导尿管相关尿路感染的目标性监测分析与干预

目的 分析导尿管相关尿路感染的危险因素,提出干预措施.方法 采用目标性监测方法,对108例在本院住院期间接受过留置导尿管患者的尿路感染发生情况与患者年龄、性别、合并慢性疾病(如慢性阻塞性肺病、糖尿病)等、膀胱冲洗与否、尿道口清洗消毒和留置尿管时间进行统计分析.结果 留置尿管的时间越久,菌尿的发生率越高(P＜0.01);膀胱冲洗组菌尿的发生率高于不冲洗组,有统计学差异(P＜0.05);尿路感染的发生率与性别有关,女性患者明显多于男性(P＜0.05);留置尿管期间用消毒剂消毒尿道口与用生理盐水清洗尿道口菌尿的发生率没有明显差异(P＞0.05);尿路感染的发生还与年龄与合并基础疾病有关.结论 严格掌握留置导尿的适应证,严格无菌操作,留置尿管后不行膀胱冲洗,尿道口清洗不用消毒剂,缩短尿管留置时间,对有严重基础疾病患者采取监控措施能降低尿路感染发生率.     

导尿管相关尿路感染的目标性监测与分析

[目的]分析导尿管相关尿路感染的危险因素,提出预防措施.[方法]采用目标性监测方法对2009年307例病人在住院期间接受过留置尿管病人的菌尿症发生情况进行分析.[结果]监测前菌尿症感染率为7.06%,监测干预后感染率为3.85%.尿路感染的发生率与性别有关,女性病人明显多于男性;更换引流袋的时间和病人的菌尿明显相关,3 d更换引流袋的菌尿发生率低于每天更换者(P<0.01);膀胱冲洗菌尿的发生率高于不冲洗组,差异有统计学意义(P<0.01);留置尿管的时间越久,菌尿的发生率越高(P<0.01);尿路感染的发生还与某些基础疾病有关.[结论]严格掌握留置导尿的适应证,严格无菌操作,留置尿管后不行膀胱冲洗,引流袋每周更换2次,缩短尿管留置时间,对有严重基础疾病病人采取监控措施能降低尿路感染发生率.     

导尿管相关尿路感染的目标性监测与分析

[目的]分析导尿管相关尿路感染的危险因素,提出预防措施。[方法]采用目标性监测方法对2009年307例病人在住院期间接受过留置尿管病人的菌尿症发生情况进行分析。[结果]监测前菌尿症感染率为7.06%,监测干预后感染率为3.85%。尿路感染的发生率与性别有关,女性病人明显多于男性;更换引流袋的时间和病人的菌尿明显相关,3d更换引流袋的菌尿发生率低于每天更换者（P〈0.01）;膀胱冲洗菌尿的发生率高于不冲洗组,差异有统计学意义（P〈0.01）;留置尿管的时间越久,菌尿的发生率越高（P〈0.01）;尿路感染的发生还与某些基础疾病有关。[结论]严格掌握留置导尿的适应证,严格无菌操作,留置尿管后不行膀胱冲洗,引流袋每周更换2次,缩短尿管留置时间,对有严重基础疾病病人采取监控措施能降低尿路感染发生率。     

持续质量改进在预防ICU导尿管相关尿路感染中的应用研究

目的 探讨持续质量改进在预防ICU导尿管相关尿路感染（catheter-associated urinary tract infection,CAUTI）中的应用效果。方法 对现有CAUTI防控措施进行修订,参照修订后的CAUTI防控集束化干预策略,选取2021年11月我院综合ICU 留置导尿患者158例进行CAUTI防控措施正确实施的现状调查,发现缺陷问题,并针对缺陷问题制定改进措施。选取2022年1-3月综合ICU留置导尿患者339例进行持续质量改进,每2周为一个质量周期,共进行6个质量周期,每个质量周期均遵循培训推广→质量检查→结果汇总分析→针对不足之处再教育培训的方法。比较质量改进前（2021.11）和每个质量周期（2022.1-3）CAUTI防控措施的正确实施情况,同时监测同期CAUTI相关数据。结果 通过持续质量改进,在第2质量周期,7项CAUTI防控措施的正确实施率（66.67%～83.33%）就较质量改进前（0～55.00%）有所提高,差异具有统计学意义（P＜0.05）,并在之后的质量周期逐步提高,在第6质量周期各项目的正确实施率达到92.39%～100%。CAUTI发生率总体呈下降趋势,质量改进后期导尿管使用率（50.90%）较质量改进前（62.38%）降低,差异具有统计学意义（P＜0.05）。结论 持续质量改进可有效提升CAUTI各防控环节的护理质量,降低导尿管使用率,从而减少CAUTI的发生。     

