GEREKSİZ KULLANILAN KALICI ÜRİNER KATETERLERİN SONLANDIRILMASI İÇİN HATIRLATICI MÜDAHALE YÖNTEMLERİ

Yıl 2021, Cilt: 4 Sayı: 1, 28 - 45, 10.06.2021

Şenay Şener Özalp , Yurdanur Dikmen

Öz

Hastane kaynaklı idrar yolu enfeksiyonu gelişen hastaların %60-80’inde enfeksiyon gelişmesinde kalıcı üriner kateterlerin sorumlu olduğu ve üriner kateterin her gün için hastada %5-10 enfeksiyon riskini artırdığı belirtilmektedir. Yoğun Bakım Ünitelerinde (YBÜ) nerdeyse her hasta için üriner kateter kullanılmakta ve üriner kateter ilişkili enfeksiyon oranının %30-40 olduğu bildirilmektedir. YBÜ görülen nozokomiyal enfeksiyonlar arasında ikinci sırada üriner kateter ilişkili enfeksiyonların yer aldığı vurgulanmaktadır. Kaldı ki üriner kateter ilişkili üriner sistem enfeksiyonu (ÜKİ-ÜSE) oranlarının yoğun bakım ünitesinde yatmayan hastalarda da benzer olduğu literatürde belirtilmektedir.
Üriner kateterler hasta yönetimi için önemli bir tıbbi cihaz olmasına rağmen kateterlerin uzun süreli ve gereksiz kullanımı, hem enfeksiyöz hem de enfeksiyöz olmayan komplikasyonlara neden olma açısından hasta güvenliği için de risk oluşturur.
ÜKİ-ÜSE insidansını azaltmak için en önemli değişebilir risk faktörü gereksiz kateter kullanımının azaltılmasıdır. Üriner kateterlerin uzun süreli ve gereksiz kullanımı önlemek için hastaların sürekli kateter ihtiyaçlarını değerlendirmek üzere hatırlatıcı müdahaleler geliştirilmiştir. Günlük kontrol listeleri, yazılı-sözlü hatırlatmalar, hastanın çizelgesi veya kateter torbasınının üzerine etiketleme, bir elektronik cihaz yardımı veya hastane bilişim sistemleri üzerinden hatırlatmalar olarak çeşitli müdahaleler yapılabilmektedir. Hatırlatma müdahalelerinde 24 saat hastayı takip eden hemşirelerin kilit rol oynayacağı düşünülmektedir.

Anahtar Kelimeler

Üriner Kateter, Hatırlatıcı müdahaleler, Hemşire

Destekleyen Kurum

Makaleyi destekleyen herhangi bir kurum bulunmamaktadır.

REMINDER INTERVENTION METHODS FOR TERMINATION OF NON-USED PERMANENT URINARY CATHETERS SUMMARY

Öz

It is reported that 60-80% of patients with hospital-acquired urinary tract infections are responsible for the development of permanent urinary catheters and that the urinary catheter increases the risk of infection by 5-10% per day. In the ICUs, urinary catheters are used for almost every patient and associated urinary catheters are used. infection rate is reported to be 30-40%. It is emphasized that urinary catheter related infections are the second most common nosocomial infections seen in ICU. In addition, urinary catheter-related urinary tract infection (UTI-UTI) rates are similar in patients who are not hospitalized in the intensive care unit.
Although urinary catheters are an important medical device for patient management, long-term and unnecessary use of catheters poses a risk for patient safety in terms of causing both infectious and non-infectious complications.
The most important variable risk factor to reduce the incidence of UTI-UTI is to reduce unnecessary catheter use. To prevent prolonged and unnecessary use of urinary catheters, reminding interventions have been developed to evaluate the continuous catheter needs of patients. Various interventions can be performed, such as daily checklists, written and oral reminders, labeling on the patient's chart or catheter bag, assistance with an electronic device or reminders via hospital information systems. It is thought that nurses following the patient for 24 hours will play a key role in reminder interventions.

