Background

Escherichia coli bacteraemia rates in the UK have risen; rates are highest among older adults. Previous urinary tract infections (UTIs) and catheterization are risk factors.

Aim

To examine effectiveness of behavioural interventions to reduce E. coli bacteraemia and/or symptomatic UTIs for older adults.

Methods

Sixteen databases, grey literature, and reference lists were searched. Titles and/or abstracts were scanned and selected papers were read fully to confirm suitability. Quality was assessed using Critical Appraisal Skills Programme guidelines and Scottish Intercollegiate Guidelines Network grading.

Findings

Twenty-one studies were reviewed, and all lacked methodological quality. Six multi-faceted hospital interventions including education, with audit and feedback or reminders reduced UTIs but only three supplied statements of significance. One study reported decreasing catheter-associated UTI (CAUTI) by 88% (F (1,20) = 7.25). Another study reported reductions in CAUTI from 11.17 to 10.53 during Phase I and by 0.39 during Phase II (χ² = 254). A third study reported fewer UTIs per patient week (risk ratio = 0.39). Two hospital studies of online training and catheter insertion and care simulations decreased CAUTIs from 33 to 14 and from 10.40 to 0. Increasing nursing staff, community continence nurses, and catheter removal reminder stickers reduced infection. There were no studies examining prevention of E. coli bacteraemias.

Conclusion

The heterogeneity of studies means that one effective intervention cannot be recommended. We suggest that feedback should be considered because it facilitated reductions in UTI when used alone or in multi-faceted interventions including education, audit or catheter removal protocols. Multi-faceted education is likely to be effective. Catheter removal protocols, increased staffing, and patient education require further evaluation.

中文翻译：

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在所有护理机构中，采取行为干预措施以减少老年人的尿路感染和大肠杆菌菌血症的有效性：系统评价

背景

英国的大肠杆菌菌血症发生率有所上升；在老年人中发病率最高。先前的尿路感染（UTI）和导管插入术是危险因素。

目的

检查行为干预措施以降低老年人的大肠杆菌菌血症和/或有症状的尿路感染的有效性。

方法

搜索了16个数据库，灰色文献和参考文献列表。扫描标题和/或摘要，并充分阅读所选论文，以确认其适用性。使用“关键评估技能计划”准则和苏格兰大学间准则网络等级对质量进行评估。

发现

对21项研究进行了回顾，所有研究均缺乏方法论质量。包括教育在内的六项多方面医院干预措施，包括审计，反馈或提醒措施，减少了尿路感染，但只有三项提供了重要的说明。一项研究报告导管相关性尿路感染（CAUTI）降低了88％（F（1,20）= 7.25）。另一项研究报告，从11.17至10.53期间I期和0.39二期过程中减少CAUTI（χ ² = 254）。第三项研究报道每位患者每周的尿路感染较少（风险比= 0.39）。两项关于在线培训以及导管插入和护理模拟的医院研究将CAUTI从33减少到14，从10.40减少到0。增加护理人员，社区自控护士和移除导管提醒贴纸可以减少感染。没有研究检查预防大肠杆菌菌血症。

结论

研究的异质性意味着不能推荐一种有效的干预措施。我们建议应考虑反馈，因为当单独使用或在多方面的干预措施（包括教育，审计或导管移除方案）中使用时，它有助于减少UTI。多方面的教育可能是有效的。导管拆除方案，人员增加和患者教育需要进一步评估。