居家护理干预对脑卒中患者导尿管相关尿路感染的预防效果

目的:探讨居家护理干预对脑卒中患者导尿管相关尿路感染(CAUTI)的预防效果。方法:选取2018年12月1日～2019年12月1日收治的80例留置导尿管的脑卒中患者为研究对象,随机分为对照组和观察组各40例,对照组给予常规干预,观察组给予居家护理干预。采用自制的照顾者照顾行为问卷评估照顾者的照顾行为,并比较两组留置导尿管维护合格率、CAUTI及并发症发生率。结果:干预后,两组照顾者照顾行为得分高于干预前(P0.01),且观察组高于对照组(P0.01);观察组留置导尿管维护合格率(卫生情况除外)高于对照组(P0.05);干预后14、21、28 d,观察组CAUTI发生率低于对照组(P0.05);观察组导尿管堵塞、尿液外漏及导尿管脱落发生率均低于对照组(P0.05)。结论:居家护理干预能改善患者的照顾者照顾行为,提高留置导尿管维护合格率,降低脑卒中患者CAUTI、并发症发生率。     

重症患者导尿管相关性尿路感染的目标性监测及干预

尿路感染是医院内最常见的感染之一,约占医院感染的36％～40％,其80％～90％尿路感染与导尿管插入有关。有研究表明,降低留置导尿管相关尿路感染的防控措施对短期放置导尿管的病人有较好的效果．但对长期留置导尿管的病人效果却有限。     

重症监护病房留置导尿管相关尿路感染原因分析及护理对策

目的分析重症监护病房(ICU)导尿管尿路感染相关危险因素,制定相应护理对策,为ICU导尿管相关尿路感染提供防控依据。方法对ICU 2011年—2012年184例导尿管相关尿路感染患者进行目标性监测,分析感染相关危险因素,于2012年1月开始采取相应护理干预措施,对比评估干预前后效果。结果干预前(2011年)1 229例患者中,有951例留置导尿管,共发生导尿管相关尿路感染127例,感染率13.35%;干预后(2012年)1 437例患者中,有841例留置导尿管,发生尿路感染57例,感染率6.78%,差异有统计学意义(P<0.001)。结论采取有效的护理干预措施,能有效减少ICU导尿管尿路感染的发生,保证医疗护理的安全。     

医疗失效模式与效应分析在预防老年患者导尿管相关尿路感染管理中的应用

目的以老年住院患者在留置导尿管期间发生尿路感染为切入点,研究医疗失效模式及效应分析(HFMEA)在预防老年患者导尿管相关尿路感染(CAUTI)管理中的应用,识别患者和医疗服务者并存的潜在危险因素,进行原因分析及流程改进,为预防和控制CAUTI提供新的对策。方法基于规范老年住院留置导尿管患者的管理流程,选择2011年11月~2012年10月73例留置导尿管患者为对照组,2012年11月~2013年10月36例留置导尿管患者为干预组,成立预防CAUTI流程改进小组,把留置导尿管分3个子流程:置管前、置管中、置管后,对3个子流程中的每一个步骤列出所有可能的失效模式,针对每个列出的失效模式,找出所有可能出现的失效原因及导致的结果,计算发生尿路感染的风险指数(RPN),对RPN值达到100分的11个失效模式进行干预,比较两组前后的RPN值的差异及CAUTI的发生率。结果干预组与对照组CAUTI发生情况比较(χ2=9.57,P=0.002)差异具有统计学意义,RPN值降低64.12%,CAUTI发生率下降了31.22%。结论通过HFMEA识别导致CAUTI的失效行为,针对性的采取预防和控制措施,降低CAUTI是有效可行的,为导尿管相关尿路感染的防治提供了新的有效模式基础。     

