Catheter-associated urinary tract infection (CAUTI) is an important cause of prolonged hospital stay, which increases economic and medical burden for patients and hospitals, and it is a key focus of hospital infection prevention and control. However, there are currently few studies that convert evidence-based scientific evidence on CAUTI prevention and control into clinical applications and evaluation on its practical effects in combination with standardized infection ratio (SIR), the critical indicator of infection prevention and control. This study aims to establish a precision management plan for reducing the incidence of CAUTI, driven by the findings of a comprehensive evidence summary, to apply this plan across all the nursing units within the entire hospital, followed by a comparative analysis of CAUTI incidence, SIR, the average duration of indwelling urinary catheter for each patient, and the compliance rate on hand hygiene protocols for medical staff before and after the implementation of the precision management plan.
Based on a comprehensive review of the best evidence for preventing CAUTI, a precision management plan was meticulously developed through panel discussions and 2 rounds of expert consultations using Delphi technique. Subsequently, a historical control study was conducted to evaluate the plan's effectiveness. A total of 17 658 patients with indwelling urinary catheter in inpatient departments from January to December 2021 comprised the control group. These patients received standard nursing measures for CAUTI. Another 18 753 patients with indwelling urinary catheters in the inpatient departments from January to December 2022 comprised the intervention group, underwent the precision management scheme based on the best available evidence, to enhance CAUTI prevention. The incidence and SIR of CAUTI, the average duration of indwelling urinary catheter for each patient, and the compliance rate on hand hygiene protocols for medical staff were compared between the 2 groups.
Compared with the control group, the incidence of CAUTI in the intervention group was significantly decreased (0.48‰ vs 1.12‰, χ2=20.814, P<0.001), SIR was decreased in the intervention group (0.55 vs 1.37); the average duration of indwelling urinary catheter for each patient was significantly decreased [(4.33±1.55) d vs (4.43±1.79) d, t=11.941, P<0.001]. The ratio of compliance rate of medical staff with strict hand hygiene protocols higher than 95% in the intervention group was significantly higher than that in the control group (93.3% vs 83.3%, χ2=5.822, P=0.016).
The implementation of the precision management plan for reducing CAUTI based on a summary of the best available evidence on CAUTI prevention and control in patients with indwelling urinary catheters has found to be effective. This approach significantly reduces the incidence of CAUTI, reduces the average duration of indwelling urinary catheter, and enhances hand hygiene compliance among medical staff. It provides a scientific and efficient strategy for preventing and controlling CAUTI in the hospital, ultimately saving patients from unnecessary medical expense.
目的: 导尿管相关尿路感染(catheter-associated urinary tract infection，CAUTI)是导致患者住院时间延长、患者经济负担和医疗负担加重的重要原因，是医院感染防控的重点，然而目前鲜有研究将基于循证的CAUTI防控科学证据在临床上转化应用并结合标准化感染比(standardized infection ratio，SIR)这一感染防控指标探索其应用效果。本研究基于最佳证据总结以构建CAUTI精准化管理方案，并在全院护理单元中应用，比较精准化管理方案实施前后全院的CAUTI发病率、SIR、平均导尿管留置天数及手卫生执行率。方法: 基于CAUTI预防的最佳证据总结，采用专题小组讨论和2轮德尔菲专家咨询的方法构建CAUTI的精准化管理方案；采用历史前后对照研究方法，将2021年1—12月全院护理单元中17 658例留置导尿管的患者作为对照组，对照组实施常规导尿管相关护理；将2022年1—12月全院护理单元中18 753例留置导尿管的患者作为干预组，干预组实施基于最佳证据总结的精准化管理方案以预防CAUTI，比较2组患者的CAUTI发病率及SIR、平均导尿管留置天数、医护人员手卫生执行率。结果: 与对照组患者相比，干预组患者CAUTI发病率(0.48‰ vs 1.12‰，χ2=20.814，P<0.001)和SIR均降低(0.55 vs 1.37)，且干预组SIR小于1；在实施研究后，干预组患者的平均导尿管留置天数显著少于对照组[(4.33±1.55) d vs (4.43±1.79) d，t=11.941，P<0.001]；干预组医护人员手卫生执行率高于95%的比例显著多于对照组(93.3% vs 83.3%，χ2=5.822，P=0.016)。结论: 对留置导尿管的患者实施基于最佳证据总结的CAUTI精准化管理方案能有效降低CAUTI发病率，减少平均导尿管留置天数，提高医护人员手卫生执行率，可为医院CAUTI的预防和管理提供科学和有效的方案，为患者节约不必要的医疗支出。.
Catheter-associated urinary tract infection (CAUTI) is an important cause of prolonged hospital stay, which increases economic and medical burden for patients and hospitals, and it is a key focus of hospital infection prevention and control. However, there are currently few studies that convert evidence-based scientific evidence on CAUTI prevention and control into clinical applications and evaluation on its practical effects in combination with standardized infection ratio (SIR), the critical indicator of infection prevention and control. This study aims to establish a precision management plan for reducing the incidence of CAUTI, driven by the findings of a comprehensive evidence summary, to apply this plan across all the nursing units within the entire hospital, followed by a comparative analysis of CAUTI incidence, SIR, the average duration of indwelling urinary catheter for each patient, and the compliance rate on hand hygiene protocols for medical staff before and after the implementation of the precision management plan.
Based on a comprehensive review of the best evidence for preventing CAUTI, a precision management plan was meticulously developed through panel discussions and 2 rounds of expert consultations using Delphi technique. Subsequently, a historical control study was conducted to evaluate the plan’s effectiveness. A total of 17 658 patients with indwelling urinary catheter in inpatient departments from January to December 2021 comprised the control group. These patients received standard nursing measures for CAUTI. Another 18 753 patients with indwelling urinary catheters in the inpatient departments from January to December 2022 comprised the intervention group, underwent the precision management scheme based on the best available evidence, to enhance CAUTI prevention. The incidence and SIR of CAUTI, the average duration of indwelling urinary catheter for each patient, and the compliance rate on hand hygiene protocols for medical staff were compared between the 2 groups.
Compared with the control group, the incidence of CAUTI in the intervention group was significantly decreased (0.48‰ vs 1.12‰, χ2=20.814, P<0.001), SIR was decreased in the intervention group (0.55 vs 1.37); the average duration of indwelling urinary catheter for each patient was significantly decreased [(4.33±1.55) d vs (4.43±1.79) d, t=11.941, P<0.001]. The ratio of compliance rate of medical staff with strict hand hygiene protocols higher than 95% in the intervention group was significantly higher than that in the control group (93.3% vs 83.3%, χ2=5.822, P=0.016).
The implementation of the precision management plan for reducing CAUTI based on a summary of the best available evidence on CAUTI prevention and control in patients with indwelling urinary catheters has found to be effective. This approach significantly reduces the incidence of CAUTI, reduces the average duration of indwelling urinary catheter, and enhances hand hygiene compliance among medical staff. It provides a scientific and efficient strategy for preventing and controlling CAUTI in the hospital, ultimately saving patients from unnecessary medical expense.
Zhong nan da xue xue bao. Yi xue ban = Journal of Central South University. Medical sciences. 0000 Dec [Epub]
Chunhong Ruan, Shuangjiao Shi, Zhiying Shen, Lanping Guo, Lina Gong
Department of Hematology, Third Xiangya Hospital, Central South University, Changsha 410013. ., Department of Hematology, Third Xiangya Hospital, Central South University, Changsha 410013., Nursing Department, Third Xiangya Hospital, Central South University, Changsha 410013., Nursing Department, Third Xiangya Hospital, Central South University, Changsha 410013. .