Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.830
Filtrar
2.
Pediatrics ; 146(4)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32883806

RESUMO

BACKGROUND: Catheter-associated urinary tract infections (CAUTIs) are a leading cause of health care-associated infection. Catheter insertion bundles (IBs) and maintenance bundles (MBs) have been developed to prevent CAUTIs but have not been extensively validated for use in pediatric populations. We report the CAUTI prevention efforts of a large network of children's hospitals. METHODS: Children's hospitals joined the Children's Hospitals' Solutions for Patient Safety engagement network from 2011 to 2017, using an open start time engagement approach, and elected to participate in CAUTI prevention efforts, with 26 submitting data initially and 128 at the end. CAUTI prevention recommendations were first released in May 2012, and IBs and MBs were released in May 2014. Hospitals reported on CAUTIs, patient-days, and urinary catheter-line days and tracked reliability to each bundle. For the network, run charts or control charts were used to plot CAUTI rates, urinary catheter use, and reliability to each bundle component. RESULTS: After the introduction of the pediatric CAUTI IBs and MBs, CAUTI rates across the network decreased 61.6%, from 2.55 to 0.98 infections per 1000 catheter-line days. Centerline shifts occurred both before and after the 2015 Centers for Disease Control and Prevention CAUTI definition change. Urinary catheter use rates did not decline during the intervention period. Network reliability to the IBs and MBs increased to 95.4% and 86.9%, respectively. CONCLUSIONS: IBs and MBs aimed at preventing CAUTIs were introduced across a large network of children's hospitals. Across the network, the rate of urinary tract infections among hospitalized children with indwelling urinary catheters decreased 61.6%.


Assuntos
Infecções Relacionadas a Cateter/prevenção & controle , Cateteres de Demora/efeitos adversos , Infecção Hospitalar/prevenção & controle , Pacotes de Assistência ao Paciente , Cateterismo Urinário/efeitos adversos , Infecções Urinárias/prevenção & controle , Infecções Relacionadas a Cateter/epidemiologia , Criança , Infecção Hospitalar/epidemiologia , Hospitais Pediátricos , Humanos , Segurança do Paciente , Melhoria de Qualidade/organização & administração , Reprodutibilidade dos Testes , Estados Unidos/epidemiologia , Infecções Urinárias/epidemiologia
3.
Pediatr Crit Care Med ; 21(9): e819-e826, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32769704

RESUMO

OBJECTIVES: To eliminate catheter-associated urinary tract infections in a pediatric cardiac ICU. DESIGN: Quality improvement methodology. SETTING: Twenty-five bed cardiac ICU in a quaternary freestanding children's hospital. PATIENTS: All patients with an indwelling urinary catheter admitted to the cardiac ICU. INTERVENTIONS: Catheter-associated urinary tract infection was defined according to National Healthcare Safety Network criteria. Failure modes and effects analysis and Pareto charts were used to determine etiology of process failures. We implemented a team-based multi-interventional approach in 2012 using the Model for Improvement, which included as follows: 1) establish indications for inserting and/or maintaining bladder catheterization, 2) standardization of maintenance care for the indwelling urinary catheters, 3) protocol for management of the leaking urinary catheters, 4) incorporation of urinary catheter days and prompts for removal in daily rounds, and 5) review of all cases of prolonged indwelling urinary catheter use (> 3 d). Process control charts were used to evaluate change. MEASUREMENTS AND MAIN RESULTS: From 2011 to 2018, we showed an early and sustained improvement in catheter-associated urinary tract infection prevention standards compliance from 44% to 96% (52% improvement). These interventions showed a reduction and then elimination of catheter-associated urinary tract infections from January 2012 to the present day, despite fluctuations in total indwelling urinary catheter days. CONCLUSIONS: Utilization of quality improvement methodology allowed us to identify components of care that contributed to catheter-associated urinary tract infections. After addressing these issues, we noted a substantial reduction and then elimination of catheter-associated urinary tract infections in our pediatric cardiac ICU. Widely disseminating these interventions across multiple pediatric hospitals to determine the ability to achieve similar results are important next steps.


