CME Author: Désirée Lie, MD, MSEd
Released: 08/23/2010; Valid for credit through 08/23/2011
August 23, 2010 — Reminder systems may reduce catheter-associated urinary infections (CAUTIs) and catheter use in hospitalized patients, according to the results of a systematic review and meta-analysis reported in the September 1 issue of Clinical Infectious Diseases.
"Prolonged catheterization is the primary risk factor for ...CAUTI," write Jennifer Meddings, from University of Michigan and Ann Arbor VA Medical Center, and colleagues. "Reminder systems are interventions used to prompt the removal of unnecessary urinary catheters. To summarize the effect of urinary catheter reminder systems on the rate of CAUTI, urinary catheter use, and the need for recatheterization, we performed a systematic review and meta-analysis."
The reviewers identified studies by searching MEDLINE, the Cochrane Library, Biosis, the Web of Science, EMBASE, and CINAHL through August 2008. Inclusion criteria were interventional studies using reminders to physicians or nurses that a urinary catheter was in use or stop orders to prompt catheter removal in hospitalized adults. Of 6679 citations identified, 118 articles were reviewed, and 14 studies met selection criteria.
Use of a reminder or stop order was associated with a 52% decrease in the rate of CAUTI episodes per 1000 catheter-days (rate ratio, 0.48; P < .001) and a 37% reduction in the mean duration of catheterization. Compared with the control group, the intervention group had 2.61 fewer days of catheterization per patient. Overall, the pooled standardized mean difference (SMD) in the duration of catheterization was -1.11 (P = .070). Studies using a stop order showed a statistically significant decrease in the duration of catheterization (SMD, -0.30; P = .001), whereas those that used a reminder did not (SMD, -1.54; P = .071). Control and intervention groups had similar rates of recatheterization.
"[I]nterventions to routinely prompt physicians or nurses to remove unnecessary urinary catheters significantly decrease the rate of CAUTI, and no evidence indicates that these interventions increase the need for recatheterization," the study authors write. "Urinary catheter reminders and stop orders have the potential to improve patient safety by changing the default status of urinary catheters from persistent use to timely removal."
Limitations of this study include only 1 randomized controlled trial identified; and heterogeneity of the included studies in the populations investigated, details of the reminder and stop-order interventions, follow-up duration, and inclusion and exclusion criteria.
"Given the large burden of CAUTI, it is surprising that only ~1 in 10 US hospitals use reminders or stop orders", the study authors conclude. We hope that our results will encourage more hospitals to adopt reminders or stop orders as low-cost interventions that enhance patient safety."
Dr. Meddings receives assistance from the National Institutes of Health Clinical Loan Repayment Program for 2009-2010. The senior study author (Dr. Sanjay Saint) is currently supported by the National Institute of Diabetes and Digestive and Kidney Diseases and the National Institute of Nursing Research. He is also a faculty consultant for the Institute for Healthcare Improvement (IHI) on the IHI catheter-associated urinary tract infection expedition and during the past 5 years has received honoraria from the VHA and numerous individual hospitals, academic medical centers, and professional societies.
The content of the journal article is solely the responsibility of the study authors and does not necessarily represent the official views of the National Institutes of Health, the Department of Veterans Affairs, or the University of Michigan Health System. The other study authors have disclosed no relevant financial relationships.
Clin Infect Dis. 2010;51:550-560. Abstract
The Healthcare Infection Control Practices Advisory Committee's (HICPAC) Guideline for Prevention of Catheter-associated Urinary Tract Infections, 2009 is available online.
source : http://cme.medscape.com/viewarticle/727279?src=cmemp&uac=97984HK
regards, taniafdi ^_^
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