Effect of precision management scheme based on the best evidence summary on reducing catheter-associated urinary tract infection

OBJECTIVES

Catheter-associated urinary tract infection (CAUTI) is an important cause of prolonged hospital stay, which increases economic and medical burden for patients and hospitals, and it is a key focus of hospital infection prevention and control. However, there are currently few studies that convert evidence-based scientific evidence on CAUTI prevention and control into clinical applications and evaluation on its practical effects in combination with standardized infection ratio (SIR), the critical indicator of infection prevention and control. This study aims to establish a precision management plan for reducing the incidence of CAUTI, driven by the findings of a comprehensive evidence summary, to apply this plan across all the nursing units within the entire hospital, followed by a comparative analysis of CAUTI incidence, SIR, the average duration of indwelling urinary catheter for each patient, and the compliance rate on hand hygiene protocols for medical staff before and after the implementation of the precision management plan.

METHODS

Based on a comprehensive review of the best evidence for preventing CAUTI, a precision management plan was meticulously developed through panel discussions and 2 rounds of expert consultations using Delphi technique. Subsequently, a historical control study was conducted to evaluate the plan's effectiveness. A total of 17 658 patients with indwelling urinary catheter in inpatient departments from January to December 2021 comprised the control group. These patients received standard nursing measures for CAUTI. Another 18 753 patients with indwelling urinary catheters in the inpatient departments from January to December 2022 comprised the intervention group, underwent the precision management scheme based on the best available evidence, to enhance CAUTI prevention. The incidence and SIR of CAUTI, the average duration of indwelling urinary catheter for each patient, and the compliance rate on hand hygiene protocols for medical staff were compared between the 2 groups.

RESULTS

Compared with the control group, the incidence of CAUTI in the intervention group was significantly decreased (0.48‰ vs 1.12‰, χ2=20.814, P<0.001), SIR was decreased in the intervention group (0.55 vs 1.37); the average duration of indwelling urinary catheter for each patient was significantly decreased [(4.33±1.55) d vs (4.43±1.79) d, t=11.941, P<0.001]. The ratio of compliance rate of medical staff with strict hand hygiene protocols higher than 95% in the intervention group was significantly higher than that in the control group (93.3% vs 83.3%, χ2=5.822, P=0.016).

CONCLUSIONS

The implementation of the precision management plan for reducing CAUTI based on a summary of the best available evidence on CAUTI prevention and control in patients with indwelling urinary catheters has found to be effective. This approach significantly reduces the incidence of CAUTI, reduces the average duration of indwelling urinary catheter, and enhances hand hygiene compliance among medical staff. It provides a scientific and efficient strategy for preventing and controlling CAUTI in the hospital, ultimately saving patients from unnecessary medical expense.

[Accurate Management Practice of Medical Consumables in the Whole Process Based on SPD Supply Chain]

Establish a hospital logistics information SPD system, carry out internet cloud procurement, and interface with the hospital HIS system, surgical anesthesia system, internal control management system, etc, to form an information system covering the entire process of external logistics, internal logistics, and internal control audit. Accurately classify consumables in multi-dimensions, improve the consumables dictionary field information dictionary database, refine supplier management, and realize the whole process of implanting interventional and high-value consumables into three codes (material code, medical insurance consumable code, charge code) traceability management, and data visualization. At the same time, it reduces hospital inventory and cost pressure, reduces the intensity of nursing staff's management of consumables, reduces the risks and loopholes of consumables management, and improves the level of digital and intelligent management of medical consumables.

Emerging Issues and Potential Opportunities in the Rice-Wheat Cropping System of North-Western India

The rice-wheat cropping system (RWCS) is the backbone of Indian farming, especially in the north-western region. But continuous adoption of the RWCS in northwest India has resulted in major challenges and stagnation in the productivity of this system. Additionally, the Indo-Gangetic Plains of Pakistan, Nepal, and Bangladesh are also facing similar challenges for sustainable production of the RWCS. Several emerging problems, such as the exhausting nutrient pool in soil, deteriorating soil health, groundwater depletion, escalating production cost, labor scarcity, environmental pollution due to crop residue burning and enhanced greenhouse gas emissions, climatic vulnerabilities, and herbicide resistance in weed species, are a few major threats to its sustainability. To address these challenges, a wide range of sustainable intensification technologies have been developed to reduce the irrigation and labor requirements, tillage intensity, and straw burning. Awareness and capacity building of the stakeholders and policy matching/advocacy need to be prioritized to adopt time- and need-based strategies at the ground level to combat these challenges. This review summarizes the current status and challenges of the RWCS in the northwest region of the country and also focuses on the precision management options for achieving high productivity, profitability, and sustainability.