Assuntos
Infecções Relacionadas a Cateter , Infecção Hospitalar , Cateteres Urinários , Infecções Urinárias , Infecções Relacionadas a Cateter/etiologia , Infecções Relacionadas a Cateter/prevenção & controle , Cateteres de Demora/efeitos adversos , Criança , Humanos , Unidades de Terapia Intensiva Pediátrica , Melhoria de Qualidade , Cateterismo Urinário/efeitos adversos , Infecções Urinárias/etiologia , Infecções Urinárias/prevenção & controle
4.
JAMA Netw Open ; 3(7): e209700, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32639568

RESUMO

Importance: In the US, federal value-based incentive programs are more likely to penalize safety-net institutions than non-safety-net institutions. Whether these programs differentially change the rates of targeted health care-associated infections in safety-net vs non-safety-net hospitals is unknown. Objective: To assess the association of Hospital-Acquired Condition Reduction Program (HACRP) and Hospital Value-Based Purchasing (HVBP) implementation with changes in rates of targeted health care-associated infections and disparities in rates among safety-net and non-safety-net hospitals. Design, Setting, and Participants: This interrupted time series included all US acute care hospitals enrolled in the Preventing Avoidable Infectious Complications by Adjusting Payment study that participated in mandatory reporting to the National Healthcare Safety Network from January 1, 2013, through June 30, 2018. Hospital characteristics were obtained from the 2015 American Hospital Association annual survey. Penalty statuses for 2015 to 2018 were obtained from Hospital Compare. Data were analyzed between July 9, 2018, and October 1, 2019. Exposures: HACRP and HVBP implementation in fiscal year 2015 or 2016. Main Outcomes and Measures: The primary outcomes were rates of 4 health care-associated infections: central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), surgical site infection (SSI) after colon surgical procedures, and SSI after abdominal hysterectomy procedures. Regression models were fit using generalized estimating equations to assess the association of HACRP and HVBP implementation with health care-associated infection rates and disparities in infection rates. Results: Of the 618 acute care hospitals included in this study, 473 (76.5%) were non-safety net and 145 (23.5%) were considered safety net. In these hospitals, HACRP and HVBP implementation was not associated with improvements in level or trend for any health care-associated infection examined (eg, CAUTI in safety-net hospitals: incidence rate ratio [IRR] for level change, 0.98 [95% CI, 0.79-1.23; P = .89]; IRR for change in slope, 1.00 [95% CI, 0.97-1.03; P = .80]). Before program implementation, infection rates were statistically significantly higher for safety-net than for non-safety-net hospitals for CLABSI (IRR, 1.23; 95% CI, 1.07-1.42; P = .004), CAUTI (IRR, 1.38; 95% CI, 1.16-1.64; P < .001), and SSI after colon surgical procedure (odds ratio [OR], 1.26; 95% CI, 1.06-1.50; P = .009). The disparity persisted over time when comparing the last year of the study with the first year (CLABSI: ratio of ratios [ROR], 0.93 [95% CI, 0.77-1.13; P = .48]; CAUTI: ROR, 0.90 [95% CI, 0.73-1.10; P = .31]; SSI after colon surgical procedures: ROR, 0.96 [95% CI, 0.78-1.20; P = .75]). Rates of SSI after abdominal hysterectomy procedure were similar in safety-net and non-safety-net hospitals before implementation (OR, 1.13; 95% CI, 0.91-1.40; P = .27) but higher after implementation (OR, 1.43; 95% CI, 1.11-1.83; P = .006), although this change was not significant (ROR, 1.20; 95% CI, 0.91-1.59; P = .20). Conclusions and Relevance: This study found that HACRP and HVBP implementation was not associated with any improvements in targeted health care-associated infections among safety-net or non-safety-net hospitals or with changes in disparities in infection rates. Given the persistent health care-associated infection rate disparities, these programs appear to function as a disproportionate penalty system for safety-net hospitals that offer no measurable benefits for patients.


Assuntos
Infecção Hospitalar/epidemiologia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Provedores de Redes de Segurança/estatística & dados numéricos , Aquisição Baseada em Valor , Infecções Relacionadas a Cateter/epidemiologia , Cateterismo Venoso Central/efeitos adversos , Infecção Hospitalar/etiologia , Humanos , Fatores de Risco , Provedores de Redes de Segurança/economia , Provedores de Redes de Segurança/organização & administração , Estados Unidos/epidemiologia , Cateterismo Urinário/efeitos adversos , Aquisição Baseada em Valor/estatística & dados numéricos
5.
Curr Urol Rep ; 21(8): 30, 2020 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-32506179

RESUMO

PURPOSE OF REVIEW: To review the evidence regarding the usage of suprapubic tube (SPT) versus indwelling urethral catheter (IUC) after robot-assisted radical prostatectomy (RARP). RECENT FINDINGS: Available data on the use of SPT for urinary drainage after RARP is somewhat limited mostly because of the variations of study designs and non-standardized outcomes. Although it may provide some mild benefit in terms of catheter-related pain and discomfort, the benefit seems not to be clinically significant. The evidence in the literature so far does not support routine usage of SPT as the primary urinary drainage method after RARP. Further higher-quality studies that can show clinically significant advantages over IUC are still needed to justify its usage.


