尿道口清洁消毒方法预防导尿管相关尿路感染效果的贝叶斯网状Meta分析
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摘要
目的研究尿道口的不同清洁消毒方法对预防导尿管相关尿路感染的效果。方法采用Meta分析方法,对国内医疗机构不同清洗消毒尿道口的方法预防尿道插管相关感染的效果的部分文献进行分析。结果共纳入相关随机对照试验文献20篇,涉及患者1 909例。Meta分析结果显示,采用氯己定消毒液、碘伏消毒液、无菌水和生理盐水等不同方法擦拭清洗尿道口,预防尿道插管相关感染的效果之间无统计学差异,但以概率排序氯己定消毒液居首位。结论不同清洁消毒方法处理尿道口对预防尿道插管相关感染的效果没有差别。
Objective To study the different cleaning and disinfection methods for urethral orifice to prevent CAUTIs.Methods Network Meta-analysis was used to analyze some literatures about different ways of cleaning and disinfecting urethral orifice in domestic medical institutions to prevent CAUTIs in China. Results Twenty studies( 1909 patients) were eligible for inclusion,and the data were summarized in the network Meta-analysis. There was no difference in the incidence of CAUTIs when comparing different orifice cleaning versus disinfection. Even though there was no difference in the Meta-analysis,but chlorhexidine was still the first choice for preventing CAUTI from Bayesian analysis. Conclusion Current evidence shows that there are no differences between different orifice cleaning versus disinfection methods in CAUTI rates.
Objective To study the different cleaning and disinfection methods for urethral orifice to prevent CAUTIs.Methods Network Meta-analysis was used to analyze some literatures about different ways of cleaning and disinfecting urethral orifice in domestic medical institutions to prevent CAUTIs in China. Results Twenty studies( 1909 patients) were eligible for inclusion,and the data were summarized in the network Meta-analysis. There was no difference in the incidence of CAUTIs when comparing different orifice cleaning versus disinfection. Even though there was no difference in the Meta-analysis,but chlorhexidine was still the first choice for preventing CAUTI from Bayesian analysis. Conclusion Current evidence shows that there are no differences between different orifice cleaning versus disinfection methods in CAUTI rates.
引文
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[30]王莹,黄丽华,冯志仙,等.基于循证和德尔菲法构建导尿管维护策略的研究[J].中华护理杂志,2016,51(2):155-160.
[31]Galiczewski JM.Interventions for the prevention of catheter associated urinary tract infections in intensive care units:An integrative review.[J].Intensive Crit Care Nurs,2016,32:1.
[32]梁英,王世博,林志谦,等.导尿管相关尿路感染处理和预防研究进展[J].中国感染与化疗杂志,2017,17(3):341-344.
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[35]李永恒,宋桂林.导尿管相关尿路感染的影响因素分析[J].中国现代医生,2017,55(16):23-26.
[2]Trautner BW,Kelly PA,Petersen N,et al.A hospital-site controlled intervention using audit and feedback to implement guidelines concerning inappropriate treatment of catheter-associated asymptomatic bacteriuria[J].Implement Sci,2011,6:41.
[3]Ercole FF,Macieira TG,Wenceslau LC,et al.Integrative review:evidences on the practice of intermittent/indwelling urinary catheterization.[J].Rev Lat Am Enfermagem,2013,21(1):459-468.
[4]Rebmann T,Greene LR.Preventing catheter-associated urinary tract infections:an executive summary of the Association for Professionals in Infection Control and Epidemiology,Inc,Elimination Guide.[J].Am J Infect Control,2010,38(8):647-649.
[5]Cunha M,Santos E,Andrade A,et al.Effectiveness of cleaning or disinfecting the urinary meatus before urinary catheterization:a systematic review[J].Rev Esc Enferm USP,2013,47(6):1410.
[6]Hutton B,Salanti G,Caldwell DM,et al.The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions:checklist and explanations[J].Ann Intern Med,2015,162(11):777-784.
[7]Higgins Jpt GS.Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[M]//Cochrane handbook for systematic reviews of interventions/.Wiley-Blackwell,2008:102-108.