Anahtar Kelimeler

Urinary catheter infection, reminder ınterventions, nurse

Kaynakça

• Gokula RM, Smith MA, Hickner J. Emergency room staff education and use of a urinary catheter indication sheet improves appropriate use of foley catheters. Am Journal of Infect Control 2007; 35:589–93.
• Ercole FF,Macieira TGR, Wenceslau LCC, Martins AR, Campos CC, Chianca TCM.Integrativereview: Evidences on the practice of ıntermittent/ındwelling urinary catheterization. Rev. Latino-Am. Enfermagem 2013; 21 (1), 459-68.
• Kunin CM. Urinary-catheter-associated infections in the elderly. International Journal of Antimicrobial Agents2006;28 (1):78–81.
• Danchaivijir S, Dhiraputra C, Cherdrungsi R, Jintanothaitavorn D, Srihapol N. Catheter-associated urinary tract infection. Journal of the Medical Association of Thailand 2005; 88(10):26–30.
• Kurukız S, Özden D. Effects of Perineal Care performed with Distilled Water and Chlorhexidine Gluconate Solution (0.1%) on the Development of Catheter-Related Urinary Tract Infection.Dokuz Eylül Üniversitesi Hemşirelik Fakültesi Dergisi (DEUHFD) 2017; 10(4), 208-215
• Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü.Ulusal Sağlık Hizmeti İlişkili Enfeksiyonlar Sürveyans Ağı Etken Dağılımı Ve Antibiyotik Direnç Raporu 2017 (https://hsgm.saglik.gov.tr/tr)
• Manisha J,Vinita D,Bibhabati M, Archana T, Poonam SL. Knowledge and attitude of doctors and nurses regarding indication for catheterization and prevention of catheter-associate durinary tract infection in a tertiary care hospital. Indian Journal of Critical Care Medicine. 2015;19(2):76-81
• Lewis SS, Knelson LP, Moehring RW, Chen LF, Sexton DJ, Anderson DJ. Comparison of non-intensive care unit (ICU) versus ICU rates of catheter-associate durinary tract infection in community hospitals. Infect Control Hosp. Epidemiol 2013; 34:744–7
• Foxman B. Epidemiology of urinary tract infections: Incidence, morbidity, and economiccosts. American Journal of Medicine. 2002;113(1):S5–S13.
• Blodgett TJ. Reminder Systems To Reduce the Duration of Indwelling Urinary Catheters: A Narrative Review. HHS Public Access.UrolNurs.2009;29(5): 369–379
• Centres for Medicare and Medicaid Services Chenoweth CE, Infect Dis Clin N Am, 2016.
• Meddings J, Rogers MA, Krein SL, Fakih MG, Olmsted RN, Saint S. Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associate durinary tract infection: An integrative review. BMJ QualSaf. 2014;23(4):277-89
• Wald HL, Kramer AM. Nonpayment for harms resulting from medical care: Catheter-associate durinary tractt infections. Journal of the American Medical Association. 2007; 298(23):2782–2784.
• Healty care Infection Control Practise Advisory Commitee (HICPAC). Guıdelıne for preventıon of catheter-assocıate durınary tract ınfectıons. Last Update February 15, 2017
• Arda B, Atefl K, Bakır M, Güven M, Karakoç E,Özinel MA, Pirat A, Şenkul T. Üriner Kateter Enfeksiyonlarının Önlenmesi Kılavuzu. Hastane İnfeksiyonları Dergisi. 2012;16 (Ek 1):1-18
• Huang WC, Wann SR, Lin SL, Kunin CM, Kung MH, Lin CH. Catheter-associate durinary tract infections in intensive care units can be reduced by prompting physicians to remove unnecessary catheters. Infection Control and Hospital Epidemiology. 2004;25(11):974–977.
• Topal J, Conklin S, Camp Ket al. Prevention of nosocomial catheter-associate durinary tract infections through computerized feedback to physicians and a nurse-directed protocol. Am J MedQua.l 2005; 20:121–6.
• Meddings J, Rogers MA, Krein SL, Krein SL, Fakih MG, Russell NO, Saint Sanjay Reducing unnecessary urinary catheter use and other strategies to prevent catheter associate durinary tract infection: an integrative review. BMJ Quality Safety. 2013;23(4).
• Chen YY, Chi MM, Chen YC, Chan YJ, Chou SS, Wang FD. Using a criteria-based reminder to reduce use of indwelling urinary catheters and decrease urinary tract infections. Am J. Crit Care. 2013; 22(2):105-14.
• Meddings J, Rogers MA, Macy M, et al. Systematic review and meta-analysis: reminder systems to reduce catheter-associate durinary tract infections and urinary catheter use in hospitalized patients. ClinInfectDis. 2010; 51:550–60.
• Lo E, Lindsay EN, Coffin SE, Gould C, Maragakis LL, Meddings J, PeguesAD, et all. Strategies to Prevent Catheter-Associated Urinary Tract Infections in AcuteCare Hospitals. Update Chıcago Journals. Infection Control and Hospital Epidemiology.2014; 35(5): 464-479
