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

Q2D.6. Catheter team versus self-catheterizationVery low-quality evidence suggested no benefit of a catheter team to prevent CAUTI amongpatients requiring intermittent catheterization. 274 This was based on one study showing nodifference in unspecified UTI between use of a catheter care team and self-catheterization forintermittent catheterization in paraplegic patients.Q2D.7. FeedbackVery low-quality evidence suggested a benefit of using nursing feedback to prevent CAUTI. 275This was based on a decreased risk of unspecified UTI during an intervention where nursing staffwere provided with regular reports of unit-specific rates of CAUTI.Q2D.8. Nurse-directed catheter removalVery low-quality evidence suggested a benefit of a nurse-directed catheter removal program toprevent CAUTI. 276 This was based on a decreased risk of unspecified UTI during an interventionwhere criteria were developed that allowed a registered nurse to remove a catheter without aphysician’s order when no longer medically necessary. Of the three intensive care units where theintervention was implemented, differences were significant only in the coronary intensive care unit.Evidence Review Table 2D. What are the risks and benefits associated with differentsystems interventions?2D.1.a. Ensure that healthcare personnel and others who take care of catheters are givenperiodic in-service training stressing the correct techniques and procedures forurinary catheter insertion, maintenance, and removal. (Category IB)2D.1.b. Implement quality improvement (QI) programs or strategies to enhance appropriateuse of indwelling catheters and to reduce the risk of CAUTI based on a facility riskassessment. (Category IB)Examples of programs that have been demonstrated to be effective include:1. A system of alerts or reminders to identify all patients with urinary cathetersand assess the need for continued catheterization2. Guidelines and protocols for nurse-directed removal of unnecessary urinarycatheters3. Education and performance feedback regarding appropriate use, handhygiene, and catheter care4. Guidelines and algorithms for appropriate peri-operative catheter management,such as:a. Procedure-specific guidelines for catheter placement and postoperativecatheter removalb. Protocols for management of postoperative urinary retention, such as nursedirecteduse of intermittent catheterization and use of ultrasound bladderscanners原文2D.3.2D.4.Routine screening of catheterized patients for asymptomatic bacteriuria is notrecommended. (Category II)Perform hand hygiene immediately before and after insertion or any manipulation ofthe catheter site or device. (Category IB)96 < 原文 > VIII. Evidence Review