Effect of Cluster Nursing in Preventing Urinary Tract Infection in Postoperative Patients with Indwelling Urinary Catheter

Objective:This paper expounds and analyzes the effect of cluster nursing in preventing urinary tract infection in postoperative patients with indwelling urinary catheter.Methods:A total of 400 postoperative patients with indwelling urinary catheter,treated in Yancheng No.1 People’s Hospital in recent two years,were recruited as research subjects.The patients were equally divided into group A and group B,with 200 patients in each group,and all received routine anti-infectives.The patients in group A(200 cases)received routine nursing.On the basis of group A,cluster nursing was implemented for patients in group B(200 cases).Results:The indwelling time of urinary catheter,the disappearance time of bladder irritation symptoms,and the probability of urinary tract infection were compared between both groups,which showed that the nursing effect of group B was better than that of group A(P<0.05).Conclusion:The implementation of cluster nursing in postoperative patients with indwelling urinary catheter can improve the deficiency of routine nursing,consolidate the treatment effect,and reduce the complication rate of urinary tract infection.

Knowledge of Nurses toward Prevention for Catheter-Associated Urinary Tract Infection in Public Hospitals at Amran City, Yemen

Background of the study: Catheter-associated urinary tract infection (CAUTI) is the most prevalent healthcare-associated infection worldwide, according to reports. Nurses are also accountable to acquire appropriate knowledge and practices of catheter care that will prevent UTI. Nurses’ knowledge is seen to be one of the most important factors in their practice. Aim of the study: To assess the nurse’s knowledge toward the prevention of catheter-associated urinary tract infection in public hospitals at Amran City. Methods: A descriptive cross-sectional study was conducted among nurses at public hospitals in Amran City, Yemen. A convenience sampling technique was of the study consisted of 93 nurses from different public hospitals that were participated in this study. Self-administered questionnaire was used to collect data from March 2021 to April 2021. Results: The distribution of nurses’ ware female 65.6%, belonged to age group between (25 to <30 years) 43.0%. The Diploma degree was the most available qualification 88.2%, 81.7% between 1 - 5 years’ experience as nurses. Knowledge regarding prevention of catheter-associated urinary tract infection was fair 72%, while 18.3% had a good. There is a significant statistical difference between knowledge level regarding prevention of CAUTI, and sex (P-value = 0.042). Conclusion: Most of nurses had fair knowledge level regarding prevention of catheter-associated urinary tract infection. Recommendations: We recommended increasing the knowledge of nursing staff through the courses training, workshop, and curriculums.

Reducing the Rate of Catheter-Associated Urinary Tract Infection in the Non-ICU Setting

Background: In 2008, the catheter associated urinary tract infection (CAUTI) rate at King Fahad Medical City (KFMC) was 3.8/1000 urinary catheter days with some variability between departments. KFMC is the newest tertiary, referral and teaching hospital with 1100 beds in Riyadh, Saudi Arabia. The Infection Control Department at KFMC decided to implement a quality improvement project by applying the bladder bundle in our general ward (Non-ICU) using the model of National Health Service (NHS) hospitals in England even though there was good evidence supporting this infection control practice only in ICU patients?[1][2]. Our objective was to decrease CAUTI in two non-ICU units by at least 50% in one year. Study design: This was a prospective interventional quality improvement project aiming to decrease CAUTI in two non-ICU inpatient units with a total of?193 beds including children and adult patients. Our intervention includes insertion and maintenance components. Results: CAUTI decreased significantly in both departments from 23 infections in?2008 (Rate: 5.03/1000 CDs) to 12 infections in 2009 (Rate: 1.92/1000 CDs) (P?= 0.0001);in RH (Rehabilitation hospital) from 18 in 2008 (Rate: 4/1000 CDs) to 11 infections in 2009 (Rate: 0.36/1000?CDs) (P?< 0.0001) and in NSI (National Neuroscience Institute) from 5 in 2008 (Rate: 5.42/1000?CDs) to 1 infections in 2009 (Rate: 3.16/1000 CDs) (P?< 0.0001). Conclusion: Implementation of urinarycatheter insertion and daily care bundles, and creation of a competitive spirit among employees were associated with a significant reduction in catheter associated urinary tract infections.

