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

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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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20.	趙曉昆, 曹健. 醫源性泌尿生殖系統損傷: 病因、診斷及處理. 臨床泌尿外科雜志, 2017, 32(1): 1-6.
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22.	岳麗, 趙潤平, 翟謝民. 序貫式尿管選擇對長期留置導尿患者泌尿系并發癥的預防作用. 山東醫藥, 2012, 52(41): 48-49.
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26.	Krebs J, W?llner 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.

1. 侯春林. 脊髓損傷后膀胱功能重建. 2版. 北京: 人民軍醫出版社, 2012.
2. Bartel P, Krebs J, W?llner 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, W?llner 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. 王葉, 張瑞紅, 王同樂. 唐縣白求恩紀念醫院護士掌中寶. 北京: 中國工人出版社, 2011.
16. 中華人民共和國衛生部. 衛生部辦公廳關于印發《外科手術部位感染預防與控制技術指南(試行)》等三個技術文件的通知. (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. 中華人民共和國國家衛生和計劃生育委員會. 尿路感染臨床微生物實驗室診斷: WS/T 489－2016, 2016.
20. 趙曉昆, 曹健. 醫源性泌尿生殖系統損傷: 病因、診斷及處理. 臨床泌尿外科雜志, 2017, 32(1): 1-6.
21. 石英, 唐姍姍, 吳美美. 男性手術病人對留置不同型號尿管的適宜度比較. 護理研究, 2011, 25(12): 1072-1073.
22. 岳麗, 趙潤平, 翟謝民. 序貫式尿管選擇對長期留置導尿患者泌尿系并發癥的預防作用. 山東醫藥, 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. Sekuli? A, Nikoli? AK, Bukumiri? 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, W?llner 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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