Unique ID issued by UMIN | UMIN000033557 |
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Receipt number | R000038269 |
Scientific Title | Prevalence and Appropriateness of Indwelling Urinary Catheters among Stroke Patients |
Date of disclosure of the study information | 2018/11/24 |
Last modified on | 2022/08/03 14:52:06 |
Prevalence and Appropriateness of Indwelling Urinary Catheters among Stroke Patients
Prevalence and Appropriateness of Indwelling Urinary Catheters among Stroke Patients
Prevalence and Appropriateness of Indwelling Urinary Catheters among Stroke Patients
Prevalence and Appropriateness of Indwelling Urinary Catheters among Stroke Patients
Japan |
Stroke
Neurology | Infectious disease | Urology |
Neurosurgery | Emergency medicine | Nursing |
Others
NO
1) To clarify the prevalence of indwelling urinary catheter, the proportion of appropriate urinary catheter utilization, and the incidence of catheter-related urinary tract infection (CAUTI) and urinary retention among stroke patients
2) To clarify the effect on the proportion of appropriate urinary catheter utilization and the incidence of CAUTI and urinary retention by education to medical staffs about urinary catheter management for prevention of CAUTI and the system for reminding withdrawal of inappropriate urinary catheters in stroke care
Efficacy
The proportion of inappropriate catheter utilization
The proportion of catheter utilization
(The proportion of patients with urinary catheters, The number of days with urinary catheters)
The incidence rate of CAUTI
The incidence proportion of total UTI and urinary retention
Observational
20 | years-old | <= |
Not applicable |
Male and Female
Stroke patients (cerebral infarction, atraumatic intracerebral hemorrhage, atraumatic subarachnoid hemorrhage)
Use of urinary catheterization, intermittent urinalysis, urostomy, or no urine due to dialysis prior to the onset of stroke
1000
1st name | Takeo |
Middle name | |
Last name | Nakayama |
Kyoto University School of Public Health
Health Informatics
606-8501
Yoshida-Konoe-cho, Sakyo-ku, Kyoto 606-8501, JAPAN
075-753-9477
nakayama.takeo.4a@kyoto-u.ac.jp
1st name | Yasuko |
Middle name | |
Last name | Ikeda |
Kyoto University Graduate School of Medicine
Health Informatics
606-8501
Yoshida-Konoe-cho, Sakyo-ku, Kyoto 606-8501, JAPAN
075-753-9477
ikeda.yasuko.48x@kyoto-u.jp
Kyoto University
School of Public Health/Graduate School of Medicine
Self funding
Self funding
Kyoto university Clinical Biostatistics Course REDCap
Kyoto University Graduate School and Faculty of Medicine, Ethics Committe
Yoshida-Konoe-cho, Sakyo-ku, Kyoto 606-8501, JAPAN
0757534680
ethcom@kuhp.kyoto-u.ac.jp
NO
医療法人清仁会シミズ病院(京都府), 日本赤十字社和歌山医療センター(和歌山県), 市立福知山市民病院(京都府)
2018 | Year | 11 | Month | 24 | Day |
not published
Partially published
https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.13626
738
Inappropriate IUC use decreased from 50.1% in the baseline phase to 22.5% in the implementation phase (absolute risk reduction in interrupted time series analysis 42.4% [95% confidence interval, 19.2%-65.6%]). The device utilization ratio decreased from 0.302 to 0.194 (p < 0.001), whereas CAUTI did not change significantly (from 8.81 to 8.28 per 1000 catheter-days; incidence rate ratio 0.95 [0.44-1.94]). All symptomatic UTI decreased from 9.5% to 4.9% (p = 0.015), with no increase in urinary retention.
2022 | Year | 08 | Month | 03 | Day |
A total of 738 patients in the baseline and implementation phases were analyzed. The mean age was 74.1 and 74.4 years; men accounted for 55.6% and 52.6%; stroke types were cerebral infarction 67.2% and 68.0%, cerebral hemorrhage 25.2% and 25.2%, and subarachnoid hemorrhage 7.6% and 6.8% respectively.
Among 976 patients who met the inclusion criteria, 738 were analysed excluding patients due to use of indwelling urinary catheter, intermittent urinary catheter or urostomy prior to stroke onset; impossible to void for dialysis; and patients admitted during the educational phase.
no adverse events
The proportion of inappropriate IUC use decreased from 50.1% in baseline cases to 22.5% in implementation cases (p < 0.001). ITS analysis showed a level change with a decrease in inappropriate IUC use (absolute risk reduction [95% confidence interval]: 42.4% [19.2-65.6%]) immediately after the program.
Concerning secondary outcomes for effectiveness, the device utilization ratio decreased from 0.302 to 0.194 (p < 0.001), whereas the incidence rate of CAUTI did not change significantly (from 8.81 to 8.28 per 1000 catheter-days; incidence rate ratio 0.95 [0.44-1.94]). For safety, the incidence proportion of symptomatic UTI significantly decreased from 9.5% to 4.9% (p = 0.015), and the incidence proportion of urinary retention during hospitalization decreased from 17.1% to 12.8% (p = 0.11). The incidence proportion of urinary retention at discharge also decreased from 7.5% to 5.7% (p = 0.33).
Completed
2018 | Year | 07 | Month | 30 | Day |
2018 | Year | 07 | Month | 31 | Day |
2019 | Year | 01 | Month | 04 | Day |
2020 | Year | 07 | Month | 31 | Day |
<Observational period before education>
Based on existing guidelines and standards (CDC guideline etc.), we will prepare a list of reasons for proper placement of urinary catheter in stroke care.In the consolidation of expert opinion the list for this study will be comprehensive and suitable for the clinical practice situation. Using the list of complete version, the observers (several specialized doctors and nurses at each medical institution) will evaluate each day whether the reason of the urinary indwelling catheterization is appropriate/inappropriate. The occurrence of CAUTI and urinary retention will be recorded. During this period, the education about urinary catheter management for CAUTI prevention will not be given to the medical staffs (doctors and nurses who will take care stroke patients) other than the observers.
<Educational period and observational period after education>
We will have a lecture about appropriate use of urinary catheter to the medical staffs and develop a system to recommend the removal of inappropriate urinary catheter. After two months of educational period, we will compare the proportion of appropriate/inappropriate catheter utilization and the incidence of CAUTI and urinary retention.
2018 | Year | 07 | Month | 30 | Day |
2022 | Year | 08 | Month | 03 | Day |
Value
https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000038269
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