RESUMEN
This retrospective study examines trends in urinary catheter use in US emergency departments between 2002 and 2019.
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Servicio de Urgencia en Hospital , Cateterismo Urinario , Catéteres Urinarios , Servicio de Urgencia en Hospital/estadística & datos numéricos , Servicio de Urgencia en Hospital/tendencias , Estudios Retrospectivos , Estados Unidos/epidemiología , Cateterismo Urinario/estadística & datos numéricos , Cateterismo Urinario/tendencias , Catéteres Urinarios/estadística & datos numéricos , Catéteres Urinarios/tendenciasRESUMEN
ABSTRACT: Cervical cancer is a common malignancy in women. The presence of hydronephrosis in patients with cervical cancer can be a challenging clinical problem. The appropriate management of these patients and the prediction of their outcomes are concerns among gynecologists, urologists, medical oncologists, radiation oncologists, and nephrologists. We enrolled a total of 2225 patients with cervical cancer over a 12-year period from the nationwide database of Taiwan's National Health Insurance Bureau. Among them, 445 patients had concomitant hydronephrosis. The remaining 1780 patients without hydronephrosis were randomly enrolled as a control group for the analysis of associated factors. The results indicated that the proportions of patients with hypertension, chronic kidney disease, and diabetes were significantly higher in the hydronephrosis group. The hydronephrosis group showed a higher all-cause mortality than the non-hydronephrosis group (adjusted hazard ratio 3.05, 95% confidence interval 2.24-4.15, Pâ<â.001). The rates of nephrectomy and stone disease were also significantly higher in the hydronephrosis group. A higher percentage of other cancers was also observed in the hydronephrosis group than in the non-hydronephrosis group (12.36% vs 8.99%, respectively). This study shows that cervical cancer with hydronephrosis may have a higher morbidity and mortality than cervical cancer without hydronephrosis. Other factors such as human papilloma virus vaccination, smoking, and cancer staging need to be further studied.
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Hidronefrosis/etiología , Neoplasias del Cuello Uterino/complicaciones , Neoplasias del Cuello Uterino/mortalidad , Neoplasias del Cuello Uterino/patología , Adulto , Anciano , Estudios de Casos y Controles , Estudios de Cohortes , Comorbilidad , Manejo de Datos , Diabetes Mellitus/epidemiología , Femenino , Humanos , Hipertensión/epidemiología , Cálculos Renales/epidemiología , Persona de Mediana Edad , Nefrectomía/estadística & datos numéricos , Evaluación del Resultado de la Atención al Paciente , Insuficiencia Renal Crónica/epidemiología , Estudios Retrospectivos , Taiwán/epidemiología , Catéteres Urinarios/estadística & datos numéricos , Neoplasias del Cuello Uterino/prevención & controlAsunto(s)
Adenocarcinoma/cirugía , Escisión del Ganglio Linfático/métodos , Pelvis/patología , Próstata/cirugía , Adenocarcinoma/diagnóstico , Anciano , Quimioradioterapia/métodos , Humanos , Verde de Indocianina/administración & dosificación , Ganglios Linfáticos/patología , Ganglios Linfáticos/cirugía , Masculino , Estadificación de Neoplasias/métodos , Imagen Óptica/métodos , Cuidados Preoperatorios/métodos , Proctectomía/métodos , Próstata/patología , Neoplasias del Recto/patología , Resultado del Tratamiento , Catéteres Urinarios/efectos adversos , Catéteres Urinarios/estadística & datos numéricosRESUMEN
The aim of this study was to identify the main risk factors for health-care-associated infections (HAIs) following cardiac surgery and to establish an effective early warning model for HAIs to enable intervention in an earlier stage.In total, 2227 patients, including 222 patients with postoperative diagnosis of HAIs and 2005 patients with no-HAIs, were continuously enrolled in Beijing Anzhen Hospital, Beijing, China. Propensity score matching was used and 222 matched pairs were created. The risk factors were analyzed with the methods of univariate and multivariate logistic regression. The receiver operating characteristic (ROC) curve was used to test the accuracy of the HAIs early warning model.After propensity score matching, operation time, clamping time, intubation time, urinary catheter time, central venous catheter time, ≥3 blood transfusions, re-endotracheal intubation, length of hospital stay, and length of intensive care unit stay, still showed significant differences between the 2 groups. After logistic model analysis, the independent risk factors for HAIs were medium to high complexity, intubation time, urinary catheter time, and central venous catheter time. The ROC showed the area under curve was 0.985 (confidence interval: 0.975-0.996). When the probability was 0.529, the model had the highest prediction rate, the corresponding sensitivity was 0.946, and the specificity was 0.968.According to the results, the early warning model containing medium to high complexity, intubation time, urinary catheter time, and central venous catheter time enables more accurate predictions and can be used to guide early intervention after pediatric cardiac surgery.