Catheter-Associated Bacteria Urinary Tract Infection and Antibiotic Susceptibility Pattern in a Tertiary Hospital, in Ghana

Background: This study seeks to identify the prevalence of catheter associated urinary infection and the type of bacteria that are associated with this infection, as well as the antibiotic susceptibility patterns of the organisms isolated. This would guide the choice of antibiotics when there is catheter associated urinary tract infection. Method: From 1 November 2015-31 April 2016 a cross-sectional study was conducted among patients with urinary catheter in-situ. Urine samples collected were processed and cultured on CLED agar plates. Pure colonies of isolated organism were Gram and Biochemically characterized. A disc diffusion antibiotic susceptibility determined by Kirby-Bauer disc diffusion method was performed on each uropathogen isolated. Data obtained was cleaned, analyzed and presented. Result: There were 122 study subjects of which, 73 (59.8%) were males and 49 (40.2%) were females. Their median age was 42.5 (range 33 - 65) years. Significant bacterial growth was obtained in 88 (72.1%) of the urine specimen cultured of which males constituted 48 (54.5%) and females 40 (45.5%). The most prevalent uropathogens isolated were Escherichia coli 41 (46.6%), Klebsiella spp. 18 (20.6%), Pseudomonas aeruginosa 10 (11.4%), Enterobacter spp. 6 (6.8%) and Staphylococcus aureus 5 (5.8%). Bacterial isolates showed some susceptibility to Amikacin 73 (83.0%), Levofloxacin 34 (38.6%) and Ciprofloxacin 26 (29.5%) respectively. The uropathogens were least susceptible to Gentamicin 3 (3.4%), Ampicillin 3 (3.4%) and Cefuroxime 1 (1.1%) respectively. Conclusion: Catheter associated bacterial urinary tract infection (CABUTI) is prevalent at the Tamale Teaching Hospital. Micro bacterial isolates demonstrated substantial decrease in susceptibility to antibiotics commonly used. Understanding the local antibiotic susceptibility pattern could guide the choice of antibiotics used in treating CABUTI.

Incidence and Etiology of Catheter Associated Urinary Tract Infection among Admitted Patients at Kabale Regional Referral Hospital, South Western Uganda

Introduction: Catheter Associated Urinary Tract Infection is the most common hospital acquired infection worldwide. Urinary Tract Infections among catheterised patients are on rise regardless of antibiotic use and this is due to erratic use of antibiotics, treatment failure, antimicrobial resistance and emergency of Extended Spectrum Beta Lactamase producing bacteria leading to patient distress, increased healthcare costs, long hospital stay and poor patient response to antibiotics. In Uganda, no previous studies have sought to study the burden of CAUTI among catheterized patients, the bacterial pathogens involved and their antimicrobial susceptibility patterns yet there is upsurge in antimicrobial resistance of uropathogens. The effective management of patients suffering from Catheter Associated Urinary Tract infection (CAUTI) relays on the identification of uropathogens that cause CAUTI and the selection of an effective antibiotic agent to the uropathen in question. Objectives: The objectives of this study were to determine incidence, etiology and antibiotic susceptibility pattern among the uropathogens causing Catheter Associated Urinary Tract Infections among patients with indwelling catheters at Kabale Regional Referral Hospital. Methods: Using a descriptive prospective observational hospital-based study, the study was conducted on 150 catheterized patients recruited from Emergency, Obstetrics and gynecology, Medical, Maternity and Surgical wards at Kabale Regional Referral Hospital between April and May 2019. The urine samples from study participants were processed in Kabale RRH microbiology laboratory as per standard operating procedures. After isolation and identification, all the isolates were subjected to antibiotic susceptibility testing for commonly used antibiotics. Results: Following the urine culture from 150 catheterized patients, urine from 23 (15.3%) patients showed significant growth. The common bacterial isolates were Escherichia coli 12 (52%), followed by the Klebsiella pneumoniae 6 (26%), Staphylococcus aureus 3 (13%) and Pseudomonas spp. 2 (8.7%). All Gram-negative isolates were sensitive to Imipenem 20 (100%) while all S. aureus isolates (3) were 100% sensitive to Vancomycin and Cefoxitin. Isolates were sensitive to Gentamicin 20 (82.6), Ceftriaxone 16 (69.6), Ciprofloxacin 10 (43.5) and Nitrofurantoin 9 (39.1). All isolates were 100% resistant to Cotrimoxazole. 6 gram negative isolates were resistant to ceftazidime and were tested for Extended Spectrum Beta (&#223;) Lactamase (ESBL), 5 (83.3%) were identified as ESBL-producing bacteria. K. pneumonia 3 (60%) presented the highest percentage of ESBLs as compared to E. coli 2 (40%). Conclusions: The Incidence of CAUTI among patients with indwelling urinary catheters at Kabale Regional Referral Hospital is high (15.3%) and is mostly caused by E. coli and K. pneumoniae. These bacteria are resistant to most commonly used antibiotics and thus there is a need to put more emphasis on CAUTI prevention strategies and use culture and sensitivity tests before prescription of antibiotics.

