ブックタイトルカテーテル関連尿路感染の予防のためのCDCガイドライン 2009｜株式会社メディコン

概要

カテーテル関連尿路感染の予防のためのCDCガイドライン 2009｜株式会社メディコン

I. Executive SummaryThis guideline updates and expands the original Centers for Disease Control and Prevention(CDC) Guideline for Prevention of Catheter-associated Urinary Tract Infections (CAUTI) publishedin 1981. Several developments necessitated revision of the 1981 guideline, including newresearch and technological advancements for preventing CAUTI, increasing need to addresspatients in non-acute care settings and patients requiring long-term urinary catheterization, andgreater emphasis on prevention initiatives as well as better defined goals and metrics foroutcomes and process measures. In addition to updating the previous guideline, this revisedguideline reviews the available evidence on CAUTI prevention for patients requiring chronicindwelling catheters and individuals who can be managed with alternative methods of urinarydrainage (e.g., intermittent catheterization). The revised guideline also includes specificrecommendations for implementation, performance measurement, and surveillance. Although thegeneral principles of CAUTI prevention have not changed from the previous version, the revisedguideline provides clarification and more specific guidance based on a defined, systematic reviewof the literature through July 2007. For areas where knowledge gaps exist, recommendations forfurther research are listed. Finally, the revised guideline outlines high-priority recommendationsfor CAUTI prevention in order to offer guidance for implementation.This document is intended for use by infection prevention staff, healthcare epidemiologists,healthcare administrators, nurses, other healthcare providers, and persons responsible fordeveloping, implementing, and evaluating infection prevention and control programs forhealthcare settings across the continuum of care. The guideline can also be used as a resourcefor societies or organizations that wish to develop more detailed implementation guidance forprevention of CAUTI.Our goal was to develop a guideline based on a targeted systematic review of the best availableevidence, with explicit links between the evidence and recommendations. To accomplish this, weused an adapted GRADE system approach for evaluating quality of evidence and determiningstrength of recommendations. The methodology, structure, and components of this guideline areapproved by HICPAC and will be used for subsequent guidelines issued by HICPAC. A moredetailed description of our approach is available in the Methods section.To evaluate the evidence on preventing CAUTI, we examined data addressing three key questionsand related subquestions:1. Who should receive urinary catheters?A. When is urinary catheterization necessary?B. What are the risk factors for CAUTI?C. What populations are at highest risk of mortality related to urinary catheters?2. For those who may require urinary catheters, what are the best practices?Specifically, what are the risks and benefits associated with:A. Different approaches to catheterization?B. Different catheters or collecting systems?C. Different catheter management techniques?D. Different systems interventions (i.e., quality improvement programs)?3. What are the best practices for preventing CAUTI associated with obstructed urinarycatheters?< 原文 > I. Executive Summary57