集束化护理策略预防患者留置尿管期间相关性尿路感染的研究

目的研究集束化护理策略在预防患者留置尿管期间相关性尿路感染(CAUTI)中的效果,探讨预防CAUTI有效的护理方法。方法选取2009年10月~2012年10月在ICU住院留置尿管10d以上的患者102例作为实验组,采用集束化护理。选取2007年1月~2009年9月在ICU住院留置尿管10d以上的患者94例作为对照组,采用常规护理。对比分析两组CAUTI的感染率。结果与对照组比较,实验组CAUTI感染率明显下降(P<0.01)。结论集束化护理策略能降低患者留置尿管期间CAUTI的感染率,减轻患者痛苦,提高护理质量,可应用于临床。     

老年患者留置尿管致尿路感染的原因及对策

目的探讨老年住院患者留置尿管致尿路感染的相关因素,寻求有效的预防措施,以减少尿路感染的发生。方法对176例留置尿管的老年住院患者进行目标性监测,对其中发生尿路感染的患者就其相关因素进行分析。结果 176例留置尿管患者中有39例发生尿路感染,感染率为22.16%。女性明显高于男性(P<0.05﹚,留置尿管时间越长感染率越高(P<0.05﹚,不同基础疾病患者尿路感染发生率差异有统计学意义(P<0.05﹚。39例尿路感染共检出病原菌32株,其中以大肠埃希菌为主,占37.50%。结论老年患者尿路感染的发生与性别、基础疾病、尿管留置时间有关;加强尿路感染高发人群的目标性监测,针对易感因素制定相关干预措施,可降低其发生率。     

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.     

神经源性膀胱合并上尿路扩张患者尿动力学检查的护理

目的探讨神经源性膀胱合并上尿路扩张患者尿动力学特点及检查过程中的护理配合。方法回顾性分析150例神经源性膀胱合并上尿路扩张患者膀胱功能测定的护理配合要点、检查结果和并发症发生情况。结果上尿路扩张患者多表现为膀胱低顺应性、逼尿肌过度活动、高逼尿肌漏尿点压、相对安全容量显著降低、残余尿量显著增多、膀胱活动低下等,尿动力学检查后患者并发泌尿系感染的风险和严重程度明显增加。结论神经源性膀胱合并上尿路扩张患者行尿动力学检查时需加强相关的护理配合,如严格控制膀胱充盈速度及重复检测次数、及时留置导尿管持续引流尿液或进行清洁间歇导尿、预防性使用抗生素等,以保证检查结果的准确性,并有效预防检查后泌尿系感染的发生。     

The Prevalence of Urinary Tract Infections and Sexually Transmitted Disease in Women with Symptoms of a Simple Urinary Tract Infection Stratified by Low Colony Count Criteria

OBJECTIVES: Urinary tract infections (UTIs) and early pelvic infections due to sexually transmitted disease (STD) may cause similar symptoms. Therefore, a simple history and urine dip to establish a diagnosis of UTI may result in overtreatment of UTIs and undertreatment of STDs. The objective of this study was to determine the proportion of women with symptoms suggestive of a UTI who are urine culture positive versus urine culture negative, the prevalence of STDs between groups, and if elements of the history or examination may predict those requiring STD screening. METHODS: This was a prospective cohort study in an urban emergency department. Women 18-55 years of age with urinary frequency, urgency, dysuria, and no new vaginal discharge or change in discharge were enrolled. The following were performed: detailed history; bladder catheterization for urinalysis, urine dip, and urine culture; pelvic examination and cervical samples for gonorrhea and Chlamydia trachomatis DNA ligase; and wet mount examinations. Main outcome measurements were the percentage of women who were urine culture positive (using low count criteria of 10(2) colony-forming units [CFU]/mL), the proportion of STDs between urine culture groups, and univariate analysis and logistic regression of historical and examination elements. RESULTS: Ninety-two patients were enrolled; the mean age was 26 years (range, 18-51 years). All had samples for DNA ligase (one quantity not sufficient) and urinalysis or urine dip, while 75 of 92 had urine cultures performed. A total of 57.3% (43/75) were urine culture positive at 10(2) CFU/mL, while the STD rate for those with urine cultures was 17.3% (13/75). There was no statistically significant difference in the number of STDs between urine culture positive and urine culture negative groups. The only variable on logistic regression predictive of an STD (based on all 91 patients) was more than one sex partner in the past year (p = 0.013). No other element of the history or pelvic examination helped differentiate those who tested positive for an STD. CONCLUSIONS: A total of 17.3% of women with symptoms of a UTI in this study had an STD, while only 57.3% were urine culture positive by catheterization using low count criteria. The proportion of STDs between those with and without a UTI was not significantly different.     

