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。

Bundle management of catheter associated urinary tract infection in stroke patients

ObjectiveTo explore the application of bundle management in the prevention of catheter associated urinary tract infection (CAUTI) in stroke patients, so as to reduce the incidence of CAUTI in stroke patients. MethodsStroke patients who were admitted to the department of neurology of a hospital and with indwelling urinary catheter between January 2016 and May 2017 were selected, patients who were admitted between January and August 2016 were as control group (adopting routine urinary catheter maintenance method), between September 2016 and May 2017 were as trial group (adopting bundle management measures). The implementation rate of urinary catheter maintenance measures, urinary catheter indwelling time, urinary catheter contamination rate, and incidence of CAUTI were compared between two groups of patients.ResultsA total of 60 patients were enrolled in the study, 30 were in control group, and 30 in trial group. The implementation rate of catheter maintenance measures in trial group was higher than that in control group (92.55% vs 71.74%, P=0.000). The implementation rates of catheter maintenance measures in trial group on the third, tenth, and seventeenth day were 94.64%, 89.13%, and 91.30% respectively, and control group were 78.55%, 67.87%, and 54.89% respectively, there were significant difference between two groups (both P<0.05). Catheter indwelling time in trial group was shorter than control group (［9.67±3.54］ d vs ［12.40±6.52］ d, P<0.05); contamination rate of urinary catheter in trial group was lower than control group (13.33% vs 50.00%, P<0.05); incidence of CAUTI in trial group was lower than control group (3.33% vs 26.67%, P＜0.05）. ConclusionBundle management can improve the implementation of urinary catheter maintenance measures, establish feedback mechanism, continuously improve quality, combined with bladder function training and rehabilitation, it can shorten catheter indwelling time, reduce urinary catheter contamination, and reduce the incidence of CAUTI in patients.