A nurse–family partnership intervention to increase the self‐efficacy of family caregivers and reduce catheter‐associated urinary tract infection in catheterized patients

The purpose of this study was to evaluate the effects of a nurse–family partnership model on the self‐efficacy of family caregivers (FCs) and the incidence of catheter‐associated urinary tract infection (CAUTI) among patients. A randomized controlled study was conducted. We recruited 61 patients and their FCs, who were randomly divided into an experimental group (n = 30) and a control group (n = 31). In the experimental group, the main caregivers comprised a nurse–family partnership, whereas the control participants received routine care. The findings were as follows: (i) the incidence of CAUTI was lower in the experimental group than in the control group (20% vs. 38.8%), but the difference was not statistically significant; and (ii) no significant difference emerged for reported Caregiver Self‐Efficacy Score between the two groups. The nursing team and FCs must become partners in cooperative caregiving to enhance the quality of patient care.     

Toward eliminating catheter-associated urinary tract infections in an academic health center

Background

Eliminating catheter-associated urinary tract infections (CAUTI) is at the forefront of quality improvement and cost reduction for payers and hospitals alike. Herein we describe a double-focused strategy to eliminate CAUTI's on a surgical oncology unit over the course of 24 mo.

Methods

CAUTI's were tracked on a 30-bed surgical oncology unit 12 mo before and 12 mo after implementation of specific measures aimed at (1) decreasing utilization and (2) increasing catheter bundle and hand hygiene compliance. A policy of early Foley catheter removal was implemented. Univariate analyses were performed comparing nominal and numerical variables between the pre- and post-intervention groups.

Results

The pre- and post-intervention groups comprised of 1376 and 1467 patients, respectively. Postintervention, there was a significant decrease in both total Foley (P = 0.02) and patient (P = 0.03) days. This resulted in a significant reduction in utilization rate from 0.28 to 0.24, (P < 0.0001) and median CAUTI rate from 4.6 to 0.0 (P = 0.03). Reduced CAUTIs were associated with significant improvements in monthly bundle compliance at ≥95% (75% versus 17%, P = 0.003) and hand hygiene compliance at ≥95% (92% versus 58%, P = 0.05). Among our thoracic epidural cohort (n = 11), three patients (27%) required reinsertion for urinary retention. None of these epidural patients were diagnosed with a CAUTI.

Conclusions

Although not eliminated entirely, CAUTIs on our unit were significantly reduced through decreased utilization and improved compliance to institutional patient safety measures. Adoption of these strategies to other inpatient units would not only improve patient safety but also result in significant cost savings.     

脑卒中患者导尿管相关尿路感染的集束化管理

目的探讨集束化管理在预防脑卒中患者导尿管相关尿路感染(CAUTI)中的应用,以降低脑卒中患者CAUTI发病率。方法选取某院2016年1月—2017年5月神经内科病房收治的留置导尿管的脑卒中患者,2016年1—8月收治的患者为对照组(采用常规导尿管维护方法),2016年9月—2017年5月为试验组(采用集束化管理措施)。比较两组患者导尿管维护措施执行率、导尿管留置时间、导尿管污染率及CAUTI发病率。结果共纳入患者60例,对照组30例,试验组30例。试验组导尿管维护措施执行率(92.55%)高于对照组(71.74%),差异有统计学意义(P=0.000);置管后第3、10、17天导尿管维护措施执行率试验组分别为94.64%、89.13%、91.30%;对照组分别为78.55%、67.87%、54.89%,两组比较差异均有统计学意义(均P0.05)。试验组导尿管留置时间为(9.67±3.54)d,低于对照组的(12.40±6.52)d;导尿管污染率试验组为13.33%,低于对照组的50.00%;CAUTI发病率试验组为3.33%,低于对照组的26.67%,差异均有统计学意义(均P0.05)。结论集束化管理可提高导尿管维护措施的落实,建立反馈机制,持续质量改进,结合膀胱功能训练康复,可缩短导尿管留置时间,减少留置导尿管污染,降低患者CAUTI发病率。