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Procedimientos Quirúrgicos Cardíacos/estadística & datos numéricos , Infección Hospitalaria/epidemiología , Unidades de Cuidados Intensivos/estadística & datos numéricos , Catéteres Venosos Centrales/estadística & datos numéricos , China/epidemiología , Infección Hospitalaria/diagnóstico , Diagnóstico Precoz , Femenino , Humanos , Lactante , Masculino , Tempo Operativo , Puntaje de Propensión , Curva ROC , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Catéteres Urinarios/estadística & datos numéricosRESUMEN
BACKGROUND & PROBLEMS: According to the literature, 74%-84% of patients in adult critical care units have an indwelling catheter. The majority of medical and healthcare infections are urinary tract infections, which are related to urinary catheter usage. Furthermore, critical infections may cause bacteremia, which increases the risk of mortality. Prior to this project, over three-quarters (78.7%) of patients in our unit used a urinary catheter, which is a rate that is higher than all other intensive care units of our hospital's internal medicine department. Due to Foley placement, removal and care of catheters requires collaboration of teamwork. Thus, the concept of team resource management may be applied to improve the situation. PURPOSE: The aim of this study was to reduce the urinary catheter usage rate in our intensive care unit to less than 69.3%. RESOLUTIONS: This project summarized the reasons for the high catheter usage rate in this unit on 2017/1/3 and implemented several approaches to improve the situation from 2017/2/1 to 2017/6/30. These approaches included affixing reminder labels to indwelling catheters, using an ultrasound bladder scanner as a substitute for intermittent catheterization, evaluating indwelling catheters, establishing flow planning for post-catheter removal, holding cross-team meetings, and adopting a reward system. During the improvement period, we held collaborative conference meetings weekly to discuss solutions, evaluate end-of-the-month progress, and set reward policies. RESULTS: We lowered the average urinary catheter usage rate from 78.7% on 2017/3/1 to 57.8% on 2017/6/30, achieving a 26.5% reduction in catheter usage. CONCLUSIONS: This project both effectively reduced the unnecessary use of urinary catheters and significantly strengthened team spirit in our unit, thus improving the quality of medical care provided.
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Unidades de Cuidados Intensivos/organización & administración , Grupo de Atención al Paciente/organización & administración , Catéteres Urinarios/estadística & datos numéricos , Humanos , Investigación en Evaluación de Enfermería , Cateterismo Urinario/enfermeríaRESUMEN
BACKGROUND: The use of invasive devices increases the risk of healthcare associated infections (HAI). The recent national HAI point prevalence survey secondary outcomes aimed to estimate the prevalence of patients with an indwelling urinary catheter device and vascular access devices; and also identify prevalence of those managed under transmission based precautions (TBP); and those colonised or infected with a multi drug resistant organism (MDRO). METHODS: A point prevalence study was conducted in large acute care Australian public hospitals. All data were collected by two trained Research Assistants. Surveillance methodology was based on the European Centre for Disease Prevention and Control PPS Protocol. Data was also collected on prevalence of TBPs and MDROs. RESULTS: A total of 2767 acute adult inpatients were sampled across 19 hospitals. The prevalence of peripheral vascular, central vascular and urinary catheters devices was 55.2% (95%CI: 53.3%-57.1%), 14.8% (95%CI: 13.5%-16.1%) and 20.7% (95%CI: 19.2%-22.3%) respectively. Of the 2767 patients sampled 285 (10.3%, 95%CI: 9.2%-11.5%) were documented as either being infected or colonised with a MDRO, and 781 (11.8%) patients were being managed under the hospital TBP policy. CONCLUSION: This is the first national study to describe the prevalence of devices, TBPs and MDROs in Australian healthcare settings. In an era where device use should be constantly reviewed to minimise risk of HAI, and the increasing challenges of managing patients with MDROs, this data can serve as a benchmark for future studies.
