood bacterial cultivation.RESULTS:CRI happened in 147 of the 1 363 patients using the central venous catheter.The peak rate of CRI was 10.79%,with an incidence of 3.05 episodes per 1 000 catheter days.Of the147 patients,46.94%had gram-negative bacilli,40.14%had gram-positive cocci,and 12.92%had fungi.Unconditional logistic regression analysis suggests that multiple catheterization,femoral vein catheterization,the application of multicavity catheter,and the duration of catheterization were the independent risk factors for CRI.CONCLUSION:The risk factors for catheter-related infections should be controlled to prevent the occurrence of nosocomial infection.

A Fatal Complication of A Peripheral Venous Catheter

Peripheral venous catheters (PVC) are widely used in the hospital and seem to be innocent. However, complications can be devastating. We present a case of a fatal septic shock due to vertebral osteomyelitis after PVC-related Staphylococcus aureus bacteremia (SAB). Staphylococcus aureus is a leading cause of bacteraemia in both the community and the hospital with a significantly increased incidence over the last several decades. Intravascular catheters are the most common cause of SAB. Morbidity and mortality are high, even with appropriate therapy. Although complications are known and common, they may be difficult to recognize. Vertebral osteomyelitis is one of these known severe complications.

Pulmonary artery catheterization in acute myocardial infarction complicated by cardiogenic shock:A review of contemporary literature

Acute myocardial infarction(AMI)with left ventricular(LV)dysfunction patients,the most common cause of cardiogenic shock(CS),have acutely deteriorating hemodynamic status.The frequent use of vasopressor and inotropic pharmacologic interventions along with mechanical circulatory support(MCS)in these patients necessitates invasive hemodynamic monitoring.After the pivotal Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness trial failed to show a significant improvement in clinical outcomes in shock patients managed with a pulmonary artery catheter(PAC),the use of PAC has become less popular in clinical practice.In this review,we summarize currently available literature to summarize the indications,clinical relevance,and recommendations for use of PAC in the setting of AMI-CS.

Pleural effusion in critically ill patients and intensive care setting

Pleural effusion usually causes a diagnostic dilemma with a long list of differential diagnoses.Many studies found a high prevalence of pleural effusions in critically ill and mechanically ventilated patients,with a wide range of variable prevalence rates of up to 50%-60%in some studies.This review emphasizes the importance of pleural effusion diagnosis and management in patients admitted to the intensive care unit(ICU).The original disease that caused pleural effusion can be the exact cause of ICU admission.There is an impairment in the pleural fluid turnover and cycling in critically ill and mechanically ventilated patients.There are also many difficulties in diagnosing pleural effusion in the ICU,including clinical,radiological,and even laboratory difficulties.These difficulties are due to unusual presentation,inability to undergo some diagnostic procedures,and heterogenous results of some of the performed tests.Pleural effusion can affect the patient’s outcome and prognosis due to the hemodynamics and lung mechanics changes in these patients,who usually have frequent comorbidities.Similarly,pleural effusion drainage can modify the ICUadmitted patient’s outcome.Finally,pleural effusion analysis can change the original diagnosis in some cases and redirect the management toward a different way.

Umbilical Catheter Complications in Newborns during Prone Position: A Pilot Study

Introduction: It is not known whether prone position of newborns with umbilical catheters increases the complication risk. Purpose: Analysing complications of umbilical catheters in newborns during prone positioning and analysing if local complications as a wet or red rim increase severe complications. Subjects: Newborns (

Transthoracic echocardiography assists appropriate pulmonary artery catheter placement: An observational study

