Kunnskapsgrunnlaget - Håndbok for forebygging av kateterassosierte urinveisinfeksjoner

Om kunnskapsgrunnlaget

Flere anerkjente, kjente aktører innen smittevern har de seneste årene publisert omfattende kunnskapsbaserte retningslinjer for forebygging av kateterassosierte urinveisinfeksjoner.^1-11

Myndighetene i flere land, eksempelvis Australia, Skottland og Irland,^12-15 har også publisert kunnskapsbaserte retningslinjer om emnet, likeledes European Association of Urology Nurses og European Association of Urology.^{16, 17}

Det ble derfor ved arbeidets oppstart besluttet å bygge anbefalingene på eksisterende, kvalitetssikrede retningslinjer og systematiske oppsummeringer, fremfor gjennomgang av primærstudier.

For å identifisere eksisterende retningslinjer og systematiske oppsummeringer på området ble det gjennomført søk i aktuelle helsefaglige databaser, samt på hjemmesidene til kjente aktører innen smittevern og i elektroniske oversikter over eksisterende retningslinjer.

Søk i elektroniske databaser

Det er gjort søk i Ovid Medline, Embase, Ovid Nursing, Cochrane og Johanna Briggs Institute etter retningslinjer og systematiske oppsummeringer skrevet på engelsk, norsk, svensk eller dansk etter 2005. Relevante artikler ble kvalitetsvurdert etter prinsippene i kunnskapssenterets sjekklister for evaluering av fagartikler.¹⁸ Det ble også gjennomført håndsøk i referanselister. Søkestrategier fra Ovid databasene fremkommer i tabell 1.

* Embase 1980 to 2012 Week 04
**Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) 1946 to Present

I Cochrane ble det søkt etter relevante Cochrane oversiktsartikler og andre oversiktsartikler med følgende søkestrategi:

• (urinary catheter*):ti or (urinary tract infection*):ti or (UTI):ti or (CAUTI):ti

Av 23 identifiserte Cochrane oversiktsartikler og 38 oversiktsartikler identifisert fra andre kilder ble 11 inkludert i kunnskapsgrunnlaget.^29-39 På nettsiden til Johanna Briggs Institute ble det søkt etter relevante publikasjoner med søkeordene: urinary tract infection, urinary catheter, UTI og CAUTI. En oversiktsartikkel og en retningslinje (”Best Practice Sheet”) ble identifisert og inkludert i kunnskapsgrunnlaget.^{40, 41}

Søk på nettsteder til aktører innen smittevern

Det ble søkt på nettstedene til kjente internasjonale aktører innen smittevern for å identifisere gjeldende retningslinjer for forebygging av helsetjenesteassosierte UVI. Følgende nettsteder ble undersøkt februar-mai 2012:

• Agency for Healthcare Research and Quality (AHRQ)
• Australian Infection Control Association (AICA)
• Centers for Disease Control and Prevention (CDC)
• European Centre for Disease Prevention and Control (ECDC)
• European Society of Clinical Microbiology and Infectious Diseases (ESCMID)
• Healthcare Infection Society (HIS)
• Infection Prevention Society (IPS)
• International Federation of Infection Control (IFIC)
• Nasjonalt folkehelseinstitutt (FHI)
• Nasjonalt kunnskapssenter for helsetjenesten
• National Health Service (NHS)
• Smittskyddsinstitutet (Smi)
• Society for healthcare epidemiology of America (SHEA)
• Statens Serum Institut (SSI)
• The Association for Professionals in Infection Control and Epidemiology (APIC)
• The Infectious Diseases Society of America (IDSA)
• UK Department of Health
• World Health Organization (WHO)

Totalt ble 19 av publikasjonene som ble identifisert via nettstedene inkludert i kunnskapsgrunnlaget.^{2-11, 17, 19, 21, 24, 42-46}

Søk i elektroniske oversikter over publiserte retningslinjer

Med utgangspunkt i helsebiblioteket ble det søkt i kjente elektroniske oversikter over eksisterende retningslinjer. Følgende oversikter ble undersøkt:

• Helsebiblioteket
• Guideline Advisory Committee (GAC)
• National Institute for Health and Care Excellence (NICE)
• National Guideline Clearinghouse (NGC)
• Guidelines International Network (GIN)
• National Library of Health

Totalt ble tre av publikasjonene som ble identifisert via de elektroniske oversikter over eksisterende retningslinjer inkludert i kunnskapsgrunnlaget.^{2, 21, 47}

Enkelte av publikasjonene som er tatt med i håndbokens kunnskapsgrunnlag (litteraturliste) er ikke inkludert i hoveddokumentets referanseliste. Det er valgt å beholde dem i litteraturlisten da de belyser anbefalingene i nøkkelpublikasjonene veilederen bygger på.