Assuntos
Drenagem/métodos , Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Cateterismo Urinário/métodos , Humanos , Masculino , Complicações Pós-Operatórias , Prostatectomia/efeitos adversos , Uretra , Cateterismo Urinário/efeitos adversos , Cateteres Urinários/efeitos adversos
6.
PLoS One ; 15(6): e0233215, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32520937

RESUMO

OBJECTIVE: To evaluate the efficacy of noble-metal coated catheters in reducing catheter-associated urinary tract infections (CAUTI) in adult patients requiring short term catheterization. METHODS: An electronic literature search of PubMed, BioMed Central, Embase, Scopus, CENTRAL (Cochrane Central Register of Controlled Trials) and Google scholar was carried out from inception to 10th October 2019. Any prospective study or randomized controlled trial (RCT) on adult patients comparing noble-metal coated urinary catheters with any standard catheter and evaluating the incidence of CAUTI or bacteriuria was included. RESULTS: A total of 13 studies were included in the systematic review. 12 were RCTs and one was a prospective cross-over trial. Catheters employed in the study group were grouped into two sub-groups: Silver alloy coated or Noble metal alloy-coated (Gold, Silver, and Palladium) catheters. Bacteriuria was the most commonly studied outcome variable across trials. Meta-analysis indicated that silver alloy-coated catheters (RR 0.63, 95%CI 0.44-0.90, P = 0.01; I2 = 72%) and noble metal alloy catheters (RR 0.58, 95%CI 0.41-0.81, P = 0.001; I2 = 0%) significantly reduce the risk of bacteriuria. Sub-group analysis based on the duration of catheterization demonstrated that silver alloy catheters reduce the risk of bacteriuria with >1week of catheterization (RR 0.46, 95%CI 0.26-0.81, P = 0.007; I2 = 63%). Symptomatic CAUTI was evaluated only in four studies with variable results. The quality of the included studies was not high. CONCLUSIONS: Our review indicates that bacteriuria may be reduced with the use of noble metal-coated catheters during short-term catheterization of adults, however, the quality of evidence is not high. It is not clear if these catheters reduce the risk of symptomatic CAUTI. Further homogenous RCTs are needed to provide clarity.


Assuntos
Metais/uso terapêutico , Cateterismo Urinário/efeitos adversos , Cateterismo Urinário/métodos , Bacteriúria/complicações , Bacteriúria/etiologia , Infecções Relacionadas a Cateter/etiologia , Ouro , Humanos , Paládio , Prata , Cateteres Urinários/tendências , Infecções Urinárias/epidemiologia
7.
Ir Med J ; 113(2): 26, 2020 02 13.
Artigo em Inglês | MEDLINE | ID: mdl-32407011

RESUMO

Presentation A 55-year-old male patient with neuropathic bladder secondary to multiple sclerosis (MS) presented to the EmergencyDepartment (ED) with abdominal pain and no output from his suprapubic catheter (SPC) that was changed 24 hourspreviously. Diagnosis On examination, the SPC-tip was clearly visible at the external urethral meatus. Treatment The patient was managed by gently deflating the anchoring balloon, exchanging the SPC and a period of observationto ensure adequate catheter drainage. Conclusion Important learning points from this case are to observe urine draining after routine SPC change and to examine thegenitalia when a misplaced SPC is suspected.


