Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia · 2025
Reducing post-stroke urinary tract infection through protocolized bladder management.
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Tan Il Fan, Chin De Zhi, Arif Rizal Bin, De Silva Deidre Anne
Аннотация
BACKGROUND: Urinary tract infection (UTI) is a common complication among ischemic stroke patients and is associated with poorer outcomes and increased healthcare cost. We aimed to study if a bladder management protocol would lead to a reduction of UTI in post-stroke patients. within 30-days of ischemic stroke onset among patients who are admitted to Singapore General Hospital (SGH) acute stroke unit (ASU) over 12 months.
METHODS: This is a prospective study conducted at SGH ASU. A multidisciplinary team co-developed a bladder management protocol aimed at earlier detection and management of acute urinary retention to avoid urinary catheterisation. We measured the 30-day UTI incidence before and at various stages after protocol implementation. In addition, monthly UTI rates were ranked from highest and lowest and grouped by quartiles and deciles to determine if protocol compliance had an impact on UTI incidence.
RESULTS: The 30-day UTI rate decreased from 9.0 % pre-intervention to 5.6 % post-intervention (p < 0.001). Amongst the post-intervention cohort, the median length of stay was longer at 18 days (IQR 9-29) (p < 0.001) in patients with UTI versus 4 days (IQR 2-8) (p < 0.001) in those without UTI. Comparing the top versus bottom quartile (p < 0.001) as well as top decile versus other deciles (p < 0.001) by months in terms of protocol compliance rate, the 30-day UTI incidence rates were significantly lower.
CONCLUSION: Avoidance of urinary catheterisation via a nurse-led bladder management protocol is effective in reducing UTI. Adherence to the protocol was a key factor.
METHODS: This is a prospective study conducted at SGH ASU. A multidisciplinary team co-developed a bladder management protocol aimed at earlier detection and management of acute urinary retention to avoid urinary catheterisation. We measured the 30-day UTI incidence before and at various stages after protocol implementation. In addition, monthly UTI rates were ranked from highest and lowest and grouped by quartiles and deciles to determine if protocol compliance had an impact on UTI incidence.
RESULTS: The 30-day UTI rate decreased from 9.0 % pre-intervention to 5.6 % post-intervention (p < 0.001). Amongst the post-intervention cohort, the median length of stay was longer at 18 days (IQR 9-29) (p < 0.001) in patients with UTI versus 4 days (IQR 2-8) (p < 0.001) in those without UTI. Comparing the top versus bottom quartile (p < 0.001) as well as top decile versus other deciles (p < 0.001) by months in terms of protocol compliance rate, the 30-day UTI incidence rates were significantly lower.
CONCLUSION: Avoidance of urinary catheterisation via a nurse-led bladder management protocol is effective in reducing UTI. Adherence to the protocol was a key factor.