Prevention of Catheter-Associated Urinary Tract Infection in Orthopedic Patients - การป้องกันการติดเชื้อทางเดินปัสสาวะ จากการคาสายสวนปัสสาวะ ในผู้ป่วยศัลยกรรมกระดูกและข้อ โรงพยาบาลขอนแก่น

บทคัดย่อ

Catheter Associated Urinary Tract Infection (CAUTI) is one of the most common nosocomial
infections. In Male orthopedic ward of Khon Kaen Hospital, the rate of CAUTI in 2010 and 2011 was
6.46, 8.07 per 1,000 urethral catheterization days, respectively, and the infection began at 13 to 15
days after catheter insertion. Mistakes associated with catheter insertion, out-of-date practice guideline,
urine draining procedure, and lack of care giver’s participation were identified as the main causes of
CAUTI. The objective of this study was to develop and implement a program to prevent CAUTI among
patients with retained urethral catheter in the male orthopedic ward, Khon Kaen Hospital. It was conducted
in 3 phases from April 2011 to September 2012. Phase 1: situation analysis on CAUTI
situation by qualitative study with 22 participants. Phase 2: development and implementation of CAUTI
prevention strategy based on important findings in phase 1. There were 4 steps: (1) planning to set goal
and bundle of care, (2) implementing bundle of care, improving staff competency, empowering patients
and care givers, adjusting working environment to facilitate infectious control measures and
developed innovation, (3) collecting data through direct observation using checklist on 22 participants,
and (4) reflecting on the guideline and adjusting for further improvement. Phase 3: evaluation on the
incidents of urinary tract infection using nosocomial infection diagnosis’s criteria, with the target of less
than 5 infections per 1,000 urethral catheterization days. As for the phase 1, the problems identified
included non-specific hospital policy on patient safety goal, out-dated existing guideline, insufficient
infection control nurses, varying health education programs, lacking of patients’ and care givers’ empowerment,
inappropriate zoning, sharing equipments among patients, and no guideline for caring
patient retaining catheter. During phase 2, CAUTI was selected as a part of patient safety goals; the
bundle of care for CAUTI prevention was developed and was used as a framework for nursing competency
improvement. The uniform guideline for patient and care giver education was used to educate and
empower them. The environment was adjusted and the innovation was created to facilitate the infection
control measures. After the implementation, it was found that there was full compliance of the practices
on assessment of indication for retaining urinary catheter, the use of appropriate catheter size, and
patient and care giver education. The percentage of correct practices on proper catheter insertion technique,
proper urine drainage, and urinary catheter care were 95.1%, 94.2% and 94.2% respectively.
The CAUTI rate was reduced to 3.94 per 1,000 urethral catheterization days. Time to develop the first
CAUTI was increased from 15 to 25 days (range 3-102).
Key words: prevention of catheter-associated urinary tract infection, nosocomial infection, infection control