Assuntos
Remoção de Dispositivo/métodos , Falha de Equipamento , Uretra , Bexiga Urinaria Neurogênica/terapia , Cateterismo Urinário/métodos , Cateteres Urinários/efeitos adversos , Dor Abdominal/etiologia , Drenagem , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/complicações , Bexiga Urinaria Neurogênica/etiologia , Cateterismo Urinário/efeitos adversos
8.
Rev Assoc Med Bras (1992) ; 66(2): 153-159, 2020 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-32428149

RESUMO

OBJECTIVES: To prospectively investigate the alterations and normal ranges of ureteral jet dynamics after double-J-stent (DJS) removal in patients who underwent renal transplantation (RTx). METHODS: Patients who underwent RTx were prospectively evaluated between November 2017 and June 2018. After RTx, Doppler ultrasonography (D-US) was performed on all patients after DJS removal. Renal artery resistive index (RA-Ri), renal pelvis anterior-posterior diameter (RP-APD), pelvicalyceal system dilation (PCSD), and ureteral jet flow dynamics (maximum and average velocity; JETmax and JETave) were measured by D-US. Also, patients' demographics, estimated glomerular filtration rate (eGFR) levels, and acute rejection were investigated in the study. Patients were assessed two different times by D-US, about 6 and 12 weeks after DJS removal, and the two different measurements were compared with the Wilcoxon test and Chi-square test. RESULTS: A total of 25 patients were evaluated in the study. Nonobstructive PCSD rate (12% vs 8%), JETave (18.8 vs 12.9 cm/sec), and JETmax (29.2 vs 20 cm/sec) levels were significantly decreased (p values are 0.01, 0.010 and 0.014, respectively). In addition, monophasic and square pattern rates were significantly observed to increase over time (p=0.035); however, ureteral jet patterns were correlated between the two different D-US measurements (R=0.225, p=0.032). CONCLUSION: After RTx, dilation rate and ureteral jet flow velocities were significantly decreased, and monophasic and square JETpattern rates were significantly increased over time. Ureteral jet dynamics can provide useful information about the follow-up of peristaltic activity in the pelvic-ureteric system.


Assuntos
Transplante de Rim/efeitos adversos , Stents/efeitos adversos , Ureter/fisiopatologia , Cateterismo Urinário/efeitos adversos , Urodinâmica/fisiologia , Adulto , Feminino , Seguimentos , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estatísticas não Paramétricas , Fatores de Tempo , Ultrassonografia Doppler/métodos , Ureter/diagnóstico por imagem , Adulto Jovem
9.
Br J Community Nurs ; 25(5): 240-246, 2020 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-32378462

RESUMO

Infections caused by Gram-negative bacteria continue to be on the rise, despite efforts by the Government and health service to curb their numbers. Most of these infections arise in the community. The case for targeting community-onset healthcare-associated infections is stark and requires a shift in focus from traditionally providing increased efforts in the hospital setting to a diversion of attention to the community. This article describes the challenges faced with increasing Gram-negative bloodstream infections and explores measures being taken to reduce transmission. As recent guidance has highlighted a proliferation within the community setting this article particularly focuses on a three-point plan for primary care. The strategies laid out are to reduce urinary tract infections, improve hydration and control antibiotic usage. Adopting these strategies will assist in reducing infection and targeting efforts where they are needed most.


Assuntos
Infecções Comunitárias Adquiridas/prevenção & controle , Infecções por Bactérias Gram-Negativas/prevenção & controle , Gestão de Antimicrobianos , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Bacteriemia/prevenção & controle , Infecções Relacionadas a Cateter/prevenção & controle , Parede Celular/fisiologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Desidratação/complicações , Desidratação/prevenção & controle , Infecções por Bactérias Gram-Negativas/epidemiologia , Infecções por Bactérias Gram-Negativas/transmissão , Bactérias Gram-Positivas/fisiologia , Política de Saúde , Humanos , Reino Unido/epidemiologia , Cateterismo Urinário/efeitos adversos , Infecções Urinárias/diagnóstico
11.
Neurourol Urodyn ; 39(5): 1456-1463, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32339318

RESUMO

AIMS: To assess the prevalence of catheter-associated meatal pressure injury in acute hospitalized males, to determine risk factors for its formation and to propose a grading system for meatal pressure injury severity. METHODS: In this cross-sectional study, we screened all adult males concurrently hospitalized at a tertiary medical center for indwelling urethral catheters and for meatal pressure injury. We proposed a system to grade meatal pressure injury severity and used logistic-regression modeling to calculate odds ratios (ORs) of possible risk factors. RESULTS: A number of 168/751 (22.4%) hospitalized males with indwelling urethral catheters were included. Median age was 70.5 (inter-quartile range [IQR]: 57.0-80.3) years, median time from catheterization 5.5 (IQR: 2-11) days. A total of 61 (36%) had meatal pressure injury, as early as the first day after catheterization. Grade III injuries (<2 cm ulcer) developed in 22 (13%) patients, earliest noted on the second catheter day, and grade IV injuries (≥2 cm) in 7 (4%) patients, as early as 5 days post catheterization. In a multivariable analysis, catheter fixation (OR: 0.26 [95% CI: 0.10-0.70]; P = .008) was associated with reduced risk of meatal pressure injury, while catheter presence over 14 days (OR: 1.46 [95% CI: 1.01-1.08]; P = .005) and other skin ulcers (OR: 2.45 [95% CI: 1.05-5.71]; P = .038) were associated with a higher risk of meatal pressure injury. CONCLUSIONS: Meatal pressure injury is a common complication of indwelling catheters in hospitalized males, beginning days after catheterization. Meatal pressure injury was associated with prolonged catheter presence, other pressure injuries, and lack of catheter fixation. Prospective studies are needed to establish evidence-based guidelines.


