综合干预措施降低导尿管相关尿路感染的效果评价

Effect of bundle intervention on reducing catheter-associated urinary tract infection

摘要:

目的 评估综合干预措施降低导尿管相关尿路感染(CAUTI)的效果。方法 2022年1—12月对某三级甲等医院住院的留置导尿管患者进行目标性监测的基线调查(干预前),2023年1—3月(干预期)通过计划、实施、检查、处理(PDCA)工具找出主要原因,制定并落实集束化干预措施,收集2023年4—12月(干预后)数据,对比干预前后导尿管使用率、CAUTI发病率的差异。结果 干预后正确悬挂集尿袋执行率为97.00％, 及时清空集尿袋执行率为91.72％,家属手卫生知晓率为79.13％,转运时导尿管夹闭执行率为74.79％,每日评估执行率为87.68％, 分别高于干预前的85.63％、80.47％、62.75％、60.00％、79.93％。CAUTI发病率由干预前的1.23‰降至干预后的0.57‰,导尿管使用率从干预前的5.53% 降至干预后的5.37%,上述指标差异均有统计学意义(均P＜0.05)。结论 通过CAUTI目标性监测和PDCA质量工具,可以发现医院感染控制中的薄弱环节,制定更有针对性的防控措施,落实集束化干预措施可以降低CAUTI发病率。

Abstract:

Objective To evaluate the effect of bundle intervention on reducing catheter-associated urinary tract infection (CAUTI). Methods Hospitalized patients with urinary catheterization in a tertiary first-class hospital were subjected to targeted monitoring of a baseline survey from January to December 2022 (pre-intervention). The main causes were found out, and bundle intervention measures were developed and implemented through plan-do-check-act (PDCA) tools from January to March 2023 (intervention period). The data from April to December 2023 (post-intervention) were collected, difference in catheter use rate and incidence of CAUTI before and after intervention were compared. Results The implementation rate of correctly hanging urine collection bags after intervention was 97.00%, the implementation rate of timely emptying urine collection bags was 91.72%, awareness rate of hand hygiene among patient’s family members was 79.13%, implementation rate of urinary catheter clamping during transportation was 74.79%, and daily evaluation implementation rate was 87.68%, which were higher than the pre-intervention rates of 85.63%, 80.47%, 62.75%, 60.00%, and 79.93%, respectively. The incidence of CAUTI decreased from 1.23‰ before intervention to 0.57‰ after intervention, the use rate of urinary catheter decreased from 5.53% before intervention to 5.37% after intervention. Differences of the above indicators were all statistically significant (all P<0.05). Conclusion Through targeted monitoring on CAUTI and PDCA quality tools, the weak links in healthcare-associated infection control are identified, more targeted prevention and control measures are formulated, the implementation of bundle intervention measures can reduce the incidence of CAUTI.