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

We considered CAUTI outcomes, duration of catheterization, recatheterization, and transmissionof pathogens when weighing the risks and benefits of different systems interventions. Theevidence for this question consists of 1 RCT 259 and 19 observational studies. 3,25,260-276 The findingsof the evidence review and the grades for all important outcomes are shown in Evidence ReviewTable 2D.Q2D.1. Multifaceted infection control/quality improvement programsLow-quality evidence suggested a benefit of multifaceted infection control/quality improvementprograms to reduce the risk of CAUTI. 3,260-267 This was based on a decreased risk of SUTI,bacteriuria/unspecified UTI, and duration of catheter use with implementation of such programs.Studies evaluated various multifaceted interventions. The studies with significant findingsincluded: 1) education and performance feedback regarding compliance with catheter care,emphasizing hand hygiene, and maintaining unobstructed urine flow; 2) computerized alerts tophysicians, nurse-driven protocols to remove catheters, and use of handheld bladder scanners toassess for urinary retention; 3) guidelines and education focusing on perioperative cathetermanagement; and 4) a multifaceted infection control program including guidelines for catheterinsertion and maintenance. A program using a checklist and algorithm for appropriate catheteruse also suggested a decrease in unspecified UTI and catheter duration, but statisticaldifferences were not reported.Q2D.2. RemindersVery low-quality evidence suggested a benefit of using urinary catheter reminders to preventCAUTI. 268-270 This was based on a decreased risk of bacteriuria and duration of catheterizationand no differences in recatheterization or SUTI when reminders were used. Reminders tophysicians included both computerized and non-computerized alerts about the presence ofurinary catheters and the need to remove unnecessary catheters.Q2D.3. Bacteriologic monitoringVery low-quality evidence suggested no benefit of bacteriologic monitoring to prevent CAUTI. 25,271Although one study found a decreased risk of bacteriuria during a period of bacteriologicmonitoring and feedback, only 2% of SUTI episodes were considered potentially preventable withthe use of bacteriologic monitoring.Q2D.4. Hand hygieneVery low-quality evidence suggested a benefit of using alcohol hand sanitizer in reducing CAUTI.This was based on one study in a rehabilitation facility that found a decrease in unspecified UTI,although no statistical differences were reported. 272 A separate multifaceted study that includededucation and performance feedback on compliance with catheter care and hand hygieneshowed a decrease in risk of SUTI. 265Q2D.5. Patient placementVery low-quality evidence suggested a benefit of spatially separating patients to preventtransmission of urinary pathogens. 273 This was based on a decreased risk of transmission ofurinary bacterial pathogens in nursing home residents in separate rooms compared to residentsin the same rooms.< 原文 > VIII. Evidence Review95