Epidemiological Study of Rapidly Emerging Uropathogens Isolated from Urinary Catheter and Its Influential Demographic Factors Responsible for Contamination

Urinary tract infections (UTI) are very common in all the developed as well as developing countries in which the majority of infections are catheter associated. Catheter associated urinary tract infections (CAUTI) is one of the major causes of hospital acquired infections. The aim of this study is to investigate influential demographic factors responsible for contamination associated with the rate of CAUTI, while taking into account type of urinary catheter used, the most common organisms found, patient diagnosis, age, gender, and comparison with other studies. During the study, 22 uropathogenic species were isolated from the different segments of urinary catheter samples of the patients collected from 12 different hospitals of Amravati city, Maharashtra, India from January 2015 to 2018. Gram negative organisms were the most frequent isolates, with Pseudomonas aeruginosa (16.08%) being the most common followed by Escherichia coli (10%) and Candida albicans accounted for almost 11% of all the uropathogens. It was found that the majority of uropathogens were isolated from the section A (Catheter segment inside the bladder) and section E (Catheter segment connected to drainage tube) of the urinary catheter. The duration of the catheterization plays the major role in the contamination and further infection to continue. It was observed that the female catheterized patients are more prone to the contamination and infection as compared to male catheterized patient. The antibiotic sensitivity pattern indicates that MAR (Multiple Antibiotic Resistance) index was more than 0.2 for almost all the uropathogens tested concluding that there is antibiotic stress on uropathogens and rate of resistance increased rapidly. Also it was found that there was a statistically significant association between the duration of catheterization, type of disease, age of patient and type of catheter with respect to gender.

Antibiotic Sensitivity Patterns of Urine and Biofilms in Patients with Indwelling Urinary Catheter in Denden Hospital, Asmara, Eritrea

The intricate infections leading to long-term morbidity of catheterized patients are due to the presence of a covering and blocking the lumen of urinary catheters by biofilms which have increased ability of resistance to host immune system and antibiotic treatment. The biofilm mode of growth is a basic survival strategy implemented by bacteria in a wide range of settings such as environmental, industrial and clinical aquatic settings. Bacterial growth on the inner surface of the catheter with biofilm formation is frequent and may occur within days of catheter placement. This study investigated the formation of biofilm inside catheter lumen of patients from Denden hospital, Asmara, Eritrea. And also, it assessed the antimicrobial sensitivity pattern of biofilm isolates and compared it with urine isolates. Resistance to antibiotics was observed in biofilm isolates more than urine isolates. E. coli was the most frequently isolated organism in both biofilm and urine samples.

Prevention of urinary tract infection using a silver alloy hydrogel-coated catheter in critically ill patients: A single-center prospective randomized controlled study

