研究报道： 高龄妇女的非必需导尿有高风险

胡杨

研究报道： 高龄妇女的非必需导尿有高风险
2010.11.01 华盛顿
    根据APIC的AJIC杂志11月份刊登的一项在急诊部门的研究结果，高龄妇女不当使用导尿有高风险。
    该项研究在美国密歇根州底特律的一所769张床位的三级教学医院---圣约翰医院和医疗中心（St John Hospital and Medical Center）进行。作者对急诊室1年中的532例留置导尿管的病人进行研究，审查是否符合指南的留置标准。研究结果，不符合率80岁以上女性患者达50%；女性是男性的1.9倍；80岁以上老年人是50岁以下的2.9倍。
   作者总结道，“非必需留置导尿女性是男性的两倍”这一研究结果，证实了我们过去的研究结论。并强调高龄（80岁或以上）不当使用导尿有重大感染风险。
    该研究针对的是感染防控专家一直关注的领域：可预防的医院感染。泌尿道置管是泌尿系统感染的主要危险因素，目前占所有医院感染的三分之一。对高龄妇女不恰当的尿管置管增加该人群的感染风险。
    研究者指出，医院不当留置导尿管是普遍存在的问题。其增加了本可避免的泌尿道感染和并发症。
    联邦政府医保和医补中心认为，如果医院采用最佳的循证医学结果，导管相关性尿路感染基本可以避免。因此对这些医院感染不再给予报销。但目前美国的大多数医院还没有针对留置导尿建立完善的监控体系。作者指出，由于大多数患者来源于急诊部门，因此努力降低非必需导尿，这些部门是重点。


Elderly Women at Higher Risk for Unnecessary Urinary Catheterization, Study Reports

Washington, November 1, 2010 – Elderly women are at high risk for inappropriate urinary catheter utilization in emergency departments, according to a new study in the November issue of the American Journal of Infection Control, the official publication of the Association for Professionals in Infection Control and Epidemiology (APIC).
The study was conducted at St John Hospital and Medical Center, a 769-bed tertiary care teaching hospital in Detroit, Mich. The authors examined 532 instances in which urinary catheters were placed in emergency room patients over a 12-week study period. After reviewing whether the catheter’s placement conformed to established guidelines, the authors determined that half of the female patients 80 years or older who were subjected to urinary tract catheterization did not meet institutional guidelines. Women were 1.9 times more likely than men, and the very elderly (greater than 80 years) were 2.9 times more likely than those 50 years and younger, to have a urinary catheter inappropriately placed.
“We found that it was twice as likely for women to have a non-indicated UC [urinary catheter] placement compared to men,” the authors conclude. “Our results confirm what has been reported in previous studies, and underscore the significant risk of the very elderly (80 years or older) for inappropriate UC utilization.”
The study’s findings point to an area of concern among healthcare professionals tackling preventable hospital infections. Urinary tract catheterization is a major risk factor for developing urinary tract infections. The researchers note that at present, urinary tract infections account for more than one-third of all hospital-acquired infections. If urinary catheters are inappropriately placed at high rate in very elderly women, this vulnerable group of patients is at increased risk for developing an infection, according to the investigators.
“The inappropriate UC [urinary catheter] utilization has been a ubiquitous problem in the hospital setting,” say the study’s authors. “This translates to additional preventable or avoidable urinary tract infections and other complications related to UCs.” ”

The federal government’s Centers for Medicare & Medicaid Services considers catheter-associated urinary tract infections to be reasonably preventable through application of evidence-based best practices and as such no longer reimburses for these hospital-acquired infections. The authors noted that the majority of U.S. hospitals do not have formal systems to monitor urinary catheter utilization.
“Because more than half of hospital admissions come through the ED [emergency department], it is important that the ED be seen as the focus for efforts to reduce unnecessary UC utilization,” say the authors.

黑旋风

目前我们医院不当留置导尿管是普遍存在的问题，不知有什么措施降低不当留置导尿管？请各位指教！！

陈文秀

我们医院都是老年病房，大多数病人生活不能自理，大小便失禁，由于女性尿道松弛，长期有尿液流出，长期用尿布也易引起感染，不插导尿管的话，家属觉得尿布使用量很大，请问有什么好方法以减少导尿管使用？

星火

导尿管的使用与风险是医院感染监控的内容之一。合理使用导尿管是一个疑难问题?定时排尿，使用尿不湿？国内存在滥用抗菌药治疗泌尿系统感染，对医院感染造成的泌尿系统感染报告较少？也是困扰导尿的危险因素之一。

黑旋风

回复 4# zhangfh


    我们目前也发现现在临床在大量使用广谱抗菌药物，医院感染造成的泌尿系感染的报告越来越少，一报告就是多重耐药菌或泛耐药菌。现在我们很困惑，抗菌药物的合理运用得不到有效的控制；我个人认为主要是由于我们医务人员的收入不合理（我们这儿工作20年左右的医务人员工资加奖金赶不上工作1年左右的服装工人收入）；国家应该加大医务人员的收入和减少药物中间流通环节，切实降低药品价格，抗菌药物的合理运用才能等到有效的控制。不到之处请您指教！