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Infección Hospitalaria/epidemiología , Control de Infecciones , Infecciones Urinarias/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Australia/epidemiología , Catéteres de Permanencia/efectos adversos , Catéteres de Permanencia/estadística & datos numéricos , Infección Hospitalaria/etiología , Infección Hospitalaria/prevención & control , Femenino , Hospitales Públicos , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Encuestas y Cuestionarios , Catéteres Urinarios/efectos adversos , Catéteres Urinarios/estadística & datos numéricos , Infecciones Urinarias/etiología , Infecciones Urinarias/prevención & control , Adulto JovenRESUMEN
BACKGROUND: Catheter-associated bloodstream infections and urinary tract infections are frequently encountered health care-associated infections. We aimed to reduce inappropriate use of catheters to reduce health care-associated infections. METHODS: In this multicentre, interrupted time-series and before and after study, we introduced a de-implementation strategy with multifaceted interventions in seven hospitals in the Netherlands. Adult patients admitted to internal medicine, gastroenterology, geriatic, oncology, or pulmonology wards, and non-surgical acute admission units, and who had a (central or peripheral) venous or urinary catheter were eligible for inclusion. One of the interventions was that nurses in the participating wards attended educational meetings on appropriate catheter use. Data on catheter use were collected every 2 weeks by the primary research physician during the baseline period (7 months) and intervention period (7 months), which were separated by a 5 month transition period. The primary outcomes were percentages of short peripheral intravenous catheters and urinary catheters used inappropriately on the days of data collection. Indications for catheter use were based on international guidelines. This study is registered with Netherlands Trial Register, NL5438. FINDINGS: Between Sept 1, 2016, and April 1, 2018, we screened 6157 patients for inclusion, of whom 5696 were enrolled: 2650 patients in the baseline group, and 3046 in the intervention group. Inappropriate use of peripheral intravenous catheters occurred in 366 (22·0%, 95% CI 20·0 to 24·0) of 1665 patients in the baseline group and in 275 (14·4%, 12·8 to 16·0) of 1912 patients in the intervention group (incidence rate ratio [IRR] 0·65, 95% CI 0·56 to 0·77, p<0·0001). Time-series analyses showed an absolute reduction in inappropriate use of peripheral intravenous catheters from baseline to intervention periods of 6·65% (95% CI 2·47 to 10·82, p=0·011). Inappropriate use of urinary catheters occurred in 105 (32·4%, 95% CI 27·3 to 37·8) of 324 patients in the baseline group compared with 96 (24·1%, 20·0 to 28·6) of 398 patients in the intervention group (IRR 0·74, 95% CI 0·56 to 0·98, p=0·013). Time-series analyses showed an absolute reduction in inappropriate use of urinary catheters of 6·34% (95% CI -12·46 to 25·13, p=0·524). INTERPRETATION: Our de-implementation strategy reduced inappropriate use of short peripheral intravenous catheters in patients who were not in the intensive care unit. The reduction of inappropriate use of urinary catheters was substantial, yet not statistically significant in time-series analysis due to a small sample size. The strategy appears well suited for broad-scale implementation to reduce health care-associated infections. FUNDING: Netherlands Organisation for Health Research and Development.
Asunto(s)
Infecciones Relacionadas con Catéteres/prevención & control , Cateterismo Periférico , Adhesión a Directriz/normas , Procedimientos Innecesarios , Catéteres Urinarios , Administración Intravenosa , Adulto , Cateterismo Periférico/efectos adversos , Cateterismo Periférico/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Países Bajos , Estudios Prospectivos , Catéteres Urinarios/efectos adversos , Catéteres Urinarios/estadística & datos numéricos , Infecciones Urinarias/prevención & controlRESUMEN
OBJECTIVES: Indwelling urinary catheters (IUCs) are commonly used devices in acute care that may lead to catheter-associated urinary tract infections or noninfectious complications. Responsibilities for IUC are usually shared between nurses and physicians, and a common mental model among the two professional groups is thus essential for a successful reduction in catheter use. The aim of this study was to determine variation in the perceptions of current practices and culture regarding IUC use between these two groups. METHODS: Nurses and physicians (N = 1579) from seven Swiss hospitals completed a written survey on safe IUC use in their institution. The survey assessed participant's perceptions of current practices and culture in their institution, and their perceived responsibilities related to IUC care. t tests and logistic regression were used to examine differences in responses between physicians and nurses. RESULTS: Nurses and physicians each have their own tasks but also share responsibilities for catheter placement, care, and removal. Overall, nurses were more positive than physicians about current practices and culture regarding IUC use within their institution (mean scale scores = 5.4 for nurses versus 5.1 for physicians, P < 0.001). Perceptions of the two professional groups diverged most strongly on practices to avoid unnecessary placement of IUCs, the presence of shared values and attitudes in support of restrictive catheter use, and the other group's leadership commitment. CONCLUSIONS: Indwelling urinary catheter management is a strong interprofessional domain and a shared responsibility. It is crucial that measures to raise awareness and to communicate new standards target both nurses and physicians and are discussed in interprofessional formats.