A nurse‐driven process for timely removal of urinary catheters

Catheter‐associated urinary tract infection (CAUTI) comprises 30–40% of all health care‐acquired infections, and 70–80% of these infections are related with use of indwelling urinary catheters. This quality improvement (QI) project was initiated to evaluate the effectiveness of a nurse‐driven urinary catheter removal process in reducing the duration of urinary catheter usage in a general medical ward in Singapore. A pre‐ and post‐study design was adopted. The pre‐implementation data included urinary catheter utilization ratio and CAUTI rates. Over a 6‐months period, nurses used a nurse‐driven urinary catheter removal process to improve rates of timely removal of catheter. Data collected included nurses' compliance with the process and clinical outcomes, such as urinary catheter utilization ratio and CAUTI rates before and after implementation. Compliance with the use of the nurse‐driven process by staff was 89%. The urinary catheter utilization ratio revealed a raise from 0·12 before implementation to 0·18 after implementation. However, CAUTI rates decreased from 4 to 0 per 1000 catheter‐days, indicating a marginally significant difference between the pre and post‐implementation rates (p = 0.06), using Fisher's exact test. The nurse‐driven process decision support tool for optimizing appropriate catheter usage had the potential of reducing a patient's risk of acquiring CAUTI.     

某中医院246例尿道感染大肠埃希菌临床分布及耐药性分析

目的探讨尿路感染病原菌的分布特点及耐药性,为临床抗菌药物的使用提供依据。方法收集2009～2011年尿液标本中分离出的大肠埃希菌246株,用VITEK-32鉴定仪鉴定,药敏试验采用K-B纸片扩散法。结果 246株大肠埃希菌中超广谱β-内酰胺酶(ESBLs)菌株112株,阳性率高达45.5%。大肠埃希菌对亚胺培南、美洛培南、阿米卡星、哌拉西林/他唑巴坦和头孢哌酮/舒巴坦的耐药率小于20.0%;对头孢唑啉、氨苄西林、环丙沙星、头孢曲松和左氧氟沙星头孢曲松、哌拉西林的耐药率大于60.0%。产ESBLs菌株对常用的18种抗生素耐药性高于非产ESBLs菌株。结论临床尿液标本分离大肠埃希菌耐药率和耐药性逐年增强,临床医师应该重视病原菌的培养和药物敏感试验,根据药敏结果合理应用抗菌药物。     

Multimodal Intervention Approach Reduces Catheter-associated Urinary Tract Infections in a Rural Tertiary Care Center