Assuntos
Cateteres de Demora/efeitos adversos , Pênis/lesões , Cateteres Urinários/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Hospitalização , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pressão , Fatores de Risco , Cateterismo Urinário/efeitos adversos
12.
Anesthesiology ; 133(1): 64-77, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32304405

RESUMO

BACKGROUND: Catheter-related bladder discomfort occurs because of involuntary contractions of the bladder smooth muscle after urinary catheterization. Magnesium is associated with smooth muscle relaxation. This study hypothesized that among patients having transurethral resection of bladder tumor, magnesium will reduce the incidence of postoperative moderate-to-severe catheter-related bladder discomfort. METHODS: In this double-blind, randomized study, patients were randomly allocated to the magnesium group (n = 60) or the control group (n = 60). In magnesium group, a 50 mg/kg loading dose of intravenous magnesium sulfate was administered for 15 min, followed by an intravenous infusion of 15 mg · kg · h during the intraoperative period. Patients in the control group similarly received normal saline. The primary outcome was the incidence of catheter-related bladder discomfort above a moderate grade at 0 h postoperatively. None, mild, moderate, and severe catheter-related bladder discomfort at 1, 2, and 6 h postoperatively, patient satisfaction, and magnesium-related adverse effects were also assessed. RESULTS: The incidence of catheter-related bladder discomfort above a moderate grade at 0 h postoperatively was significantly lower in the magnesium group than in the control group (13 [22%] vs. 46 [77%]; P < 0.001; relative risk = 0.283; 95% CI, 0.171 to 0.467; absolute risk reduction = 0.55; number needed to treat = 2); similar results were observed for catheter-related bladder discomfort above a moderate grade at 1 and 2 h postoperatively (5 [8%] vs. 17 [28%]; P = 0.005; relative risk = 0.294; 95% CI, 0.116 to 0.746; and 1 [2%] vs. 14 [23%]; P < 0.001; relative risk = 0.071; 95% CI, 0.010 to 0.526, respectively). Patient satisfaction on a scale from 1 to 7 was significantly higher in the magnesium group than in the control group (5.1 ± 0.8 vs. 3.5 ± 1.0; P < 0.001; 95% CI, 1.281 to 1.919). Magnesium-related adverse effects were not significantly different between groups. CONCLUSIONS: Magnesium reduced the incidence of catheter-related bladder discomfort above a moderate grade and increased patient satisfaction among patients having transurethral resection of bladder tumor.


Assuntos
Sulfato de Magnésio/uso terapêutico , Complicações Pós-Operatórias/tratamento farmacológico , Doenças da Bexiga Urinária/tratamento farmacológico , Neoplasias da Bexiga Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos , Administração Intravenosa , Idoso , Método Duplo-Cego , Feminino , Humanos , Sulfato de Magnésio/administração & dosagem , Masculino , Pessoa de Meia-Idade , Relaxamento Muscular/efeitos dos fármacos , Dor Pós-Operatória , Satisfação do Paciente , Comportamento de Redução do Risco , Resultado do Tratamento , Doenças da Bexiga Urinária/etiologia , Neoplasias da Bexiga Urinária/complicações , Cateterismo Urinário/efeitos adversos
13.
Curr Gastroenterol Rep ; 22(6): 26, 2020 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-32285214

RESUMO

PURPOSE OF REVIEW: Individual elements in enhanced recovery pathways may be associated with specific complication risks. In this review, we highlight three areas of controversy surrounding complications in enhanced recovery: (1) whether enhanced recovery is associated with increased rates of acute kidney injury, (2) whether NSAID use is associated with anastomotic leaks, and (3) whether early urinary catheter removal is justified following colorectal surgery. RECENT FINDINGS: Acute kidney injury has been reported at several institutions following implementation of enhanced recovery pathways highlighting the importance of institutional data tracking. NSAID use has been implicated in anastomotic leak rates for non-elective colorectal procedures, and criteria for its use should be implemented. Early urinary catheter removal has been supported despite increased urinary retention rates in order to decrease urinary tract infections. Enhanced recovery protocols will continue to evolve, and risk profiles associated with individual elements should continue to be evaluated.