AIM: To investigate the utility of transthoracic echocardiography in confirming appropriate pulmonary artery catheter(PAC) placement. METHODS: Three commonly used transthoracic echocardiography(TTE) views were used to confirm PAC position in 103 patients undergoing elective cardiac surgery- the parasternal short axis right ventricular inflow-outflow view; the subcostal short axis right ventricular inflow-outflow view; and the parasternal short axis ascending aortic view. All PACs were inserted by the managing anesthesiologist under pressure waveform guidance alone, who was blinded to all sonographic information. A sonographer blinded to all pressure waveform information confirmed visualisation of an "empty" PA before PAC insertion, and visualisation of the PAC balloon in the main PA(MPA) or right PA(RPA) after attempts at placement were complete. Agreement, sensitivity and specificity of TTE in confirming appropriate PAC placement was compared against pressure waveformguidance as the "gold standard". The successful view used was compared against patients' anthropomorphic indices, presence of lung hyperinflation, and insertion of PAC during positive pressure ventilation. Agreement between TTE and pressure waveform guidance was analysed using Cohen's Kappa statistic. The relative proportion of total RPA seen by subcostal vs parasternal TTE views was also compared with a further 20 patients' computed tomography(CT) pulmonary angiograms(CTPA), to determine efficacy in detection of distal RPA PAC placement. RESULTS: Appropriate positioning of the PAC balloon, and its to-and-fro movement consistent with a nonwedged state, within the MPA or RPA was confirmed by TTE in 98 of the 103 patients [sensitivity 95%(95%CI: 89%-98%)], and absence of the PAC balloon before insertion correctly established in 100 patients [specificity 97%(92%-99%)]. This was in very good agreement with pressure waveform guidance [Cohen's Kappa 0.92,(0.87-0.98)]. The subcostal view was the best view to visualise the PAC tip when it was placed in the right pulmonary artery(OR 70, P < 0.0001), was more successful in patients with COAD(OR 9.5, P = 0.001), and visualized 61%(vs 44% by parasternal views, P < 0.001) of mean RPA lengths compared with CTPA; however the parasternal views were more successful in patients with higher body mass indexs(OR 0.78 for success with subcostal views, P < 0.001). There was a trend towards insertion during intermittent positive pressure ventilation favoring visualisation by subcostal views(OR 3.9, P = 0.08). The subcostal view visualized a greater length of the RPA than parasternal views(3.9 cm vs 2.9 cm, P < 0.0001). PACs were more often placed in the MPA than RPA(80 vs 18 patients). Three patient's pulmonary arteries were not visible by any TTE view; in a further 2 patients, despite preinsertion visualisation of their pulmonary arteries, the PAC balloon was not visible by any view with TTE where correct placement by pressure waveform was unequivocal.

Ultrasound-Guided Central Venous Catheterization: A Protocol to Be Followed in Pediatrics?

Objective: To investigate the effectiveness of ultrasound-guided central venous catheterization when compared to the conventional procedure. Method: A prospective cohort study was carried out over a 9-month period from February to October 2016 involving 144 inpatients at PICU of Irmandade da Santa Casa de Sao Paulo Hospital, undergoing central venous catheterization. The patients were matched in pairs of identical patients according to the levels of potentially intervening variables (age, nutritional status, puncture site, professional experience), differing only as to the CVC technique: ultrasound-guided (USG-CVC) or conventional (C-CVC). Discarding data from non-paired patients, the remaining did forming 47 pairs, matched as two related samples: USG-CVC and C-CVC groups. Success parameters: number of puncture attempts;time spent at CVC;success rate and complications. Results: In the USG-CVC group, the number of attempts (mean = 2.04) and the time spent at catheterization (mean = 11.89 minutes) were lower (t = 2.34, df = 46, t 0.95 = 2.02, p t = 3.07, df = 46, t 0.95 = 2.02, p < 0.05), respectively, when compared to the results obtained for the control group (C-GVC), (mean = 3.21) and (mean = 28.26 minutes), respectively. As to success, there was observed a significant difference (F (1, 46) = 16.6;Q (1) = 12.5, p < 005) when considering only one trial (USG -CVC = 27/47;C-CVC = 9/47), but no significant difference (F (1, 46) = 3.76;Q (1) = 3.56, p > 0.05) when considering several attempts. Complications were found less frequently in the USG-CVC group (3/47) than in the CVC-C (13/47), (F (1, 46) = 8.24;Q (1) = 7.14, p < 0.05). Conclusion: USG-CVC was found to be more effective than the conventional technique, especially regarding success at the first puncture attempt.

