Systematic review of the effective approach for limiting urinary catheter use and duration to reduce nosocomial catheter-associated urinary tract infections in hospitalized patients

Pao Yue-kong Library Electronic Theses Database

Systematic review of the effective approach for limiting urinary catheter use and duration to reduce nosocomial catheter-associated urinary tract infections in hospitalized patients

 

Author: Kong, Man-ying
Title: Systematic review of the effective approach for limiting urinary catheter use and duration to reduce nosocomial catheter-associated urinary tract infections in hospitalized patients
Degree: M.Sc.
Year: 2010
Subject: Hong Kong Polytechnic University -- Dissertations
Urinary tract infections -- Prevention
Urinary catheterization -- Complications
Department: Faculty of Health and Social Sciences
Pages: viii, 140 leaves : ill. ; 30 cm.
InnoPac Record: http://library.polyu.edu.hk/record=b2356825
URI: http://theses.lib.polyu.edu.hk/handle/200/5696
Abstract: Background: Catheter-associated urinary tract infection (CAUTI) is a significant type of nosocomial infection, primarily the outcome of high prevalence of inappropriate urinary catheterization in world-wide and local hospitals. Objectives: To examine the best available practice related to interventions aimed at reducing urinary catheterization and CAUTI among hospitalized patients. Selection criteria: This review considered randomized and non-randomized controlled trials, and before-after studies. Interventions related to restriction of unnecessary urinary catheter use and duration. Selection criteria included adult patients with short-term, indwelling urinary catheters, whereas long-term, intermittent and suprapubic catheters were excluded. The primary outcomes were the rate of CAUTI, duration of catheterization, the rate of catheter use, and re-catheterization. Search strategy: A comprehensive search of multiple electronic databases and manual search of reference lists using a combination of search terms for both published and unpublished studies. Study quality assessment and data extraction: Study selection, quality assessment, and data extraction were conducted by two independent reviewers. Discrepancies were resolved by a consensus or discussion with a third reviewer as required. Methodological quality of randomized controlled trials was assessed using Jadad's scale. The Effective Public Health Practice Project quality assessment tool was employed to assess the quality of all quantitative studies. Data were synthesized using a narrative approach due to marked heterogeneity. Results: Total fifteen studies with six types of intervention met all inclusion criteria. Eight of these studies met the required quality standards. The four interventions (multifaceted quality improvement programmes, reminders, automatic stop-orders and early catheter removal protocols) demonstrated to be effective at reducing duration of urinary catheterization and incidence of CAUTI. Conclusions: There was sufficient evidence to confirm the effectiveness of multifaceted quality improvement programmes, reminders, automatic stop-orders and early catheter removal protocols. Among these interventions, a nurse generated written reminder is a simple and inexpensive intervention recommended to change current catheterization prescribing practices and reduce the risk of CAUTI in the resource-limited healthcare settings.

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