• Fasugba O, Cheng AC, Russo PL, Northcote M, Rosebrock H, Mitchell BG. Reducing urinary catheter use: a protocol for a mixed methods evaluation of an electronic reminder system in hospitalised patients in Australia. 2018; 8(5):1-9
• Wang PT, Lin HY, Lin YT, Shin WH, Chien LY, Lin S. Using an Indicator-Based Reminder of Catheter Removal to Effectively Decrease Catheter-Associated Urinary Tract Infections in General Medical Patients. Hu LiZaZhi 2017; 64 (1): 70-79.
• Baillie CA, Epps M, Hanish A, Fishman NO, French B, Umscheid CA. Usability and impact of a computerized clinical decision support intervention designed to reduce urinary catheter utilization and catheter-associated urinary tract infections. Infect Control Hosp.Epidemiol 2014;35(9): 1147–1155.
• Titsworth WL, Hester J, Correia T, Reed R, Williams M, Guin P. Reduction of catheter-associated urinary tract infections among patients in a neurological intensive care unit: a single institutions success. J Neurosurg 2012; 116:911–20
• Knoll BM, Wright D, Ellingson L, Kraemer L, Patire R, Kuskowski MA, Johmson JR Reduction of in appropriate urinary catheter use at a Veterans Affairs hospital through a multifaceted quality improvement program. Clin InfectDis, 2011; 52:1283–90.
• Van den Broek PJ, Wille JC, van Benthem BHB, Rom JM Perenboom, Melske van den Akker, Niel-Weise B. Urethral catheters: can we reduce use? BMC Urology. 2011; 11 (10):2-7
• Bruminhent J, Keegan M, Lakhani A, et al. Effectiveness of a simple intervention for prevention of catheter-associated urinary tract infections in a community teaching hospital. Am J Infect Control 2010; 38:689–93.
• Elpern EH, Killeen K, Ketchem A, Wiley A, Patel G, Lateef O. Reducing use of indwelling urinary catheters and associated urinary tract infections. Am J Crit Care 2009; 18:535–41; quiz 542.
• Loeb M, Hunt D, O’halloran K, Carusone SC, Dafoe N, Walter DS. Stop orders to reduce ınappropriate urinary catheterization in hospitalized patients: A randomized controlled trial.Journal of General Internal Medicine.2008; 23:816–820.
• Fakih MG, Dueweke C, Meisner S, et al. Effect of nurse-led multi disciplinary rounds on reducing the unnecessary use of urinary catheterization in hospitalized patients. Infect Control Hosp Epidemiol 2008; 29:815–19.
• Apisarnthanarak A, Thongphubeth K, Sirinvaravong S, Kitkanggvan D, Yuekyen C, Warachan B, Warren DK, Frasen VJ. Effectiveness of multifaceted hospital wide quality improvement programs featuring an intervention to remove unnecessary urinary catheters at a tertiary care center in Thailand. Infect Control Hosp. Epidemiol2007; 28:791–8
• Crouzet J, Bertrand X, Venier AG, Badoz M, Husson C, Talon D. (2007). Control of the duration of urinary catheterization: Impact on catheter-associated urinary tract infection. Journal of Hospital Infection. 67:253–257.
• Gokula RM, Smith MA, Hickner J. Emergency room staff education and use of a urinary catheter indication sheet improves appropriate use of foley catheters. Am Journal of Infect Control.2007; 35:589–93.
• Reilly L, Sullivan P, Ninni S, Ninni S, Fochesto D, Williams K, Fetherman B. Reducing foley catheter device days in an intensive care unit: using the evidence to change practice. AACN AdvCritCare.2006; 17:272–83.
• Huang WC, Wann SR, Lin SL, Kunin CM, Kung MH, Lin CH. Catheter-associated urinary tract infections in intensive care units can be reduced by prompting physicians to remove unnecessary catheters. Infection Control and Hospital Epidemiology. 2004;25(11):974–977.
• Fleischer S, Burckhardt M, Meyer G, Berg A. Reducing inappropriate use of indwelling urinary catheters in hospitals- a multiprofessional complex intervention? Results of a scoping review. BMC Nursing 2016;15: 5-6
• Bernard MS, Hunter KF, Moore KN. A review of strategies to decrease the duration of indwelling urethral catheters and potentially reduce the incidence of catheter-associate durinary tract infections. UrolNurs. 2012; 32(1):29-37
• Saint S, Kaufman SR, Thompson M, Rogers MAM, Chenoweth CE. A reminder reduces urinary catheterization in hospitalized patients. Joint Commission Journal on Quality and Patient Safety. 2005; 31:455–461.
• Saint S, Kowalski CP, Forman J, Damschroder L, Hofer TP, Kaufman SR, Creswell JW, Krein SL.A multicenter qualitative study on preventing hospital-acquired urinary tract infection in US hospitals. Infect Control Hosp. Epidemiol.2008;29:333–41