Assuntos
Lesão Renal Aguda/etiologia , Fístula Anastomótica/induzido quimicamente , Anti-Inflamatórios não Esteroides/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Recuperação Pós-Cirúrgica Melhorada , Cateterismo Urinário/efeitos adversos , Fístula Anastomótica/etiologia , Colo/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Humanos , Complicações Pós-Operatórias/etiologia , Reto/cirurgia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Cateterismo Urinário/métodos , Retenção Urinária/etiologia
14.
Int J Nurs Pract ; 26(3): e12834, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32166846

RESUMO

AIM: To explore interventions and strategies to prevent catheter-associated urinary tract infections in hospitalized patients with a short-term indwelling urinary catheter. BACKGROUND: Interventions and strategies to prevent catheter-associated urinary tract infections are reported in the literature, but it is not clear which might be relevant when the indwelling urinary catheter is in place for a short period of time. METHODS: An integrative review was performed. A search was undertaken in databases using the following search terms: "urinary catheter, bladder catheter OR urethral catheter*"and "bundl* OR care OR manag* OR intervent*." Electronic databases were searched up until June 2019. Manual searching of reference lists of included studies was undertaken. Twelve studies reported in 15 articles were identified and analysed by two independent reviewers. RESULTS: Multifaceted interventions were informed by evidence-based protocols or guidelines. Implementation strategies included local adaption of guidelines or protocols, use of an opinion leader, audit and feedback, multidisciplinary team involvement, reminders and stop orders, and education and training. CONCLUSION: Multifaceted, evidence-based interventions to prevent catheter-associated urinary tract infections are effective in preventing infections in patients with short-term urinary catheters. However, there is little evidence to inform which combined strategies are more likely to be effective.


Assuntos
Infecções Relacionadas a Cateter/prevenção & controle , Cateteres de Demora/efeitos adversos , Cateterismo Urinário/efeitos adversos , Humanos , Infecções Urinárias/prevenção & controle
15.
Acta Med Port ; 33(3): 174-182, 2020 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-32130096

RESUMO

INTRODUCTION: The emergence of strains of methicillin-resistant Staphylococcus aureus is a serious therapeutic challenge in healthcare provision. With this study, we aimed to investigate the risk factors and clinical outcomes (mortality and length of hospital stay) associated with methicillin-resistant Staphylococcus aureus infections in patients admitted to a district hospital in Portugal. MATERIAL AND METHODS: A case-control study was performed in 96 cases and 122 controls, selected, respectively, as function of antibiotic resistance or sensitivity to methicillin. Data were obtained through consultation of clinical records and subjected to multivariate statistical analysis. RESULTS: We identified the following independent risk factors for the occurrence of methicillin-resistant Staphylococcus aureus infection: urinary catheter (aOR = 10.62, 95% CI 3.66 - 30.78), prior use of antibiotics in the last 30 days (aOR = 5.60, 95% CI 2.15 - 14.62), exposure to 5 - 7 days of hospitalization (aOR = 4.99, 95% CI 1.20 - 20.79) or to ≥ 8 days (aOR = 5.34, 95% CI 1.18 - 24.22), chronic obstructive pulmonary disease (aOR = 4.27, 95% CI 1.64 - 11.13) and recent hospitalization (aOR = 2.66, 95% CI 1.14 - 6.23). Compared to infections due to methicillin-susceptible Staphylococcus aureus, we found increased probability of having a longer hospital stay (aHR = 1.74, 95% CI 1.11 - 2.71) and in-hospital mortality was significantly higher (p = 0.001) between patients infected by methicillin-resistant Staphylococcus aureus. DISCUSSION: The results demonstrate that methicillin resistance is associated with an increased clinical risk to patients infected by Staphylococcus aureus, in particular, a raised mortality and prolonged hospitalization. CONCLUSION: Our study underlines the additional burden imposed by methicillin resistance in Staphylococcus aureus infections. This highlights an urgent need to reinforce and optimize prevention, control, timely detection and effective treatment strategies for multidrug--resistant Staphylococcus aureus strains.