[8]徐波,王惠,高绪芳.留置尿管病人尿道口消毒与清洁护理的效果比较[J].中华护理杂志,2006,41(11):1044-1045.
[9]冷晓辉,庄红仙.留置导尿患者尿道口护理方法效果比较[J].护士进修杂志,2008,23(19):1806-1807.
[10]沈钺,王瑞臣.碘伏预防留置尿管并发尿路感染的效果观察[J].中华医院感染学杂志,2008,18(4):524-525.
[11]张桂凤.洗必泰和生理盐水对留置尿管病人消毒尿道口的效果比较[J].医学新知,2010,20(4):364-365.
[12]李慧.生理盐水用于尿道口护理的效果观察[J].当代护士(学术版),2010(9):83-84.
[13]梁萍.留置尿管患者尿道口护理方法效果比较[J].医学理论与实践,2010,23(11):1390-1391.
[14]黄琳竣,张馨梅,陈柯.生理盐水与碘伏消毒留置尿管尿道口的效果比较[J].医学信息旬刊,2011,24(21):436.
[15]周岳敏,李永红.2种会阴护理方法在留置尿管患者中的效果研究[J].当代护士(学术版),2011(7):64.
[16]张勍.关于老年中风患者留置尿管尿路感染护理措施的研究[J].中外健康文摘,2012(43):116-117.
[17]潘唐远.留置导尿患者尿道口护理方法效果比较[J].中国保健营养旬刊,2012,23(z1):1806-1807.
[18]王玉秋.留置导尿患者尿道口护理方法效果比较[J].当代护士:(下旬刊),2012,23(9):154-155.
[19]王珺.留置尿管病人尿道口消毒与清洁护理的效果比较[J].医学美学美容,2012,20(7):14.
[20]陈庆妙.留置导尿患者两种尿道口护理的效果比较[J].中外健康文摘,2013(28):239-240.
[21]覃燕.留置尿管患者尿道口消毒与清洁护理效果观察[J].临床合理用药杂志,2013,6(18):150.
[22]刘春兰,李华,赵晓瑞,等.留置导尿管患者尿道口护理方法效果比较[J].临床合理用药杂志,2014,7(8):95-96.
[23]钟美莲.留置导尿管患者尿道口消毒与清洁的护理体会[J].中国民族民间医药,2014(21):130.
[24]翁玲玲.留置尿管病人尿道口消毒与清洁方法对尿路感染的影响[J].现代养生B,2014(7):168-169.
[25]刘红霞.留置尿管患者尿道口消毒与清洁护理的效果分析[J].医学信息,2015(27):42.
[26]吴晓霞.清洁式会阴抹洗在留置尿管患者中的效果[J].中国医药导报,2015,12(11):141-144.
[27]王绘龙.留置尿管病人尿道口碘伏消毒与清洁水擦洗的效果比较[J].医药前沿,2017,7(15):122-124.
[28]Gould CV,Umscheid CA,Agarwal RK,et al.Guideline for Prevention of Catheter-Associated Urinary Tract Infections 2009[J].Infect Control Hosp Epidemiol,2010,31(4):319-326.
[29]中华人民共和国卫生部.导尿管相关尿路感染预防与控制技术指南(试行)[S].2010.
[30]王莹,黄丽华,冯志仙,等.基于循证和德尔菲法构建导尿管维护策略的研究[J].中华护理杂志,2016,51(2):155-160.
[31]Galiczewski JM.Interventions for the prevention of catheter associated urinary tract infections in intensive care units:An integrative review.[J].Intensive Crit Care Nurs,2016,32:1.
[32]梁英,王世博,林志谦,等.导尿管相关尿路感染处理和预防研究进展[J].中国感染与化疗杂志,2017,17(3):341-344.
[33]Bennett JV,Brachman PS.Bennett&Brachman's hospital infections[M].Lippincott Williams&Wilkins,2007.
[34]李海峰,于力娜,贾辰,等.ICU导尿管相关尿路感染预防及影响因素分析[J].中华医院感染学杂志,2017,27(13):2897-2899.
[35]李永恒,宋桂林.导尿管相关尿路感染的影响因素分析[J].中国现代医生,2017,55(16):23-26.