ICU护士预防导尿管相关尿路感染知信行现状的调查分析

目的:了解ICU护士预防导尿管相关尿路感染(CAUTI)的知信行现状,并分析影响因素,为ICU内CAUTI的预防提供科学依据。方法:2019年2月—2019年3月采用自行设计的“ICU护士预防导尿管相关性尿路感染知信行问卷”对6所医院11个成人ICU的433名护士通过在线的方式进行调查。结果:ICU护士预防CAUTI的知识、态度、行为得分分别为(13.50±2.22)分、(37.19±3.35)分、(53.67±4.23)分。不同学历、职称、职务的ICU护士预防CAUTI知信行总分比较差异有统计学意义(P<0.05)。结论:ICU护士对预防CAUTI的态度积极,但相关知识掌握不平衡、行为落实有待进一步提升。管理者应定期为ICU护士进行预防CAUTI的相关知识教育,提高措施落实的依从性,以期降低ICU内CAUTI发生率。     

苏州地区ICU护士对导尿管相关尿路感染的认知现状

目的调查苏州地区ICU护士对导尿管相关尿路感染的认知现状。方法采用横断面调查,应用微信问卷星发放调查问卷,调查苏州地区16家2级以上医院的240名ICU护士对导尿管相关尿路感染的认知现状。结果苏州地区240名ICU护士尿道口护理液选择主要是0.05%碘伏溶液;预防导尿管相关尿路感染的知识掌握情况较好,不足之处主要体现在导尿管相关尿路感染的治疗方法和影响因素;预防导尿管相关尿路感染依从性良好。结论苏州地区ICU护士导尿管相关尿路感染的认知能力有待进一步提高,执行预防导尿管相关尿路感染措施的依从性需要进一步观察研究。     

Development and validation of a user-friendly risk nomogram for the prediction of catheter-associated urinary tract infection in neuro-intensive care patients

ObjectiveThis study aimed to develop a user-friendly nomogram model to evaluate the risk of catheter-associated urinary tract infections in neuro-critically ill patients.MethodsA retrospective cohort analysis was conducted on 537 patients with indwelling catheters admitted to the neuro-intensive care unit. Patients’ general information, laboratory examination findings, and clinical characteristics were collected. Multivariate regression analysis was applied to develop the nomogram for the prediction of catheter-associated urinary tract infections in this group of patients. The discriminative capacity, calibration ability, and clinical effectiveness of the nomogram were evaluated.ResultsThe occurrence of catheter-associated urinary tract infections was 3.91 % and Escherichia coli was the major causative pathogen. Multivariate regression analysis showed that age ≥ 60 years (odds ratio: 35.2, 95 % confidence interval: 2.3–550.8), epilepsy (39.3, 5.1–301.4), a length of neuro-intensive care stay > 30 days (272.2, 8.3–8963.5), and low albumin levels (<35 g/L) (12.1, 2.1–69.9) were independent risk factors associated with catheter-associated urinary tract infection in neuro-intensive care patients. The nomogram demonstrated good calibration and discrimination in both the training and the validation sets. The model exhibited good clinical use since the decision curve analysis covered a large threshold probability.ConclusionsWe developed a user-friendly nomogram to predict catheter-associated urinary tract ibfection in neuro-intensive care patients. The nomogram incorporated clinical variables collected on admission (age, admission diagnosis, and albumin levels) and the length of stay and enabled the effective prediction of the likelihood of catheter-associated urinary tract infections.     

导尿管相关性尿路感染的预防和护理研究进展

综述导尿管相关性尿路感染的危险因素,包括患者年龄、性别、操作因素、导管因素、药物因素等。通过感染控制项目的实施、导尿管型号及材质的选择、抗生素预防以及多学科合作等方面的预防护理措施,可以降低导尿管相关性尿路感染的发生。     