重症患者导管相关性血流感染的病原菌分布与影响因素分析

目的探讨重症患者导管相关性血流感染(catheter-related bloodstream infection,CRBSI)的病原菌分布及影响因素。方法回顾性分析2019年7月1日至2022年7月2日期间在简阳市人民医院重症医学科接受中心静脉置管患者的临床资料,依据患者是否发生中心静脉CRBSI分为CRBSI组与非CRBSI组。对CRBSI组患者行病原菌种类分析,同时比较两组临床资料信息,并将有统计学意义的变量纳入多因素Logistic回归分析,明确接受中心静脉置管患者发生CRBSI的危险因素,通过受试者工作特征曲线(ROC)构建重症患者发生CRBSI的预测模型。结果共纳入接受中心静脉置管患者293例,其中CRBSI组38例、非CRBSI组255例。38例CRBSI患者共检出病原菌52珠,其中革兰氏阳性菌占比50.00%(26/52),以金黄色葡萄球菌19.23%(10/52)、表皮葡萄球菌7.69%(4/52)为主;革兰氏阴性菌占比44.23%(23/52),以大肠埃希菌17.31%(9/52)、肺炎克雷伯杆菌13.46%(7/52)为主;真菌占比5.77%(3/52),均为白色念珠菌。CRBSI组年龄≥60岁、合并糖尿病、置管部位为股静脉或颈内静脉、静脉营养液输液、置管前应用抗菌药物者占比显著高于非CRBSI组;CRBSI组BMI、入院时APACHEⅡ评分显著高于非CRBSI组,置管时间显著长于非CRBSI组,P值均<0.05。多因素Logistic回归分析结果显示,年龄≥60岁、高BMI、合并糖尿病、入院时高APACHEⅡ评分、置管部位为股静脉或颈内静脉、置管时间长、输液类型为静脉营养液、置管前应用抗菌药物为重症患者发生CRBSI的危险因素。ROC分析表明,BMI、入院时APACHEⅡ评分、置管时间均能用于重症患者发生CRBSI的预测,曲线下面积分别为0.778、0.919、0.975(P<0.05)。结论重症患者中心静脉置管后CRBSI的病原菌以金黄色葡萄球菌、大肠埃希菌较为多见,同时CRBSI的发生与年龄、BMI、置管天数、置管部位等因素关系密切,临床治疗过程中应当予以关注。

Care Measures and Health Outcomes in a Pediatric Intensive Care Unit in Brazil

Introduction: In low- and middle-income countries, including Brazil, conditions that favor mortality in the PICU remain significant. Compared to developed countries, there is a shortage of skilled human resources, lower availability of technological resources, greater difficulty of access and a higher incidence of infections, including both those acquired prior to admission and those resulting from treatment and hospitalization (i.e., healthcare-associated infections (HAIs)). HAIs in the PICU include ventilator-associated pneumonia and catheter-related bloodstream infections. Actions for the prevention of HAIs can minimize the occurrence of negative outcomes. Materials and Methods: This is an epidemiological study comparing admissions at the PICU of a high-complexity hospital in South Brazil over two three-year periods: 2012-2014 (before the measures were adopted) and 2015-2017 (after the measures). The care measures were adopted mainly at the beginning of 2015 and consisted of expansion of physical therapy care, adoption of care protocols, acquisition of new materials and equipment (transparent dressings for central catheters, high-tech mechanical ventilators and multiparametric monitors) and multidisciplinary team training. The frequency of the outcomes mortality, length of PICU stay, diagnosis of catheter-related bloodstream infection, need for and duration of ventilatory support and diagnosis of ventilator-associated pneumonia were compared between the two trienniums using logistic regression with adjustment for age in months and need of vasoactive drugs. Results: A total of 1140 admissions were analyzed (470 in the first triennium and 670 in the second), representing an increase in the admission rate of 42.6% after the adoption of the measures. After adjustments, significant reductions in the frequency of mortality (adjusted OR [adjOR] = 0.54;CI 95%: 0.34 - 0.84), length of PICU stay > 7 days (adjOR = 0.75;CI 95%: 0.57 - 0.97) and duration of ventilatory support > 7 days (adjOR = 0.54;CI 95%: 0.39 - 0.74) were observed. Conclusion: The results indicate the benefits of care measures for children admitted to the PICU in terms of a reduction in adverse events and expansion of access.

