Evidence - Based Practice Of Guidelines For Prevention Of Urinary Tract Infection

Background Catheter associated urinary tract infection (CAUTI) refers to the urinary system infection occurred during the catheterization period or within 48 hours after removal of the catheter. CAUTI can cause pain, discomfort and fever to patients, reduce the quality of life of patients and increase health care costs and mortality. Currently, the world has developed several guidelines to provide clear advice and guidance for the prevention of CAUTI. A number of aborad studies have shown that the use of the best evidence of clinical practice guidelines can effectively reduce the incidence of CAUTI, also improve the quality of health care. However, there is a gap between our clinical nursing practice and best evidence of the guidelines, and it is important to introduce the evidence into nursing practice due to following potential changes in CAUTI prevention.Objectives Based on KTA model, we are going to search systematically, to evaluate and to select CAUTI prevention guidelines; to assess influential factors for nurses using CAUTI guideline in pilot wards; to describe the process that introducing guideline’s local evidence into the pilot ward infection preventive care circuit; to develop and implement practical strategies; monitored the application of evidence, and to evaluate the feasibility and effectiveness of the guidelines applied in pilot wards as well.Methods The quality of included CAUTI guidelines was evaluated by using AGREE II. An expert meeting was conducted to identify the gap between clinical practice and the guideline, and then to determine which guideline should be selected. A questionnaire survey was conducted to assess influential factors of nurses in the pilot ward to implement guideline recommendations. Literature review and brainstorming were used to develop guideline implementation interventions to targeted and solved out practice barriers. Before and after self-controlled study and non-concurrent controlled study were conducted to evaluate feasibility and effectiveness of evidence implementation.Results1. Systematic reviews of CAUTI guidelines from the domestic and aborad found that there were existing five CAUTI prevention guidelines, one of which was developed in China. Quality evaluation results showed five guidelines had the highest score in clarity of the presentation field and average scored of 72%, followed by the editorial independence field scored 64%, the purpose and scope field average scored 62%, the scores of the rigor of development field was 53%, the scores of the applicability fields was 46%, the stakeholder involvement field was the worst, average scored of 44%. Among them, three reviewers agreed that the Guideline for Prevention of CAUTI 2009 released by US Centers for Disease Control and Prevention in 2010 was recommended, and a further three guidelines could use after revised.2. There are total 61 recommendations in the recommended application guideline. Based on the expert meeting, there are 31 recommendations which have been folly implemented in clinical nursing practice. Among them, there were 10 recommendations partial implemented, 15 recommendations were not applied, but because of a variety of reasons, we did not consider to introduce those recommendations into practice, and the other five recommendations got experts recognized, as the evidence to introduce into practice.3. Through the survey on pilot ward, nurses’ CAUTI prevention knowledge was inadequate, attitude was good, behavior need improve. In terms of evidence-based nursing practice barriers existed around the lack of nursing research specialists, difficulty to search and evaluate information, without doctors’ working with the new program, without enough time to try new ideas, ignoring the value of nursing research and et al.4. The literature review and brainstorming were conducted to target the practical obstacles, and seven interventions to implement recommendations were developed.5. After interventions fully carried out, nurses’ CAUTI prevention knowledge and behavior scores were significantly higher than before, and the difference were statistically significant (P<0.05). Nurses’ CAUTI prevention attitude scores had higher than those before, but no significant difference (P>0.05). After the intervention, nurses’ compliance rate to each introduced evidence had improved significantly, the differences were statistically significant (P<0.05). In terms of patients, CAUTI infection rate decreased from 35.14% before the introduction of evidence to 18.75%, but the difference was not statistically significant (P>0.05). Patients’ satisfaction rate with catheter-related care was increased compared with before, and the difference statistically significant (P<0.05).Conclusion The localization and application of CAUTI guideline may be feasible and effectiveness.