Assuntos
Mortalidade Hospitalar , Tempo de Internação , Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Estudos de Casos e Controles , Infecções Relacionadas a Cateter/microbiologia , Infecções Relacionadas a Cateter/mortalidade , Intervalos de Confiança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Portugal/epidemiologia , Doença Pulmonar Obstrutiva Crônica/complicações , Estudos Retrospectivos , Fatores de Risco , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/isolamento & purificação , Estatísticas não Paramétricas , Cateterismo Urinário/efeitos adversos
16.
Dtsch Arztebl Int ; 117(6): 83-88, 2020 02 07.
Artigo em Inglês | MEDLINE | ID: mdl-32102727

RESUMO

BACKGROUND: Urinary tract infections are among the more common types of nosocomial infection in Germany and are associated with catheters in more than 60% of cases. With increasing rates of antibiotic resistance worldwide, it is essential to distinguish catheter-associated asymptomatic bacteriuria from catheter-associated urinary tract infection (CA-UTI). METHODS: This review is based on publications from January 2000 to March 2019 that were retrieved by a selective search in Medline. Randomized clinical trials and systematic reviews in which the occurrence of CA-UTI in adult patients was a primary or secondary endpoint were included in the analysis. Two authors of this review, working independently, selected the publications and extracted the data. RESULTS: 508 studies were identified and 69 publications were selected for analysis by the prospectively defined criteria. The studies that were included dealt with the following topics: need for catheterization, duration of catheterization, type of catheter, infection prophylaxis, education programs, and multiple interventions. The duration of catheterization is a determinative risk factor for CA-UTI. The indications for catheterization should be carefully considered in each case, and the catheter should be left in place for the shortest possible time. The available data on antibiotic prophylaxis do not permit any definitive conclusion, but they do show a small benefit from antibiotic-impregnated catheters and from systemic antibiotic prophylaxis. CONCLUSION: Various measures, including careful consideration of the indication for catheterization, leaving catheters in place for the shortest possible time, and the training of nursing personnel, can effectively lower the incidence of CA-UTI. The eous in some respects, and thus no recommendations can be given on certain questions relevant to CA-UTI.


Assuntos
Infecções Relacionadas a Cateter/epidemiologia , Infecção Hospitalar/epidemiologia , Cateterismo Urinário/efeitos adversos , Infecções Urinárias/epidemiologia , Adulto , Alemanha/epidemiologia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Revisões Sistemáticas como Assunto
17.
Biomed Res Int ; 2020: 8241637, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32104707

RESUMO

Objective: To assess the value of clinically relevant data for predicting the failure of removal of the urinary catheter within 48 hours after TUERP. Materials and Methods. We retrospectively analyzed the medical records of 357 patients who underwent TUERP between January 2015 and July 2018, all of whom stopped bladder irrigation and removed urinary catheter within 48 hours after the operation. According to whether the removal of the catheter was successful, the patients were classified into 2 groups: Group A was successful and group B was a failure. Univariate analysis was performed to determine the association between the failure of removal of the catheter and the patients' preoperative clinical characteristics. Logistic regression analysis and receiver operating characteristic analysis (ROC) were conducted to establish the prediction model. Then the area under the curve (AUC) and the cut-off value were calculated. Results: 357 patients were divided into group A (n = 305, 85.4%) and group B (n = 305, 85.4%) and group B (P=0.006), history of acute urinary retention (AUR) (P=0.006), history of acute urinary retention (AUR) (P=0.006), history of acute urinary retention (AUR) (P=0.006), history of acute urinary retention (AUR) (P=0.006), history of acute urinary retention (AUR) (P=0.006), history of acute urinary retention (AUR) (P=0.006), history of acute urinary retention (AUR) (P=0.006), history of acute urinary retention (AUR) (P=0.006), history of acute urinary retention (AUR) (. Conclusion: This study demonstrated that IPSS, QoL, drug medication, history of AUR, TPV, and IPP are independent factors associated with the failure of removal of the urethral catheter within 48 hours after TUERP.