Anbefalingene i håndboken er gitt uten gradering av kunnskapsgrunnlaget. Mitchell et. al¹⁹og Conway et. al⁴⁸ gir imidlertid en god oversikt over graderingene slik de fremstår i de fleste av nøkkelreferansene som anbefalingene i håndboken bygger på. Graderingene er også godt beskrevet i den enkelte nøkkelreferanse.^{1, 2, 6, 10, 24}

Litteraturliste

1. Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA, Healthcare Infection Control Practices advisory Committee (HICPAC). Guideline for prevention of catheter-associated urinary tract infections 2009. HICPAC, 2009.
2. Hooton TM, Bradley SF, Cardenas DD et al. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis 2010;50(5):625-663.
3. Greene L, Marx J, Oriola S. Guide to the Elimination of Catheter-Associated Urinary Tract Infections (CAUTIs). Developing and Applying Facility-Based Prevention Interventions in Acute and Long-Term Care Settings. APIC, 2008.
4. Smith PW, Bennett G, Bradley S et al. SHEA/APIC guideline: infection prevention and control in the long-term care facility, July 2008. Infect Control Hosp Epidemiol 2008;29(9):785-814.
5. Lo E, Nicolle L, Classen D et al. Strategies to prevent catheter-associated urinary tract infections in acute care hospitals. Infect Control Hosp Epidemiol 2008;29 Suppl 1:S41-S50.
6. Yokoe DS, Mermel LA, Anderson DJ et al. A compendium of strategies to prevent healthcare-associated infections in acute care hospitals. Infect Control Hosp Epidemiol 2008;29 Suppl 1:S12-S21.
7. Nicolle LE. Urinary tract infections in long-term-care facilities. Infect Control Hosp Epidemiol 2001;22(3):167-175.
8. Damani N. The IFIC Basic Concepts of Infection Control (2011). International Federation of Infection Control, 2012.
9. Pratt RJ, Pellowe C, Loveday HP et al. The epic Project: Developing National Evidence-based Guidelines for Preventing Healthcare associated Infections. Guidelines for preventing infections associated with the insertion and maintenance of short-term indwelling urethral catheters in acute care. J Hosp Infect 2001;2001(47 (supplement)):39-46.
10. Pratt RJ, Pellowe CM, Wilson JA et al. epic2: National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect 2007;65 Suppl 1:S1-64.
11. National Institute for Health and Clinical Excellence . Infection. Prevention and control of healthcare-associated infections in primary and community care. National Institute for Health and Clinical Excellence, 2012. NICE clinical guideline 139.
12. Health Protection Scotland, National Services Scotland. Targeted literature review: What are the key infection prevention and control recommendations to inform a urinary catheter maintenance care quality improvement tool? Health Protection Scotland, National Services Scotland, Version 1, April 2012.
13. Health Protection Scotland, National Services Scotland. Targeted literature review: What are the key infection prevention and control recommandations to inform a urinary catheter insertion quality improvement tool? Health Protection Scotland, National Services scotland,Version 1, April 2012.
14. The Strategy for the Control of Antimicrobial Resistance in Irland (SARI). Guidelines for the Prevention of Catheter-associated Urinary Tract Infection. Health Protection Surveillance centre, 2011.
15. Australian guidelines for the prevention and control of infection in healthcare. National health and medical research council (NHMRC). Commonwealth of Australia, 2010.
16. Geng V, Cobussen-Boekhorst H, Farrell J et al. Evidence-based Guidelines to Best Practice in Urological Health Care. Catheterisation. Indwelling catheters in adults. Urethral and Suprapubic. European association of Urology Nurses, 2012.
17. Grabe M, Bjerklund-Johansen TE, Botto H et al. Guidelines on Urological Infections. European Association of Urology, 2011.
18. Nasjonalt kunnskapssenter for helsetjenesten. Sjekklister for vurdering av forskningsartikler. http://www.kunnskapssenteret.no/  (12.12.2012).
19. Mitchell B, Ware C, McGregor A et al. ASID (HICSIG)/AICA Position Statement: Preventing catheter-associated urinary tract infections in patients. Healthcare Infection 2011;16(2):45-52.
20. 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. Am J Infect Control 2010;38(8):644-646.
21. Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA. Guideline for prevention of catheter-associated urinary tract infections 2009. Infect Control Hosp Epidemiol 2010;31(4):319-326.
22. Hameed A, Chinegwundoh F, Thwaini A. Prevention of catheter-related urinary tract infections. Br J Hosp Med (Lond) 2010;71(3):148-2.
23. Shuman EK, Chenoweth CE. Recognition and prevention of healthcare-associated urinary tract infections in the intensive care unit. Crit Care Med 2010;38(8 Suppl):S373-S379.
