Evaluating a Nurse-Driven Protocol for Indwelling Bladder Catheter Removal in Patients With Traumatic Brain Injury.

IF 0.9 4区医学 Q4 HEALTH CARE SCIENCES & SERVICES

Journal for Healthcare Quality Pub Date : 2025-04-25 DOI:10.1097/JHQ.0000000000000477

Christian Makar, Aeryus Holloway, Olutola Akande, Akhil Chandekar, Olive Anagu, Mallory Jebbia, Victor C Joe

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引用次数: 0

Abstract

Introduction: Catheter-associated urinary tract infections (CAUTIs) are common complications in patients with traumatic brain injury (TBI) who require indwelling bladder catheters (IBCs). This study examined the impact of an Acute Urinary Retention Algorithm (AURA) nursing protocol that incorporates intermittent catheterization (IC) on CAUTI incidence.

Methods: A retrospective analysis was conducted on TBI patients with IBCs placed between 2018 and 2022 at a Level I trauma center in Southern California. Catheter-associated urinary tract infection incidence and catheter-associated complications were compared between patients treated with and without the AURA protocol.

Results: Among 73,005 patients with IBC, 255 had TBI and were admitted to the intensive care unit. Only 27 (10.6%) patients had catheters removed through the AURA protocol and had longer dwell times than the nonprotocol patients (2.59 vs. 2.44 days, p < .001). Catheter-associated urinary tract infection incidence was statistically similar between the protocol (7.4%) and nonprotocol groups (3.5%) (p = .327). However, patients who developed CAUTI were more likely to have undergone more than one IC.

Conclusions: Timely removal of IBCs is crucial to minimizing the risk of CAUTI. This study highlights the underutilization of nurse-driven protocols such as AURA and suggests a careful application of IC in such protocols because of its potential association with increased CAUTI risk.

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评估创伤性脑损伤患者留置膀胱导管拔除的护士驱动方案。

导读：导尿管相关性尿路感染（CAUTIs）是创伤性脑损伤（TBI）患者需要留置膀胱导尿管（IBCs）的常见并发症。本研究探讨了急性尿潴留算法（AURA）护理方案，包括间歇导尿（IC）对CAUTI发病率的影响。方法：回顾性分析2018年至2022年在南加州一级创伤中心安置的IBCs TBI患者。比较采用和不采用AURA方案的患者的导尿管相关尿路感染发生率和导尿管相关并发症。结果：在73,005例IBC患者中，255例有TBI并被送入重症监护病房。只有27例（10.6%）患者通过AURA方案拔除了导管，并且停留时间比非方案患者更长（2.59天对2.44天，p < 0.001）。导尿管相关尿路感染发生率在方案组（7.4%）和非方案组（3.5%）之间具有统计学差异（p = 0.327）。然而，发生CAUTI的患者更有可能经历不止一次的icc。结论：及时切除IBCs对于降低CAUTI的风险至关重要。本研究强调了护士驱动的方案（如AURA）的利用不足，并建议在此类方案中谨慎应用IC，因为它可能与增加的CAUTI风险相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal for Healthcare Quality HEALTH CARE SCIENCES & SERVICES-

CiteScore

2.10

自引率

0.00%

发文量

期刊介绍： The Journal for Healthcare Quality (JHQ), a peer-reviewed journal, is an official publication of the National Association for Healthcare Quality. JHQ is a professional forum that continuously advances healthcare quality practice in diverse and changing environments, and is the first choice for creative and scientific solutions in the pursuit of healthcare quality. It has been selected for coverage in Thomson Reuter’s Science Citation Index Expanded, Social Sciences Citation Index®, and Current Contents®. The Journal publishes scholarly articles that are targeted to leaders of all healthcare settings, leveraging applied research and producing practical, timely and impactful evidence in healthcare system transformation. The journal covers topics such as: Quality Improvement • Patient Safety • Performance Measurement • Best Practices in Clinical and Operational Processes • Innovation • Leadership • Information Technology • Spreading Improvement • Sustaining Improvement • Cost Reduction • Payment Reform