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Catéteres de Permanencia/estadística & datos numéricos , Cateterismo Urinario/estadística & datos numéricos , Catéteres Urinarios/estadística & datos numéricos , Adulto , Catéteres de Permanencia/efectos adversos , Estudios Transversales , Femenino , Humanos , Masculino , Enfermeras y Enfermeros , Percepción , Médicos , Encuestas y Cuestionarios , Cateterismo Urinario/efectos adversos , Catéteres Urinarios/efectos adversosRESUMEN
Purpose: We conducted a prospective randomized controlled trial to compare postoperative urinary catheter removal 2 versus 12 h after elective cesarean section in terms of irritative symptoms, first void time, incidence of urinary tract infection, postoperative mobilization time, and hospitalization time.Methods: A total of 134 women admitted to Duzce University Hospital for primary or recurrent elective cesarean section were randomized into two groups. A total of 62 women were enrolled in the early group, with indwelling catheter removal 2 h after cesarean section; 74 women were enrolled in the delayed group, with catheter removal 12 h after the cesarean section. The groups were prospectively compared in terms of irritative urinary symptoms, bacteriuria, hematuria, length of hospital stay, and mobilization time.Results: Urinary frequency (p = .04), microscopic hematuria incidence (p = .04), postoperative mobilization time (p = .01), and length of hospital stay (p = .009) were significantly lower in the early group than in the delayed group. There were no significant differences in terms of bacteruria, urinary retention, dysuria, and first postoperative voiding time.Conclusions: Early removal of urinary catheters after elective cesarean section is associated with reduced mobilization time and hospital stay.
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Catéteres de Permanencia , Cesárea , Remoción de Dispositivos/métodos , Cateterismo Urinario , Catéteres Urinarios/efectos adversos , Adulto , Infecciones Relacionadas con Catéteres/epidemiología , Catéteres de Permanencia/efectos adversos , Catéteres de Permanencia/estadística & datos numéricos , Cesárea/efectos adversos , Cesárea/instrumentación , Cesárea/métodos , Cesárea/estadística & datos numéricos , Remoción de Dispositivos/efectos adversos , Remoción de Dispositivos/estadística & datos numéricos , Procedimientos Quirúrgicos Electivos/efectos adversos , Procedimientos Quirúrgicos Electivos/instrumentación , Procedimientos Quirúrgicos Electivos/métodos , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Paridad/fisiología , Cuidados Posoperatorios/efectos adversos , Cuidados Posoperatorios/métodos , Cuidados Posoperatorios/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Embarazo , Factores de Tiempo , Resultado del Tratamiento , Turquía/epidemiología , Cateterismo Urinario/efectos adversos , Cateterismo Urinario/estadística & datos numéricos , Catéteres Urinarios/estadística & datos numéricos , Retención Urinaria/epidemiología , Retención Urinaria/etiología , Infecciones Urinarias/epidemiología , Infecciones Urinarias/etiología , Adulto JovenRESUMEN
Surgery of obstructive urolithiasis in small ruminants is often unsatisfactory due to postoperative development of strictures. The present study aimed to establish an endoscopic technique for the placement of a transurethral urinary catheter into the bladder of rams. This catheter was used as a removable stent-like drainage. The procedure was performed in three sheep rams that were euthanized and placed for surgery in 45° Trendelenburg position. In one ram, cystotomy was performed via right paramedian laparotomy. A 3 mm flexible fiberscope was introduced into the urinary bladder and advanced via urethra to the tip of the penis. Placing a guide wire through the endoscopic working channel into the urethra enabled the retrograde insertion of a transurethral urinary catheter into the bladder. In two rams, retrograde insertion of a fiberscope was performed. Again, a guidewire was used to insert a balloon catheter into the bladder. Paramedian right laparotomy was performed to ascertain the correct position of the balloon. Both techniques, antero- and retrograde endoscopy, were possible and could be successfully performed. Mucous membranes and urinary microliths were easily observed. Repeated advancing of the endoscope or the catheter resulted in marked damage of the mucous membranes. The patency of the urethra may be restored by means of endoscopic placement of a transurethral catheter in male small ruminants. The applicability and clinical outcome of this procedure as well as the effects on stricture formation should be further examined with controlled clinical studies.