24. Tenke P, Kovacs B, Bjerklund Johansen TE, Matsumoto T, Tambyah PA, Naber KG. European and Asian guidelines on management and prevention of catheter-associated urinary tract infections. Int J Antimicrob Agents 2008;31 Suppl 1:S68-S78.
25. Regal RE, Pham CQ, Bostwick TR. Urinary tract infections in extended care facilities: preventive management strategies. Consult Pharm 2006;21(5):400-409.
26. Godfrey H, Fraczyk L. Preventing and managing catheter-associated urinary tract infections. Br J Community Nurs 2005;10(5):205-212.
27. Trautner BW, Hull RA, Darouiche RO. Prevention of catheter-associated urinary tract infection. Curr Opin Infect Dis 2005;18(1):37-41.
28. Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA, Healthcare Infection Control Practices Advisory Committee. Guideline for prevention of catheter-associated urinary tract infections 2009. Infect Control Hosp Epidemiol 2010;31(4):319-326.
29. Niel-Weise BS, van den Broek PJ. Urinary catheter policies for short-term bladder drainage in adults. Cochrane Database Syst Rev 2005;(3):CD004203.
30. Hagen S, Sinclair L, Cross S. Washout policies in long-term indwelling urinary catheterisation in adults. Cochrane Database Syst Rev 2010;(3):CD004012.
31. Niel-Weise BS, van den Broek PJ. Urinary catheter policies for long-term bladder drainage. Cochrane Database Syst Rev 2005;(1):CD004201.
32. Jahn P, Preuss M, Kernig A, Seifert-Huhmer A, Langer G. Types of indwelling urinary catheters for long-term bladder drainage in adults. Cochrane Database Syst Rev 2007;(3):CD004997.
33. Phipps S, Lim YN, McClinton S, Barry C, Rane A, N'Dow J. Short term urinary catheter policies following urogenital surgery in adults. Cochrane Database Syst Rev 2006;(2):CD004374.
34. Johnson JR, Kuskowski MA, Wilt TJ. Systematic review: antimicrobial urinary catheters to prevent catheter-associated urinary tract infection in hospitalized patients. Ann Intern Med 2006;144(2):116-126.
35. Meddings J, Rogers MA, Macy M, Saint S. Systematic review and meta-analysis: reminder systems to reduce catheter-associated urinary tract infections and urinary catheter use in hospitalized patients. Clin Infect Dis 2010;51(5):550-560.
36. Saint S, Elmore JG, Sullivan SD, Emerson SS, Koepsell TD. The efficacy of silver alloy-coated urinary catheters in preventing urinary tract infection: a meta-analysis. Am J Med 1998;105(3):236-241.
37. van den Eijkel E, Griffiths P. Catheter valves for indwelling urinary catheters: a systematic review. Br J Community Nurs 2006;11(3):111-2, 114.
38. Palese A, Buchini S, Deroma L, Barbone F. The effectiveness of the ultrasound bladder scanner in reducing urinary tract infections: a meta-analysis. J Clin Nurs 2010;19(21-22):2970-2979.
39. Lockwood C, Page T, Conroy-Hiller T, Florence Z. Management of short-term indwelling urethral catheters to prevent urinary tract infections. JBI Reports 2004;2(8):271-291.
40. Moola S, Konno R. A systematic review of the management of short-term indwelling urethral catheters to prevent urinary tract infections.   Joanna Briggs Institute Library of Systematic Reviews 2010;8(17):695-729.
41. Joanna Briggs Institute. Management of short-term indwelling urethral catheters to prevent urinary tract infections Best Practice: evidence-based information sheets for health professionals. 2010;14(12):1-4.
42. Burman LG. Vårdrelaterade urinvägsinfektioner. In: Socialstyrelsen, editor. Att forebygga vardrelaterade infektioner. Ett kunskapsunderlag. Lindesberg: Socialstyrelsen; 2006:122-138.
43. NHS Quality Improvement Scotland. Best Practice Statement ~ June 2004. Urinary Catheterisation & Catheter Care. NHS Quality Improvement Scotland, 2004.
44. Emblem EL, Frugård J, Høisæter PÅ, Otnes B. Nasjonale retningslinjer for helsepersonell ved bruk av intermitterende kateterisering - IK. NSF`s faglige sammenslutning av sykepleiere i urologi og Norsk urologisk forening, 2005.
45. Ducel G, Fabry J, Nicolle L. Prevention of hospital - acquired infections. A practical guide. 2nd edition. World Health Organization Department of Communicable Disease Surveillance and Response, 2002.
46. National Institute for Health and Clinical Excellence (UK). Infection Control: Prevention of Healthcare-associated Infections in Primary and Community Care [Internet]. National Institute for Health and Clinical Excellence (UK), 2003.
47. Section 3 - Urinary Catheterisation. Guidelines for preventing healthcare-associated infections during long-term urinary catheterisation in primary and community care. Infection Control: Prevention of Healthcare-associated Infections in Primary and Community Care. National Institute for Health and Clinical Excellence; 2003:98-117.
48. Conway LJ, Larson EL. Guidelines to prevent catheter-associated urinary tract infection: 1980 to 2010. Heart Lung 2012;41(3):271-283.