Background:A new type of silver alloy hydrogel-coated(SAH)catheter has been shown to prevent bacterial adhesion and colonization by generating a microcurrent,and to block the retrograde infection pathway.However,these have only been confirmed in ordinary patients.This study aims to evaluate the effectiveness of a SAH catheter for preventing urinary tract infections in critically ill patients.Methods:This was a prospective single-center,single-blind,randomized,controlled study.A total of 132 patients requiring indwelling catheterization in the intensive care unit(ICU)of the First Affiliated Hospital of the University of Science and Technology of China between October 2022 and February 2023 and who met the study inclusion/exclusion criteria were randomly divided into two groups.Patients in the SAH catheter group received a SAH catheter,while patients in the conventional catheter group received a conventional siliconized latex Foley catheter.The main outcome measure was the incidence of catheter-associated urinary tract infections(CAUTIs).Secondary outcome indicators included urine positivity for white blood cells and positive urine cultures on 3 days,7 days,10 days,and 14 days after catheterization,number of viable bacteria in the catheter biofilm on day 14,pathogenic characteristics of positive urine cultures,length of ICU stay,overall hospital stay,ICU mortality,and 28-day mortality.All the data were compared between the two groups.Results:A total of 68 patients in the conventional catheter group and 64 patients in the SAH catheter group were included in the study.On day 7 after catheter placement,the positivity rate for urinary white blood cells was significantly higher in the conventional catheter group than in the SAH catheter group(33.8%vs.15.6%,P=0.016).On day 10,the rates of positive urine cultures(27.9%vs.10.9%,P=0.014)and CAUTIs(22.1%vs.7.8%,P=0.023)were significantly higher in the conventional catheter group than in the SAH catheter group.On day 14,the numbers of viable bacteria isolated from the catheter tip([3.21±1.91]×10^(6) colony-forming units[cfu]/mL vs.[7.44±2.22]×10^(4) cfu/mL,P<0.001),balloon segment([7.30±1.99]×10^(7) cfu/mL vs.[3.48±2.38]×10^(5) cfu/mL,P<0.001),and tail section([6.41±2.07]×10^(5) cfu/mL vs.[8.50±1.46]×10^(3) cfu/mL,P<0.001)were significantly higher in the conventional catheter group than in the SAH catheter group.The most common bacteria in the urine of patients in both groups were Escherichia coli(n=13)and Pseudomonas aeruginosa(n=6),with only one case of Candida in each group.There were no significant differences between the two groups in terms of ICU hospitalization time,total hospitalization time,ICU mortality,and 28-day mortality.Conclusion:SAH catheters can effectively inhibit the formation of catheter-related bacterial biofilms in critically ill patients and reduce the incidence of CAUTIs,compared with conventional siliconized latex Foley catheters;however,regular replacement of the catheter is still necessary.

Catheters coated with Zn-doped CuO nanoparticles delay the onset of catheter-associated urinary tract infections

Catheter-associated urinary tract infections （CAUTIs） are among the most common bacterial infections associated with medical devices. In the current study, the synthesis, coating, antibiofilm properties, and biocompatibility of urinary catheters coated with Zn-doped CuO （Zn0.12Cu0.880） nanoparticles （NPs） were examined. The doped NPs were synthesized and subsequently deposited on the catheter by the sonochemical method. The coated catheters displayed high antibiofilm activity and promising biocompatibility, as indicated by low in vitro cytotoxicity, negligible associated cytokine secretion, and absence of detectable irritation. The biocompatibility and ability of the Zn-doped CuO coating to inhibit biofilm formation were also evaluated in vivo using a rabbit model. Rabbits catheterized with uncoated catheters scored positive for CAUTI by day 4 of the experiment. In contrast, rabbits catheterized with Zn-doped CuO-coated catheters did not exhibit CAUTI until day 7 or remained completely uninfected for the whole duration of the 7-day experiment. Furthermore, the in vivo biocompatibility assays and examinations supported the biosafety of Zn-doped CuO-coated catheters. Taken together, these data highlight the potential of Zn-doped CuO nanocomposite as effective antibiofilm compound.

八宝丹胶囊预防导尿管相关性尿路感染的效果

目的:探讨八宝丹胶囊预防导尿管相关性尿路感染(CAUTI)的效果。方法:选择2022年6月至2023年2月于郑州大学第一附属医院泌尿外科就诊且留置导尿管的患者。根据治疗方案分为3组,留置导尿管后静脉给予抗生素(拉氧头孢钠)者为对照组(n=73),给予八宝丹胶囊者为试验组A(n=72),给予八宝丹胶囊联合抗生素者为试验组B(n=72)。在留置导尿管第3、5、7天及拔除导尿管48 h行尿常规、尿培养检查,比较各组总CAUTI发生率、膀胱过度活动症(OAB)发生率及不良反应发生率。结果:对照组、试验组A、试验组B总CAUTI发生率分别为39.7%、36.1%、20.8%,OAB发生率分别为30.1%、18.1%、11.1%,试验组B总CAUTI发生率、OAB发生率低于对照组(P<0.017)。3组治疗期间均未发生不良反应。结论:八宝丹胶囊联合抗生素使用可有效预防CAUTI发生,并且具有良好的安全性。