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Endoscopía/veterinaria , Oveja Doméstica , Cateterismo Urinario/veterinaria , Catéteres Urinarios/estadística & datos numéricos , Animales , Cadáver , Estudios de Factibilidad , Masculino , Proyectos Piloto , Vejiga Urinaria , Cateterismo Urinario/métodosRESUMEN
Foley catheters (FCs) are often used during inguinal hernia operations; however, the impact of intraoperative FC use on postoperative urinary retention (POUR) is not well understood. We reviewed unplanned returns to the urgent care or ED for 27,012 inguinal hernia operations across 15 Southern California Kaiser Permanente medical centers over 6.5 years. In total, 239 (0.88%) patients returned to urgent care/ED with POUR [235 (98%) men versus 4 (2%) women]. Overall, POUR increased with age (P < 0.00001). POUR was higher in open repairs using general anesthesia versus local with monitored anesthesia care (0.7% vs 0.3%, P < 0.0001). Of 5,017 laparoscopic operations, 28 per cent had FC use. Although POUR was greater for laparoscopic versus open operations (2.21 vs 0.58%, P < 0.00001), there was no difference in POUR for intraoperative FC versus no FC use in the laparoscopic approach (2.36% vs 2.15%, P = 0.33). For all laparoscopic operations, there was no difference in urinary tract infection within 7 or 30 days when comparing intraoperative FC versus no FC use (P = 0.28). POUR can be minimized by avoiding general anesthesia for open inguinal hernia repairs, but intraoperative FC use does not affect POUR or urinary tract infection rates for laparoscopic inguinal hernia repair.
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Hernia Inguinal/cirugía , Herniorrafia/efectos adversos , Complicaciones Posoperatorias/etiología , Catéteres Urinarios/efectos adversos , Retención Urinaria/etiología , Distribución por Edad , Factores de Edad , Anciano , Anestesia General/efectos adversos , Anestesia General/estadística & datos numéricos , California/epidemiología , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Herniorrafia/métodos , Herniorrafia/estadística & datos numéricos , Humanos , Laparoscopía/efectos adversos , Laparoscopía/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Catéteres Urinarios/estadística & datos numéricos , Retención Urinaria/epidemiología , Infecciones Urinarias/epidemiología , Infecciones Urinarias/etiologíaRESUMEN
OBJECTIVES: To compare results of prostate laser photovaporization (PVP) by age groups to evaluate morbidity and functional results. Then, to specifically analyze surgical data for patients with an indwelling bladder catheter. DESIGN: Monocentric retrospective study of a prospective maintained database of all laser PVPs performed at our university hospital between December 2012 and June 2017. SETTINGS AND PARTICIPANTS: A total of 305 patients (three groups: younger than 70, 70-80, and older than 80 years) were operated on in our hospital center for the treatment of urinary tract disorders related to benign prostatic hyperplasia. RESULTS: A difference was found between the three age groups, with a higher rate of complications for patients older than 80 years (45%) (P = .013). Rate of patients with postoperative bladder catheters at 1 year was higher for patients older than 80 years (15%) (P = .004). Postoperative quality-of-life (QoL) score was worse for patients older than 80 years (P = .04). For patients with an indwelling bladder catheter undergoing surgery, morbidity was greater in patients older than 80 years, but the difference was not significant. International Prostate Symptom Score and QoL score were not significantly different between the three groups. Rate of patients with a remaining bladder catheter at 1 year was higher for patients older than 80 years (17.1% vs 7.1% for patients between 70 and 80, and 4.8% for patients under 70.) but with no statistical difference. CONCLUSION: PVP had a greater morbidity in octogenarians compared to younger subjects. Functional results were less satisfactory for patients older than 80 years compared to younger ones. For subjects operated on with an indwelling bladder catheter, no significant difference in outcome and morbidity was found between the three groups. J Am Geriatr Soc 67:1888-1894, 2019.