今福生壳聚糖抗菌成膜喷剂预防老年男性患者留置尿管并发尿路感染的作用

目的探讨今福生壳聚糖抗菌成膜喷剂在预防老年男性患者留置尿管后尿路感染发生的作用。方法将80例留置尿管的老年男性患者,按入院先后次序分为实验组和对照组,每组各40例。对照组按常规用生理盐水棉球清洁尿管表面与患者尿道口,2次/d,实验组用今福生壳聚糖抗菌成膜喷剂喷洒于尿管表面与患者尿道口,2次/d。比较两组患者留置尿管后第3、5、7d膀胱内尿液标本细菌培养的差异。结果留置尿管后第5d和第7d,实验组患者尿细菌培养阳性率均低于对照组,两组比较,均P<0.05,差异具有统计学意义。两组患者无1例发生不良反应。结论今福生壳聚糖抗菌成膜喷剂喷洒于留置尿管表面与患者尿道口,可降低老年男性患者留置尿管后尿路感染的发生率,值得临床推广应用。     

PDCA循环管理在ICU导尿管相关性尿路感染控制中的应用

目的探讨PDCA循环管理模式在降低ICU导尿管相关性尿路感染(CAUTI)发生率中的应用效果。方法将2017年1-12月我院ICU留置导尿管的647例患者作为对照组,采用常规管理。对发生CAUTI患者查找发生CAUTI的真因,制定整改措施;将2018年1-12月在我院ICU留置导尿管的559例患者作为观察组,采用PDCA循环管理模式进行管理,比较两组患者CAUTI发生率。结果观察组患者留置尿管率、CAUTI发生率低于对照组(P <0. 05);CAUTI的防控措施执行率中,尿管留置时间≥7 d率低于对照组(P <0. 05),尿道口清洁率、尿袋固定正确率、无菌操作合格率均高于对照组(P <0. 05)。结论 PDCA循环管理能显著提高ICU导尿管相关性尿路CAUTI的防控措施落实率,有效降低CAUTI发生率。     

导尿管相关尿路感染生物被膜菌及药敏结果分析

目的了解九江地区近2年来导尿管插管后患者尿路感染的病原菌构成,细菌耐药性和生物被膜形成情况,以便指导临床合理用药。方法于2009年8月至2011年8月选择我院住院部收治的CAUTI患者145例为对象,对其导尿管进行细菌培养,药敏试验和细菌生物被膜的检测。结果共分离出118株生物被膜菌,检出率81.4%;以大肠埃希菌为主,占46.61%;大多数生物被膜菌株有较厚的生物被膜;革兰阴性菌中大肠埃希菌等对β-内酰胺类抗生素有很高的耐药率,对阿米卡星的耐药率较低,大肠埃希菌和肺炎克雷伯菌对亚胺培南敏感率为100%。革兰阳性球菌的耐药情况也相当严重。结论针对大多数生物被膜菌株有较厚的生物被膜,要选择细菌生物被膜敏感的抗菌药物,根据菌株的药敏试验,合理地制定治疗方案,以便控制感染。     

A study of nurses' views about the prevention of nosocomial urinary tract infections

• ? This study sought to discover the contribution of nursing practice to the prevention of hospital-acquired or nosocomial urinary tract infections (NUTIs), the most commonly occurring nosocomial infection.
• ? Seventy-five per cent of such infections are associated with urethral catheters.
• ? The practices of nurses who are caring for patients on a 24 h basis would appear to be fundamental to achieving any reduction in the incidence of NUTIs.
• ? This qualitative study utilized unstructured interviews to explore the views of 12 registered nurses about three key issues: first, what care do nurses give with the aim of preventing catheter-associated NUTIs; secondly, what improvements in practice would further prevent catheter-associated NUTIs; thirdly, what do nurses see as constraints to the prevention of catheter-associated NUTIs?
• ? The nurses identified many of the measures that were cited in the literature as effective for preventing NUTIs; however, in reality, they stated that their practice differed because of a lack of time to give care and to update themselves.
• ? The consequences of under-staffing were that junior and temporary staff (whose competence in preventing NUTIs was questioned) worked unsupervised.
• ? Those interviewed identified feelings of powerlessness in effecting preventative measures, and identified not only the role of medical staff in influencing NUTIs but also their inconsistent approach to care.
• ? All these forces effectively limited the nurses' ability to prevent NUTIs.
• ? The study is concluded with recommendations for changes in practice and further research.