PowerPICC导管全程集束化护理管理在神经外科重症监护病房中的应用

目的探讨PowerPICC全程集束化护理管理在神经外科重症监护病房中的应用效果。方法选取2021年8月—2022年11月医院收治的神经外科重症监护病房的住院患者120例为研究对象,根据组间基本资料具有可比性的原则将患者分为对照组65例和观察组55例。对照组患者接受常规护理;观察组患者接受PowerPICC导管全程集束化护理管理。干预结束后,对比两组患者的穿刺次数、一次性穿刺到位率、一次性置管成功率、导管留置时间、治疗过程中不良事件(导管堵塞、机械性静脉炎、导管相关性血流感染、非计划性拔管)发生率、患者出院时对护理服务、环境设施、住院舒适的满意度评分以及综合满意度评分。结果观察组患者的平均穿刺次数低于对照组,一次性穿刺到位率、一次性置管成功率、导管留置时间均高于对照组,差异有统计学意义(P<0.05)。患者对护理服务、环境设施、住院舒适的满意度以及综合满意度评分均高于对照组,差异有统计学意义(P<0.05)。治疗期间观察组患者的不良事件(导管堵塞、机械性静脉炎、导管相关性血流感染、非计划性拔管)与对照组比较组间差异无统计学意义(P>0.05)。结论PowerPICC全程集束化护理管理能够提高一次性成功置管率,延长导管留置时间,提升了患者对医疗服务的满意度。

利伐沙班在预防导管相关性血栓中的作用

目的:对比利伐沙班和低分子肝素对重症监护室(ICU)患者导管相关性血栓(CRT)预防的影响。方法:选取2019年6月—2021年9月包头市中心医院ICU收治的120例符合中心静脉置管入组标准的患者作为研究对象,按随机数表法分为利伐沙班组、低分子肝素组和空白对照组,各40例。三组行深静脉穿刺置管后均给予深静脉导管常规护理,分别给予利伐沙班,低分子肝素及不抗凝处理。比较三组CRT发生率、不同时点的凝血指标[血浆纤维蛋白原(FIB)、D-二聚体(D-D)]及抗凝药物相关性出血的发生情况。结果:空白对照组CRT发生率显著高于利伐沙班组、低分子肝素组,差异有统计学意义(P<0.05),利伐沙班组和低分子肝素组CRT发生率比较,差异无统计学意义(P>0.05)。T_(2)、T_(3)和T_(4)时,利伐沙班组、低分子肝素组FIB、D-D低于T_(1)时,T_(3)和T_(4)时,利伐沙班组、低分子肝素组FIB、D-D低于T_(2)时,T_(4)时,利伐沙班组、低分子肝素组FIB、D-D低于T_(3)时,差异有统计学意义(P<0.05);T_(2)、T_(3)和T_(4)时,利伐沙班组FIB、D-D低于低分子肝素组及空白对照组,且低分子肝素组低于空白对照组,差异有统计学意义(P<0.05)。三组不同时间点FIB及D-D比较,差异有统计学意义(P<0.001);三组间FIB及D-D比较,差异有统计学意义(P<0.001);组间和时间存在交互作用(P<0.001)。低分子肝素组相关性出血总发生率高于利伐沙班组,差异有统计学意义(P<0.05)。结论:在ICU患者CRT的预防中,利伐沙班与低分子肝素均有效,但利伐沙班对凝血功能的改善效果更佳,安全性更高。