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。

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。

SHEA/IDSA/APIC实践建议:预防医院感染策略纲要(2022年更新版)

美国医疗保健流行病学学会/美国感染病协会/感染控制和流行病学专业人员协会(SHEA/IDSA/APIC)2022年更新了“急诊医院医疗保健相关感染的预防策略纲要”,内容包括“导尿管相关尿路感染(CAUTI)的预防策略”“中央导管相关血流感染(CLABSI)的预防策略”“艰难梭菌感染(CDI)的预防策略”“预防耐甲氧西林金黄色葡萄球菌(MRSA)传播和感染的策略”“手术部位感染(SSI)的预防策略”“呼吸机相关肺炎(VAP)和呼吸机相关事件(VAE)的预防策略”“预防非呼吸机医院获得性肺炎(NV-HAP)的策略”“通过手卫生预防医疗保健相关感染的策略”“实施预防医疗保健相关感染的策略”九部分。

基于Web of Science的导管相关性尿路感染研究文献计量学分析

目的:检索导管相关性尿路感染研究的文献,分析当前研究现状和热点。方法:采用计算机检索Web of Science核心合集数据库中2013年1月1日—2023年1月1日发表的导管相关性尿路感染文献,运用CiteSpace软件对作者、机构、国家和关键词等进行可视化分析。结果:共纳入472篇文献,2013—2023年发文量较少但整体呈上升趋势,发文量最多的国家为美国。INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY是该研究领域重要的核心期刊。导管相关性尿路感染的预防、危险因素、流行病学和相关指南是该领域的研究热点。结论:导管相关性尿路感染相关因素和预防、流行病学以及构建相关指南共识是研究热点,“导尿管”“感染控制”可能成为今后研究的热点和方向。

导管相关性尿路感染护理干预的研究进展

导管相关性尿路感染(CAUTI)是医院内感染最常见的类型之一。CAUTI是一种由插入尿管引起的严重的并发症,通常出现在患者接受插管治疗后的48 h内或者在取出导尿管之后。本本研究就引发CAUTI的主要影响因素、导尿管的选取、导管的留置操作、管路维护以及医院管理等方面进行综述,旨在为防治CAUTI提供可靠参考。

ICU患者导管相关尿路感染发生风险的列线图预测模型构建

目的构建ICU患者发生导管相关尿路感染(CAUTI)的风险列线图预测模型。方法纳入821例留置导尿管的ICU患者,其中589例作为建模组,232例作为验证组。记录患者的CAUTI发生情况,收集CAUTI发生前的临床资料。基于建模组数据,采用多因素Logistic回归模型分析ICU患者发生CAUTI的影响因素,并根据影响因素构建列线图预测模型。在验证组中,采用受试者工作特征(ROC)曲线和Hosmer‑Lemeshow检验对模型进行内部及外部验证。结果821例患者中,CAUTI发生率为4.99%(41/821)。留置导尿管时间、糖尿病合并情况、血清白蛋白水平、尿亚硝酸盐阳性情况是ICU患者发生CAUTI的影响因素(P<0.05)。基于以上4个因素构建列线图预测模型,内部及外部验证结果均提示模型具有较好的拟合度(Hosmer‑Lemeshow检验结果显示χ^(2)=4.347、P=0.739,χ^(2)=4.632、P=0.796),ROC曲线下面积分别为0.890、0.781。结论留置导尿管时间≥7 d、合并糖尿病、血清白蛋白水平<40 g/L、尿亚硝酸盐阳性的ICU患者发生CAUTI的风险增加。基于上述因素构建的列线图预测模型有助于医护人员筛查发生CAUTI的高危ICU患者,从而尽早制订预防措施以降低感染风险。