     

导管相关性尿路感染危险因素分析及干预效果研究

[目的]调查某三级甲等医院导管相关性尿路感染(CAUTI)现况,分析危险因素并干预,为有效控制CAUTI提供依据。[方法]对某三级甲等医院2014年4月—2014年12月557例留置导尿病人进行目标性监测,分析CAUTI现况及危险因素并于2015年1月开始干预,对比干预前后感染率,评价干预效果。[结果]单因素分析显示有住院时间、入住重症监护室(ICU)时间、留置尿管时间、24h尿量、合并糖尿病、大便失禁6个变量与CAUTI明显相关,多因素分析筛选出独立危险因素,依次为留置尿管时间≥20d、大便失禁、糖尿病、入住ICU时间≥20d,保护因素为24h尿量≥3 000mL;干预前感染率35.37%,干预后20.44%,差异有统计学意义(P0.05)。[结论]该三级甲等医院CAUTI发生率较高,危险因素较多,采取针对性干预措施可有效控制CAUTI。     

Risk factors of nosocomial catheter-associated urinary tract infection in a polyvalent intensive care unit

Objective To determine the risk factors for catheter-associated urinary tract infection in a polyvalent intensive care unit (ICU).Design Prospective cohort study.Setting Sixteen-bed polyvalent ICU in a French university hospital.Interventions Prospective patient surveillance of patients included in two successive studies of two urine drainage systems.Main outcome measures Bacteriuria occurrence in 553 ICU patients requiring a bladder catheter for longer than 48 h. The following variables were analyzed as possible risk factors: age, sex, severity score at admission, diagnosis on admission, duration of bladder catheterization, length of ICU stay, prior exposure to antibiotics, and system of urine drainage.Results The frequency of catheter-associated bacteriuria was 9.6%. From the multivariate analysis, five independent risk factors were determined: female sex, length of ICU stay, use of an antimicrobial therapy, severity score at admission, and duration of catheterization.Conclusion In our study, the drainage system did not influence the occurrence of bacteriuria. To decrease the rate of catheter-associated bacteriuria in polyvalent ICU patients, removal of the bladder catheter must be performed as soon as possible.An erratum to this article can be found at     

Risk factors of nosocomial catheter-associated urinary tract infection in a polyvalent intensive care unit

Objective To determine the risk factors for catheter-associated urinary tract infection in a polyvalent intensive care unit (ICU).Design and setting Prospective cohort study in a 16-bed polyvalent ICU in a French university hospital.Interventions Prospective patient surveillance of patients included in two successive studies of two urine drainage systems.Measurements and results Bacteriuria occurrence in 553 ICU patients requiring a bladder catheter for longer than 48 h. The following variables were analyzed as possible risk factors: age, sex, severity score at admission, diagnosis on admission, duration of bladder catheterization, length of ICU stay, prior exposure to antibiotics, and system of urine drainage. The frequency of catheter-associated bacteriuria was 9.6%. From the multivariate analysis, five independent risk factors were determined: sex female, length of ICU stay, use of an antimicrobial therapy, severity score at admission, and duration of catheterization.Conclusions In our study the drainage system did not influence the occurrence of bacteriuria. To decrease the rate of catheter-associated bacteriuria in polyvalent ICU patients removal of the bladder catheter must be performed as soon as possible.An erratum to this article can be found at     

The correlation between non-O blood group type and recurrent catheter-associated urinary tract infections in critically ill patients: A retrospective study

ObjectiveTo investigate the correlation between the ABO blood group and the risk of recurrent catheter-associated urinary tract infections (CA-UTI) and multi-drug resistant (MDR) organism reinfection in the critically ill.MethodsThis retrospective cohort study enrolled adult patients admitted to the intensive care unit (ICU) with confirmed CA-UTI to investigate the correlation between ABO type and the susceptibility to recurrent, reinfection and MDR reinfection. Patients were classified into two groups based on ABO type (O blood group versus non-O blood group).ResultsA total of 81 patients were included in the study: 37 in the O blood group and 44 in the non-O blood group. Patients in the O blood group were associated with significantly lower odds of recurrent CA-UTI (adjusted odds ratio 0.28; 95% confidence interval 0.08, 0.95), a shorter ICU length of stay (LOS) (estimate [SE] –0.24 [0.05]), hospital LOS (estimate [SE] –0.15 [0.03]) and mechanical ventilation duration (estimate [SE] –0.41 [0.07]) compared with the non-O blood group type.ConclusionNon-O blood group type might be a risk factor for recurrent CA-UTI and infection with MDR organism.