ICU护士导尿管相关尿路感染预防知信行现况及影响因素

目的:调查重症监护室(ICU)护士导尿管相关尿路感染(CAUTI)预防知信行现况,并分析其影响因素。方法:选取2022年1月在上海交通大学医学院附属第一人民医院ICU工作的临床护士195人作为研究对象,采用一般资料调查表、CAUTI预防培训调查表、CAUTI预防知信行量表进行调查。结果:ICU护士在CAUTI知识中留置导尿适应证维度得分为(28.50±3.23)分,知识中CAUTI预防策略维度得分为(58.84±5.34)分,信念维度得分为(24.85±3.52)分,行为维度得分为(21.45±2.59)分;是否参加过培训的情况不同,我院ICU护士的CAUTI预防知识、行为得分不同(P<0.05);科室、工作年限、近3年参加培训的次数不同,我院ICU护士的CAUTI预防知信行得分不同(P<0.05)。结论:我院ICU护士整体的CAUTI预防知信行水平较高,但仍存在不足,医疗机构应扩大培训范围,改变ICU护士的经验性认知,提高ICU护士对于CAUTI的知信行水平。

实现重症医学科导管相关血流零感染不是梦

导管相关血流感染(catheter related blood stream infection, CRBSI)是重症医学科的常见并发症,可导致患者住院时间延长、医疗费用增加,甚至发生脓毒症致使死亡率增加。CRBSI的感染控制已成为重症医学科乃至医院管理的重点及质量控制的核心。目前,重症医学科的CRBSI预防方案已基本完善,并建立了中心静脉导管置入和维护的国家标准,这些规范的建立和实施可有效降低CRBSI的发生率。重症医学科的CRBSI问题广泛存在且后果严重,表明临床中心静脉置管及使用过程中的无菌操作存在缺陷,针对其操作流程进行改进,从理论、管理、教育、规范、监督等多个层面努力,完善和落实各项感染控制要求,可有效避免和减少CRBSI的发生,甚至实现零感染。

ICU护士血管导管相关感染预防与控制知识的现状调查

目的调查重症医学科(intensive care unit,ICU)护士血管导管相关感染(vessel catheter associated infection,VCAI)预防与控制知识的现状,为提高ICU护理质量提供改进依据。方法采用便利抽样方法,选取2022年11—12月厦门大学附属第一医院ICU 60名在职护士作为调查对象。采用一般资料调查表、VCAI预防与控制知识现状调查表和学习情况调查表对其进行调查,并调查2020—2022年ICU的VCAI发生率。结果60名护士VCAI预防与控制知识总得分为10~27分,平均(20.57±3.50)分,平均得分率为76.18%,处于中等水平,各维度知识掌握水平不等。2020年发生1例VCAI,发生率为3.19‰;2021年发生2例VCAI,发生率分别为2.52‰、2.91‰;2022年未发生VCAI。结论ICU护士对VCAI知识掌握程度处于中等水平,应进一步加强对护士相关知识的培训和考核,规范操作流程,提高ICU护理质量。

项目管理法在内科重症监护病房导尿管相关尿路感染防控中的临床实践

目的通过项目管理法制定预防留置导尿管相关尿路感染(CAUTI)的方案,并评价其在内科重症监护病房(MICU)留置导尿管患者CAUTI防控中的应用效果。方法选择某院MICU收治的153例留置导尿管患者,2021年7月—2022年3月患者为对照组(78例),采用常规方法进行护理;2022年7—12月患者为干预组(75例),采用项目管理法完善的护理措施进行干预。比较两组患者导尿管留置日数、住院日数、CAUTI发生率;同时比较干预组带入导尿管患者与本科室留置导尿管患者在三个质量周期主要指标的差异。结果干预组患者留置导尿管日数短于对照组[(9.51±2.57)d VS(11.10±2.82)d],差异有统计学意义(t=8.207,P=0.038);两组患者住院日数比较,差异无统计学意义(P>0.365)。患者导尿管留置日数:第二质量周期短于第一质量周期,第三质量周期短于第二质量周期,差异均有统计学意义(均P<0.05)。干预组留置导尿管患者CAUTI总体发生率低于对照组(20.00%VS 24.36%),差异有统计学意义(χ^(2)=6.937,P=0.026)。第一、二质量周期:带入与本科留置导尿管患者留置日数比较,差异均有统计学意义(均P<0.05);干预组、第一和第二质量周期:带入与本科留置导尿管患者CAUTI发生率比较,差异均有统计学意义(均P<0.05)。结论应用项目管理法可降低MICU留置导尿管患者CAUTI的发生率,减少留置导尿管日数,提升留置导尿管全流程的护理质量。