Application Of FOCUS-PDCA On The Risk Management Of Catheter-Associated Urinary Tract Infections In Critical Patients

ObjectiveIt is well known that catheter-associated urinary tract infections(CAUTI)is one of the most common nosocomial infection in intensive care unit(ICU).Once critically ill patients are infected with the CAUTI which will not only result in the antibiotic resistance and deteriorate their conditions,increase the disease morbidity and mortality,but also extend the length of hospital stay and aggravate the economic burden on patients.The United States Center for Medicare and Medicaid Services(CMS)has taken measures that made CAUTI as an extra cost to stop paying hospital nosocomial complications,which puts forward higher requirements of hospital managers and clinical medical personnel in 2008.Although the prevention and control of CAUTI have achieved certain achievements in critically ill patients in China,but the application of quality management tools is limited and sometimes the incidences of CAUTI are still high and unstable due to the influences of season and environment in some places.Therefore,it is necessary and urgent for us to use an effective quality management tool for contemporary critical care managers to continuously and effectively control CAUTI in critically ill patients.FOCUS-PDCA program is an effective quality management tool by verification.This study improves the quality of indwelling catheter operation effectively and strengthens the control of the risk of CAUTI by putting into use the FOCUS-PDCA.The measures are taken for quality improvement and effective implementation so as to continuously reduce the occurrence rate of CAUTI in severe patients.MethodsThe risk management of CAUTI for severe patients was implemented step by step according to the process and method of the FOCUS-PDCA.The first step was to find the research topic and organize a continuous quality improvement team.The methods of literature review,brainstorming,expert interview,focus group discussions and clinical practice were adopted to collect the influential factors of CAUTI in domestic and foreign literature and clinical work.Then we designed an observe list of affecting factors for CAUTI in critically ill patients.The method of convenient sampling was used to study the severe patients with urinary tube by random selecting in ICU,Neurological Intensive Care Unit(NCU)and Cardiac Surgical Intensive Care Unit(CSICU)in a Grade A Class ? hospital in June 2014.After the survey,we applied the means of project analysis,factor analysis,Pearson correlation analysis and Cronbach 's alpha coefficient to test the reliability and validity of observation schedule.The second step was to clarify the issues and understand the current process.We chose the critically ill patients from 13 units including ICU,the various special ICU and general wards as respondents to conduct clinical investigation by observation form of influencing factors for CAUTI in a Grade A Class ? hospital during August 2014 and April 2015.Patients were divided into two groups,one group for inserting catheter in their own department,the other group for admission with catheter including indwelling catheter from the other wards in the same hospital or other hospitals.The single factor X2 test,multiple stepwise regression and T-test analysis were taken to analyze influential factors of CAUTI in critically ill patients.The last step was to select and optimize the procedure,to formulate the prevention and control measures of CAUTI for severe patients,to plan how to implement the measures,to lay down the operating standards and took measures to prevent and control the incidence of CAUTI for severe patients according to the results of clinical research.Critical patients with placing a urinary catheter in ICU were studied by making intervention during September 2015 and November 2015,and the single factor X2 test and multiple stepwise regression were used to find out the incidence and the influential factors of CAUTI in severe patients.After these procedures,the effectiveness of the measures were checked and the validated procedures were acted in the ICU,and then we applied the new process to the other wards.ResultsWe planned to provide 135 observation forms of influencing factors for reliability and validity testing in critically ill patients with CAUTI,actually 133 were distributed and 130 were recycled and the effective response rate was 97.7%.The Cronbach 's alpha coefficient of the observation form was 0.869 and the Spearman-Brown split-half coefficient was 0.828.The Kaiser-Meyer-Olkin(KMO)was 0.790,Bartlett ball inspection,X2 = 3094.563,sig=0.000.The observation table with influencing factors for CAUTI in critical patients consisted of five dimensions and 26 items.The clinical research of influencing factors in critically ill patients with CAUTI showed that the independent risk factors of CAUTI for inserting catheter in their department were female,inserting catheter in ICU,non-pre-connected the ureter with urine collection bags,touching the front of catheter and indwelling time of catheter;the risk factors for admission of catheter were indwelling time of catheter and non-replace the drainage bag.Latex catheter was the protective factor in all critical patients.Since the implementation of intervening measures were performed,the incidence of CAUTI in severe patients was decreased from 9.96 to 5.85 per millennium catheter indwelling day.Female,fecal incontinence and combined urine collection bag were the risk factors in critically ill patients with CAUTI.Fecal incontinence was a new risk factor for CAUTI in severe patients that was found in this study.ConclusionsWe utilized FOCUS-PDCA program to form a team to focus on problems,collect influential factors comprehensively and reduce the incidence of CAUTI in critically ill patients by working out effective prevention and control measures.The observation form of influential factors for CAUTI which was compiled and evaluated by tested of the reliability and validity in critically ill patients and it played an important role in process of collecting data.The measurable prevention and control measures worked out in logical way were applied to the clinical work,which guaranteed the scientificity and practicability of clinical research.Eventually we controlled CAUTI effectively by implementing nursing intervention measures in clinical practice.