Assuntos
Remoção de Dispositivo , Próstata/cirurgia , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/efeitos adversos , Cateterismo Urinário/efeitos adversos , Cateteres Urinários/efeitos adversos , Idoso , Humanos , Masculino , Estudos Retrospectivos , Fatores de Tempo
18.
Crit Care Nurse ; 40(1): e12-e17, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32006039

RESUMO

BACKGROUND: Catheter-associated urinary tract infections are common health care-associated infections and have been associated with increased mortality, morbidity, length of stay, and cost. Prevention strategies are grouped into bundles focused on reducing unnecessary catheter use and promptly removing urinary catheters. Before intervention in the study institution, no urinary catheters were unnecessarily used and compliance with the catheter-associated urinary tract infection bundle was 84%. OBJECTIVE: To increase bundle compliance by using targeted rounds specifically focused on eliminating dependent loops in drainage tubing and ensuring appropriate catheter use to reduce the incidence of catheter-associated urinary tract infections. METHODS: A multidisciplinary team was formed to identify misperceptions, highlight best practices, and eliminate barriers to success over 1 year in a single pediatric intensive care unit. The team completed a quality improvement project of daily targeted rounding for patients with an indwelling urinary catheter. The goals were to assess appropriateness of catheterization, increase bundle compliance, and decrease catheter-associated urinary tract infection risk. Targeted rounds were conducted in addition to the medical team rounds. RESULTS: Bundle compliance supported by targeted rounding increased from 84% to 93% and helped reduce the overall catheter-associated urinary tract infection rate from 2.7 infections per 1000 catheter-days at baseline to 0. This change was sustained for 1 year. CONCLUSION: Targeted rounding for pediatric patients with an indwelling urinary catheter is an effective and sustainable strategy to reduce catheter-associated urinary tract infections. The ease of implementation for this intervention lends itself to generalizability to other patient populations.


Assuntos
Infecções Relacionadas a Cateter/etiologia , Infecções Relacionadas a Cateter/prevenção & controle , Cateteres de Demora/efeitos adversos , Unidades de Terapia Intensiva Pediátrica/normas , Medicina Preventiva/normas , Cateterismo Urinário/efeitos adversos , Infecções Urinárias/prevenção & controle , Adolescente , Criança , Pré-Escolar , Infecção Hospitalar/prevenção & controle , Feminino , Georgia , Humanos , Lactente , Recém-Nascido , Masculino , Guias de Prática Clínica como Assunto
19.
Female Pelvic Med Reconstr Surg ; 26(2): 120-127, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31990800

RESUMO

OBJECTIVE: The aim of the study was to determine the best practice guidelines regarding the use of indwelling catheters after minimally invasive sacrocolpopexy. METHODS: Multicenter (3 sites) randomized control trial comparing the standard overnight indwelling urethral catheterization (group 2) with removal of catheter immediately after surgery (group 1). Our primary outcome is the need for recatheterization. Secondary outcomes include the number of patients discharged with a catheter, length of hospital stay, number of urinary tract infections, patient satisfaction/pain scores, and whether patients would use the same treatment again. RESULTS: There were 32 patients (43.8%) in group 1 and 41 patients (56.2%) in group 2. On average, patients in group 1 required straight catheterization 0.8 (SD = 0.9) times versus 0.6 (SD = 0.9) times for group 2 (P = 0.239). The number of days with a catheter between the 2 groups was not statistically significant. There was no statistical significance between group 1 and group 2 in terms of operative time, times to leave the operating room, and hospital. Zero patients in group 1 and 2 patients in group 2 had a urinary tract infection. After dividing the groups based on whether or not they underwent a transvaginal tape procedure, the final results were similar. CONCLUSIONS: We did not observe a difference in the risk of recatheterization or discharge home with a urinary catheter between the 2 groups. Addition of transvaginal tape to sacrocolpopexy did not show a difference in the risk of recatheterization. One reason for the lack of difference between the 2 groups could be due to a lack of power in our study.


Assuntos
Remoção de Dispositivo/métodos , Procedimentos Cirúrgicos em Ginecologia/métodos , Dor Pós-Operatória , Procedimentos Cirúrgicos Reconstrutivos/métodos , Cateterismo Urinário , Infecções Urinárias , Cateteres de Demora/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Avaliação de Processos e Resultados em Cuidados de Saúde , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/prevenção & controle , Cuidados Pós-Operatórios/métodos , Retratamento/métodos , Retratamento/estatística & dados numéricos , Risco Ajustado , Cateterismo Urinário/efeitos adversos , Cateterismo Urinário/instrumentação , Cateterismo Urinário/métodos , Cateteres Urinários/efeitos adversos , Infecções Urinárias/etiologia , Infecções Urinárias/prevenção & controle
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA