Effect of evidence-based nursing of catheterization on urinary tract infection in patients with spinal cord injury and catheterization_West China Medical Journal

Authors：

WANG Wenli , ZHU Zheng , CHEN Xuefan , PENG Shuang ,  TAN Xiaoju

Department of Spinal Surgery, the Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P. R. China;

Corresponding author：

TAN Xiaoju, Email: txj1021@163.com

Keywords：

Spinal cord injury; Long-term indwelling catheter; Urinary catheterization; Urinary tract injury; Urinary tract infection

DOI：

10.7507/1002-0179.202007224

Video：

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Objective To explore the influence of evidence-based nursing care of catheterization on the incidence of urinary tract injury and urinary tract infection in patients with spinal cord injury and long-term indwelling catheters.Methods From July 1st, 2017 to November 30th, 2018, 100 patients with spinal cord injury indwelling catheters in Department of Spinal Surgery were prospectively selected as the research objects. According to the admission time, patients admitted between July 2017 and February 2018 were assigned into the control group (n=50), and patients admitted between March 2018 and November 2018 were assigned into the observation group (n=50). Traditional catheter placement was used in the control group, while evidence-based catheter placement was used in the observation group. The incidences of catheter-related urethral injury and urinary tract infection after the catheterization were compared between the two groups.Results There was no statistically significant difference in gender, age, diagnosis, or length of hospital stay between the two groups (P>0.05). Catheter placement was performed 57 times in the control group and 59 times in the observation group during hospitalization. After catheterization, the incidences of urethral hemorrhage and gross hematuria in the control group [22.80% (13/57) and 15.78% (9/57), respectively] were higher than those in the observation group [both were 1.69% (1/59)], with statistical differences between the two groups (P<0.05). The incidence of urinary tract infection in the control group differed from that in the observation group [42.0% (21/50) vs. 18.0% (9/50), P=0.009].Conclusion The evidence-based urinary catheterization method for patients with spinal cord injury and long-term indwelling catheter can effectively prevent catheter-related urinary tract injury, reduce the incidence of catheter-related urinary tract infection during hospitalization, and improve the quality of clinical care.

Citation： WANG Wenli, ZHU Zheng, CHEN Xuefan, PENG Shuang, TAN Xiaoju. Effect of evidence-based nursing of catheterization on urinary tract infection in patients with spinal cord injury and catheterization. West China Medical Journal, 2020, 35(10): 1181-1184. doi: 10.7507/1002-0179.202007224 Copy

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22.	岳丽, 赵润平, 翟谢民. 序贯式尿管选择对长期留置导尿患者泌尿系并发症的预防作用. 山东医药, 2012, 52(41): 48-49.
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27.	Davis NF, Quinlan MR, Bhatt NR, et al. Incidence, cost, complications and clinical outcomes of iatrogenic urethral catheterization injuries: a prospective multi-institutional study. J Urol, 2016, 196(5): 1473-1476.