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Satisfacción del Paciente/estadística & datos numéricos , Hiperplasia Prostática/cirugía , Resección Transuretral de la Próstata/estadística & datos numéricos , Catéteres Urinarios/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Humanos , Masculino , Periodo Posoperatorio , Estudios Prospectivos , Calidad de Vida , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: Removing an indwelling urinary catheter as soon as possible is the cornerstone of catheter-associated urinary tract infections (CAUTI) prevention. However, implementing this measure may be challenging in clinical settings. To evaluate the impact of implementing a healthcare workers (HCWs) educational program and a daily checklist for indwelling urinary catheter indications among critical patients on the incidence of CAUTI. METHODS: This was a quasi-experimental study performed in a general intensive care unit of a tertiary-care hospital over a 12 years period, from January 1, 2005 to December 31, 2016. Rates of urinary catheter use and incidence density of CAUTI were monthly evaluated following the Centers for Disease Control and Prevention (CDC) criteria throughout the study period. Phase I (2005-2006) was the pre-intervention period. In phase II (2007-2010), HCWs routine training on CAUTI prevention was performed twice-a-year. In phase III (2011-2014), we implemented a daily checklist for indwelling urinary catheter indications, in addition to the biannual training. In phase IV, (2015-2016) the biannual training was replaced by training only newly hired HCWs and the daily checklist was maintained. RESULTS: The mean rate of urinary catheter utilization decreased from phase I to phase IV (73.1%, 74.1%, 54.9%, and 45.6%, respectively). Similarly, the incidence density of CAUTI decreased from phase I to phase IV (14.9, 7.3, 3.8, and 1.1 per 1000 catheter-days, respectively). CONCLUSIONS: HCWs education and daily evaluation of indwelling urinary catheter indications were highly effective in reducing the rates of catheter utilization as well as the incidence density of CAUTI.
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Infecciones Relacionadas con Catéteres/prevención & control , Personal de Salud/educación , Control de Infecciones/métodos , Catéteres Urinarios/efectos adversos , Infecciones Urinarias/prevención & control , Brasil , Infecciones Relacionadas con Catéteres/epidemiología , Lista de Verificación/métodos , Enfermedad Crítica/terapia , Humanos , Incidencia , Unidades de Cuidados Intensivos/normas , Ensayos Clínicos Controlados no Aleatorios como Asunto , Evaluación de Programas y Proyectos de Salud/métodos , Cateterismo Urinario/efectos adversos , Catéteres Urinarios/estadística & datos numéricos , Infecciones Urinarias/epidemiología , Infecciones Urinarias/etiologíaRESUMEN
This study investigated the incidence, rationales, and associated factors of inappropriate urinary catheter use among hospitalized older patients by gender. A longitudinal study of 321 patients with urinary catheter was conducted. Demographic factors, present health factors, urinary catheter factors, and indications of catheter use were collected. A total of 53.7% of urinary catheter-days were inappropriate. For both men and women, there was no significant difference in the incidence and common rationales of inappropriate use. Women, however, have another associated factor with inappropriate use. More tailored alternatives are needed for women to increase comfort to avoid inappropriate catheter use.