皮瘤丝孢酵母所致导尿管相关性尿路感染1例

报道1例皮瘤丝孢酵母引起的导管相关性尿路感染。患者男性,63岁,尿频、尿急、尿痛,伴右侧腰部隐痛。通过对患者的清洁中段尿、留置双J管、肾盂穿刺尿、膀胱尿进行培养及鉴定。在不同培养温度(25℃、35℃)下,沙堡弱培养皿上表现为两种不同形态的菌落。一种是有脑回状褶皱的乳白色圆形菌落;另一种是中间明显凸起的花簇样灰色菌落。哥伦比亚血琼脂培养皿培养96 h以菌落为中心出现三条裂开琼脂的放射状直线。VITEK 2 COMPACT鉴定结果为皮瘤丝孢酵母,确诊患者为皮瘤丝孢酵母引起的导尿管相关性尿路感染。使用氟康唑0.4 g/d静滴1周,患者尿路感染症状基本缓解。

关联规则在成人住院病人导尿管相关尿路感染中的应用研究

目的:挖掘成人住院病人导尿管相关尿路感染(CAUTI)事件各变量之间的关系,为临床预防CAUTI的发生提供参考依据。方法:收集某医院2021年1月1日—2023年3月31日上报的144例导尿管相关尿路感染事件发生的数据信息,运用Apriori算法进行关联分析。结果:通过条件设定、结合专业知识评定,最终获得全院导尿管相关尿路感染的强关联规则8条,规则1~3揭示了短期留置导尿管病人发生CAUTI的相关因素、规则4揭示了长期留置导尿管病人发生CAUTI的相关因素、规则5和规则6揭示了意识障碍病人发生CAUTI的相关因素、规则7和规则8揭示了高龄病人发生CAUTI的相关因素。结论:对导尿管相关尿路感染的变量之间进行关联分析,可发现不同条件下发生CAUTI的危险因素,为临床导尿管相关尿路感染事件的发生进行预见性、个性化护理提供了理论依据。

神经外科导尿管相关性尿路感染的高危因素及预防策略

目的探讨神经外科导尿管相关性尿路感染(catheter-associated urinary tract infection,CAUTI)发生的高危因素及预防干预策略。方法选择2018年1月—2023年10月广西医科大学第一附属医院神经外科收治的218例留置导尿管患者作为研究对象。统计不同临床特征患者CAUTI的发生率,进行多因素logistic回归分析,并提出相应的预防干预策略。结果218例神经外科导尿管患者中,发生CAUTI的患者为35例,发生率为16.06%。其中35例CAUTI患者检出病原菌103株,大肠埃希菌82株(79.61%),肺炎克雷伯菌19株(18.45%),金黄葡萄球菌2株(1.94%)。不同性别、年龄、是否意识障碍、尿道口清洗频率、导尿管留置时间、导尿管更换时间、患者24 h尿量、是否有既往大型手术史、合并不同个数其他疾病的尿路感染率比较,差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示,女性、年龄>65~75岁、患者意识障碍、尿道口清洗频率为1次/d、导尿管留置时间>10 d、导尿管更换时间>15d是尿路感染率高的危险因素(P<0.05)。结论神经外科留置导尿管患者CAUTI发生率较高,临床需重点观察女性、年龄>65~75岁、存在意识障碍、尿道口清洗频率1次/d、导尿管留置时间>10 d、导尿管更换时间>15 d的患者,制定针对性的预防措施,降低CAUTI发生风险。

护士主导的预防心血管重症病人导管相关性尿路感染的循证护理实践

目的:探讨以护士主导的预防心血管重症病人导管相关性尿路感染(CAUTI)循证护理实践效果。方法:遵循澳大利亚Joanna Briggs Institute(JBI)循证卫生保健模式,包括证据应用前基线审查、证据应用实践变革以及证据应用后再审查3个阶段。系统检索相关数据库获取预防CAUTI最佳证据,并将证据转化为临床审查标准,制定以护士为主导的预防CAUTI审查标准,比较证据应用前后预防CAUTI护理行为依从性、导尿管留置时长以及护士相关知识掌握情况。结果:证据应用后18条审查指标护理依从性均高于证据应用前,16条审查指标依从性比较差异有统计学意义(P<0.05);导尿管留置时长由证据应用前的(7.94±7.64)d缩短至证据应用后的(5.86±5.63)d(P<0.05);42名护士预防CAUTI知识问卷得分由证据应用前的(64.86±9.59)分提升至证据应用后的(80.21±8.72)分(P<0.05)。结论:以护士为主导最佳证据实践可以提高护理行为的依从性,减少非必要的置管,规范CAUTI护理管理,提升病人照护质量。