Objective:To compare the catheter-associated urinary tract infections (CAUTI) standardized infection rate (SIR) before and after implementation of a multimodal intervention approach in a rural tertiary hospital.Design:Before–after analysis of a multimodal intervention to evaluate primary outcomes of the incidence of inpatient CAUTI, the SIR for CAUTI, and number of urinary catheter days.Setting:All inpatient departments of a rural 504-bed tertiary care facility in the Midwest.Participants:Patients admitted for in-patient care.Interventions:A multimodal intervention composed of: (a) physician and nurse education, (b) modification of progress note templates and daily provider reminders for the clinical necessity of catheters, (c) implementing established best practices for eliminating CAUTIs, (d) advocating for alternative toileting options, and (e) promoting aseptic techniques for insertion and removal of catheters. SIR, CAUTI, and the number of urinary catheter days were obtained before and after implementation of the multimodal intervention in 2015 and 2017, respectively.Results:After a one-year timeframe of intervention, CAUTI event rates decreased, and SIR for CAUTI was reduced by 60.2% (from 1.524 to 0.607) with P value<0.05. Urinary catheter days were also reduced from 16,195 in 2015 to 13,348 in 2017 (17.6% reduction) with P value <0.05.Conclusions:Incidence of CAUTIs were significantly reduced with a team effort involving infection control, physician and nursing education, modification of progress note and templates and daily provider reminders for the clinical necessity of catheters and appropriate usage of urinary catheter with corresponding reduction in urinary catheter days.     

北京协和医院1990—2009年住院患者尿道感染常见病原菌及其耐药性

  目的  了解住院患者尿道细菌感染常见病原菌及其对抗菌药物的耐药性。  方法  用纸片扩散法对1990-2009年北京协和医院住院患者尿道感染分离的4565株病原菌进行抗菌药物耐药监测。  结果  20年来北京协和医院住院患者尿道感染以大肠埃希菌检出率最高(33%), 其次为粪肠球菌(12%)、屎肠球菌(8%)、凝固酶阴性葡萄球菌(7%)、铜绿假单胞菌(6%)和肺炎克雷伯菌(6%)。2006-2009年产超广谱β-内酰胺酶(extended-spectrum beta-lac-tamases, ESBLs)的大肠埃希菌检出率为60%;大肠埃希菌对亚胺培南、美罗培南和厄他培南均100%敏感, 对环丙沙星和左氧氟沙星的耐药率为77.7%和76.4%。粪肠球菌对呋喃妥因和磷霉素的耐药率均低于10%。  结论  住院患者尿道感染最常见的病原菌是大肠埃希菌, 且细菌耐药性呈增长趋势, 临床上应加强细菌耐药监测。     

Flora distribution and drug resistance in catheter‐associated urinary tract infection

To investigate flora distribution and drug resistance in catheter‐associated urinary tract infection. From January 2003 to January 2008 1,567 patients with urinary tract infection associated with the use of indwelling urinary catheters were analyzed retrospectively, whose urine specimens were cultured for bacteria and the isolated pathogens were tested for drug sensitivity by Kirby‐Baue method. 376 pathogens were isolated from the 1,567 urine specimens (24·0%), most of which were Gram‐negative bacteria. The extended spectrum β‐lactamase (ESBL) rate was 59·8% (79/132) for Escherichia coli and 47·4% (18/38) for Klebsiella pnuemoniae. The isolating rate of Methcillin‐resistant Staphylococcus aureus and Methcillin‐resistant Staphylococcus epidermidis was 54·7% and 88·2% respectively. Catheter‐associated urinary tract infection is mainly caused by Gram‐negative bacteria of multi‐drug resistance. Use of antibiotics should be based on drug sensitivity tests.     

Symptomatic Lower Urinary Tract Infection Induced by Cooling of the Feet: A Controlled Experimental Trial

We conducted an open, non-randomized experimental study as a first step to find out whether cooling of the feet may cause symptomatic lower urinary tract infection (UTI) in cystitis-prone women. Twenty-nine healthy women, aged 19–68 (mean 42.5) years, who had had three or more symptomatic episodes of UTI during the previous 12 months were included. They registered symptoms and carried out a strip urinalysis at each urination during a control period of 72 hours. Their lower legs and feet were then immersed in increasingly cold water for 30 minutes. Another 72-hour period of registration followed. Six subjects developed acute distal urinary symptoms at a mean of 55 (95% confidence interval 50 to 61) hours after the cooling, compared with none in the control period. Five of the six had bacteriologically verified lower UTI (P = 0.03 v. the control period). Cooling of the feet seems to provoke symptomatic lower UTI in cystitis-prone women.