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Mal Uso de los Servicios de Salud/estadística & datos numéricos , Pacientes Internos/estadística & datos numéricos , Factores Sexuales , Catéteres Urinarios/estadística & datos numéricos , Anciano , Femenino , Humanos , Incidencia , Estudios Longitudinales , Masculino , Factores de Riesgo , Taiwán/epidemiologíaAsunto(s)
Sistemas de Apoyo a Decisiones Clínicas/organización & administración , Uso Excesivo de los Servicios de Salud/prevención & control , Garantía de la Calidad de Atención de Salud/organización & administración , Mejoramiento de la Calidad/organización & administración , Proveedores de Redes de Seguridad/organización & administración , Pruebas Diagnósticas de Rutina , Transfusión de Eritrocitos/estadística & datos numéricos , Administración Hospitalaria , Humanos , Análisis de Series de Tiempo Interrumpido , Modelos Lineales , Dolor/prevención & control , Neumonía/prevención & control , Complicaciones Posoperatorias/prevención & control , Radiografía Torácica/estadística & datos numéricos , Catéteres Urinarios/estadística & datos numéricosRESUMEN
PURPOSE: The purpose of this study was to identify factors associated with healthcare-acquired catheter-associated urinary tract infections (HA-CAUTIs) using multiple data sources and data mining techniques. SUBJECTS AND SETTING: Three data sets were integrated for analysis: electronic health record data from a university hospital in the Midwestern United States was combined with staffing and environmental data from the hospital's National Database of Nursing Quality Indicators and a list of patients with HA-CAUTIs. METHODS: Three data mining techniques were used for identification of factors associated with HA-CAUTI: decision trees, logistic regression, and support vector machines. RESULTS: Fewer total nursing hours per patient-day, lower percentage of direct care RNs with specialty nursing certification, higher percentage of direct care RNs with associate's degree in nursing, and higher percentage of direct care RNs with BSN, MSN, or doctoral degree are associated with HA-CAUTI occurrence. The results also support the association of the following factors with HA-CAUTI identified by previous studies: female gender; older age (>50 years); longer length of stay; severe underlying disease; glucose lab results (>200 mg/dL); longer use of the catheter; and RN staffing. CONCLUSIONS: Additional findings from this study demonstrated that the presence of more nurses with specialty nursing certifications can reduce HA-CAUTI occurrence. While there may be valid reasons for leaving in a urinary catheter, findings show that having a catheter in for more than 48 hours contributes to HA-CAUTI occurrence. Finally, the findings suggest that more nursing hours per patient-day are related to better patient outcomes.
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Infecciones Relacionadas con Catéteres/epidemiología , Minería de Datos/métodos , Enfermedad Iatrogénica/epidemiología , Infecciones Urinarias/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Infecciones Relacionadas con Catéteres/enfermería , Registros Electrónicos de Salud/estadística & datos numéricos , Femenino , Humanos , Tiempo de Internación , Modelos Logísticos , Masculino , Persona de Mediana Edad , Medio Oeste de Estados Unidos/epidemiología , Indicadores de Calidad de la Atención de Salud/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , Cateterismo Urinario/enfermería , Cateterismo Urinario/normas , Cateterismo Urinario/estadística & datos numéricos , Catéteres Urinarios/efectos adversos , Catéteres Urinarios/estadística & datos numéricos , Infecciones Urinarias/enfermeríaRESUMEN
INTRODUCTION: This study is aimed at assessing the use of various types of urinary catheters, appropriateness of catheter placement and factors associated with antibiotic use in a population of chronically catheterized patients in Istria County. MATERIALS AND METHODS: This cross-sectional study, conducted between March and June 2017 in Istria County, Croatia, was initiated through a network of general family medicine offices. Data were collected from general practitioners (GPs) and from medical managers in nursing homes. Participants were asked to review medical records of their patients and to complete a 10-item questionnaire designed to retrieve information on patients with urinary catheter. RESULTS: All GPs in the county were surveyed. We identified 309 patients with urinary catheter: 216 men (70%) and 93 women (30%). The overall prevalence of individuals with urinary catheters was 0.18%: 4.7% in nursing home population and 0.1% among non-institutionalized adult population. Most common indication for catheterization was chronic urinary retention (52%). One hundred eighty-six patients (60.4%) reported antibiotic usage in the previous 3 months for treating urinary infection. CONCLUSIONS: In Istria County, the prevalence of indwelling urinary catheters is highest in males, especially among patients in nursing homes. There is a need for focused education among GPs regarding urinary catheter maintenance and antibiotic prescription for suspected urinary tract infections.
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Catéteres de Permanencia/estadística & datos numéricos , Cateterismo Urinario/instrumentación , Cateterismo Urinario/estadística & datos numéricos , Catéteres Urinarios/estadística & datos numéricos , Infecciones Urinarias/diagnóstico , Anciano , Anciano de 80 o más Años , Antibacterianos/farmacología , Croacia , Estudios Transversales , Femenino , Médicos Generales , Humanos , Vida Independiente , Masculino , Casas de Salud , Prevalencia , Encuestas y Cuestionarios , Retención Urinaria/terapia , Infecciones Urinarias/terapiaRESUMEN
BACKGROUND: Strategies to decrease use of female indwelling urinary catheters and catheter-associated urinary tract infections are challenging due to the limited availability of proper fitting external collection devices. Female urinary incontinence predisposes the skin to potential pain, itching, burning, infection, or pressure injuries. CASE STUDIES: This article discusses 3 patients' trajectory of care with use of an external female urinary collection device. All of these females were incontinent of urine after the indwelling urinary catheter was removed and managed with an external female urinary collection device. CONCLUSIONS: The use of an external female urinary collection device is a feasible alternative to an indwelling urinary catheter as well as managing urinary incontinence.
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Catéteres Urinarios/estadística & datos numéricos , Infecciones Urinarias/prevención & control , Almohadillas Absorbentes/normas , Anciano , Infecciones Relacionadas con Catéteres/enfermería , Infecciones Relacionadas con Catéteres/prevención & control , Femenino , Humanos , Persona de Mediana Edad , Incontinencia Urinaria/complicaciones , Incontinencia Urinaria/enfermería , Infecciones Urinarias/enfermería , Toma de Muestras de Orina/métodos , Toma de Muestras de Orina/enfermeríaRESUMEN
BACKGROUND Urinary catheters, many of which are placed in the emergency department (ED) setting, are often inappropriate, and they are associated with infectious and noninfectious complications. Although several studies evaluating the effect of interventions have focused on reducing catheter use in the ED setting, the organizational contexts within which these interventions were implemented have not been compared. METHODS A total of 18 hospitals in the Ascension health system (ie, system-based hospitals) and 16 hospitals in the state of Michigan (ie, state-based hospitals led by the Michigan Health and Hospital Association) implemented ED interventions focused on reducing urinary catheter use. Data on urinary catheter placement in the ED, indications for catheter use, and presence of physician order for catheter placement were collected for interventions in both hospital types. Multilevel negative binomial regression was used to compare the system-based versus state-based interventions. RESULTS A total of 13,215 patients (889 with catheters) from the system-based intervention were compared to 12,104 patients (718 with catheters) from the state-based intervention. Statistically significant and sustainable reductions in urinary catheter placement (incidence rate ratio, 0.79; P=.02) and improvements in appropriate use of urinary catheters (odds ratio [OR], 1.86; P=.004) in the ED were observed in the system-based intervention, compared to the state-based intervention. Differences by collaborative structure in changes in presence of physician order for urinary catheter placement (OR, 1.14; P=.60) were not observed. CONCLUSIONS An ED intervention consisting of establishing institutional guidelines for appropriate catheter placement and identifying clinical champions to promote adherence was associated with reducing unnecessary urinary catheter use under a system-based collaborative structure. Infect Control Hosp Epidemiol 2018;39:77-84.
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Catéteres de Permanencia/estadística & datos numéricos , Uso Excesivo de los Servicios de Salud/prevención & control , Cateterismo Urinario/estadística & datos numéricos , Catéteres Urinarios/estadística & datos numéricos , Infecciones Relacionadas con Catéteres/prevención & control , Infección Hospitalaria/prevención & control , Servicio de Urgencia en Hospital , Humanos , Michigan , Evaluación de Programas y Proyectos de Salud , Análisis de RegresiónRESUMEN
The indwelling urinary catheter (UC) is a significant bother for men after radical prostatectomy (RP) and should be removed as soon as possible without jeopardizing the outcome. Our aim was to assess the feasibility and safety of its removal on postoperative day (POD) 2 after robot-assisted laparoscopic RP (RALP). A consecutive series of patients undergoing RALP for localized prostate cancer (PCa) were prospectively enrolled. Inclusion criteria were: no bladder-neck reconstruction, watertight urethrovesical anastomosis at 150 ml filling, ≤ 200 ml of intraoperative bleeding, ≤ 80 ml of fluid from the drain on POD 1, clear urine from the UC on POD 2. Patients were discharged on POD 2. Continence was assessed at catheter removal and 1, 3 and 6 months after surgery. Urethrovesical anastomosis was performed with a standard technique on 3 layers. Sixty-six patients were enrolled. The UC was removed on POD 2 in all the cases and 96.4% of the patients were discharged on POD 2. Re-catheterization was needed 16 times and it was always performed easily. Twenty-four complications were reported by 20 patients, mostly Clavien-Dindo (CD) grade II; 2 CD IIIB complications were observed. No anastomotic strictures were diagnosed. At catheter removal, 29% of the patients were completely continent, 41% at 1 month, 67% at 3 months and 92% at 6 months. In selected patients, removing the UC 48 h after RALP is feasible and safe and has no negative impact on continence if compared with the best international standards.