1. 侯春林. 脊髓损伤后膀胱功能重建. 2版. 北京: 人民军医出版社, 2012.
2. Bartel P, Krebs J, Wöllner J, et al. Bladder stones in patients with spinal cord injury: a long-term study. Spinal Cord, 2014, 52(4): 295-297.
3. Adriaansen JJ, van Asbeck FW, Tepper M, et al. Bladder-emptying methods, neurogenic lower urinary tract dysfunction and impact on quality of life in people with long-term spinal cord injury. J Spinal Cord Med, 2017, 40(1): 43-53.
4. Pannek J, Wöllner J. Management of urinary tract infections in patients with neurogenic bladder: challenges and solutions. Res Rep Urol, 2017, 9: 121-127.
5. Gui-Zhong L, Li-Bo M. Bladder cancer in individuals with spinal cord injuries: a meta-analysis. Spinal Cord, 2017, 55(4): 341-345.
6. Wilde MH, McMahon JM, Crean HF, et al. Exploring relationships of catheter-associated urinary tract infection and blockage in people with long-term indwelling urinary catheters. J Clin Nurs, 2017, 26(17/18): 2558-2571.
7. Ansell T, Harari D. Urinary catheter-related visits to the emergency department and implications for community services. Br J Nurs, 2017, 26(9): S4-S11.
8. Welk B, Liu K, Winick-Ng J, et al. Urinary tract infections, urologic surgery, and renal dysfunction in a contemporary cohort of traumatic spinal cord injured patients. Neurourol Urodyn, 2017, 36(3): 640-647.
9. Bonfill X, Rigau D, Esteban-Fuertes MA, et al. Efficacy and safety of urinary catheters with silver alloy coating in patients with spinal cord injury: a multicentric pragmatic randomized controlled trial. The ESCALE trial. Spine J, 2017, 17(11): 1650-1657.
10. Stillman MD, Barber J, Burns S, et al. Complications of spinal cord injury over the first year after discharge from inpatient rehabilitation. Arch Phys Med Rehabil, 2017, 98(9): 1800-1805.
11. Manack A, Motsko SP, Haag-Molkenteller C, et al. Epidemiology and healthcare utilization of neurogenic bladder patients in a US claims database. Neurourol Urodyn, 2011, 30(3): 395-401.
12. National Institute for Health and Clinical Excellence (NICE). Healthcare-associated infections: prevention and control in primary and community care. (2012-01-01)[2017-02-01]. https://www.nice.org.uk/guidance/cg139.
13. The Joanna Briggs Institute (JBI). Indwelling catheter (long term): urinary tract infections. (2015-11-17)[2016-11-23]. http://ovidsp.dc2.ovid.com/ovid-a/ovidweb.cgi?&S=OBBFFPIFGBEBCHLJJPAKMGHGCGECAA00&Complete+Reference=S.sh.36%7c5%7c1&Counter5=SS_view_found_complete%7cJBI24361%7cjbi%7cjbidb%7cjbi&Counter5Data=JBI24361%7cjbi%7cjbidb%7cjbi.
14. The Joanna Briggs Institute (JBI). Long-term urinary catheterization: infection control. (2017-01-23)[2018-11-23]. http://ovidsp.dc2.ovid.com/ovid-a/ovidweb.cgi?&S=LIMIFPOFCAEBCHIPIPAKJEOGJDJNAA00&Link+Set=S.sh.18%7c1%7csl_190.
15. 王叶, 张瑞红, 王同乐. 唐县白求恩纪念医院护士掌中宝. 北京: 中国工人出版社, 2011.
16. 中华人民共和国卫生部. 卫生部办公厅关于印发《外科手术部位感染预防与控制技术指南(试行)》等三个技术文件的通知. (2010-11-29)[2017-01-23]. http://www.gov.cn/gzdt/2010-12/14/content_1765450.htm.
17. World Health Organization. Antimicrobial resistance: global report on surveillance 2014. Geneva: World Health Organization, 2014[2017-01-23]. http://www.who.int/drugresistance/documents/surveillancereport/en/.
18. Waites KB, Chen Y, Devivo MJ, et al. Antimicrobial resistance in gram-negative bacteria isolated from the urinary tract in community-residing persons with spinal cord injury. Arch Phys Med Rehabil, 2000, 81(6): 764-769.
19. 中华人民共和国国家卫生和计划生育委员会. 尿路感染临床微生物实验室诊断: WS/T 489－2016, 2016.
20. 赵晓昆, 曹健. 医源性泌尿生殖系统损伤: 病因、诊断及处理. 临床泌尿外科杂志, 2017, 32(1): 1-6.
21. 石英, 唐姗姗, 吴美美. 男性手术病人对留置不同型号尿管的适宜度比较. 护理研究, 2011, 25(12): 1072-1073.
22. 岳丽, 赵润平, 翟谢民. 序贯式尿管选择对长期留置导尿患者泌尿系并发症的预防作用. 山东医药, 2012, 52(41): 48-49.
23. Wald HL, Fink RM, Makic MB, et al. Prevention of catheter-associated urinary tract infection// Boltz M, Capezuti EA, Fulmer T, et al. Evidence-based geriatric nursing protocols for best practice. 4 ed. New York: Springer Publishing Company, 2012: 388-408.
24. Sekulić A, Nikolić AK, Bukumirić Z, et al. Analysis of the factors influencing development of urinary tract infections in patients with spinal cord injuries. Vojnosanit Pregl, 2015, 72(12): 1074-1079.
25. Hwang S, Lee BS, Han Z, et al. Factors related to the occurrence of urinary tract infection following a urodynamic study in patients with spinal cord injury. Ann Rehabil Med, 2016, 40(4): 718-724.
26. Krebs J, Wöllner J, Pannek J. Risk factors for symptomatic urinary tract infections in individuals with chronic neurogenic lower urinary tract dysfunction. Spinal Cord, 2016, 54(9): 682-686.
27. Davis NF, Quinlan MR, Bhatt NR, et al. Incidence, cost, complications and clinical outcomes of iatrogenic urethral catheterization injuries: a prospective multi-institutional study. J Urol, 2016, 196(5): 1473-1476.

West China Medical Journal

Effect of evidence-based nursing of catheterization on urinary tract infection in patients with spinal cord injury and catheterization

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