Một đề tài hay về các yếu tố nguy cơ dẫn đến nhiễm trùng tiết niệu ở bệnh nhân nội trú tại bệnh viện.Kết quả nghiên cứu cho thấy:The study conducted from May to September 20013 enroled 46 catheterized patients to investigate the prevalence of CAUTIs and risk factors and the results could be summarized as follows:1. The prevalence of CAUTIs in patients with catheterization > 48h was 17.4 %.2. A total of 31 factors were explored to find out the association with infectious condition. There were 03 factors had significant associations with infectious condition including:History of morbidity and infection condition: patients with diabetes mellitus had a risk of CAUTIs of 3.6 times higher than patients without (p = 0.03). Number of commorbidities and infectious condition: patients with 1 condition had a risk of CAUTIs of 6 times higher than patients did not any condition and patients with ≥ 2 conditions had a risk of CAUTIs of 36 times higher than patients did not any condition (p < 0.05).Hypertension drug intake and infectious condition: Patients with hypertension drug intake had a risk of CAUTIs of 3.6 times higher than patient without.Một nghiên cứu hay có trích dẫn Endnote đầy đủ
ABBREVIATIONS CAUTIs : Catheter-associated urinary tract infections CDC : Centers for Disease Control and Prevention CI : Confidence interval ICU : Intensive care unit PR : Prevalence ratio UTI : Urinary tract infections WHO : World Health Organization LIST OF FIGURES AND TABLES Trang ABBREVIATIONS CAUTIs : Catheter-associated urinary tract infections CDC : Centers for Disease Control and Prevention CI : Confidence interval ICU : Intensive care unit PR : Prevalence ratio UTI : Urinary tract infections WHO : World Health Organization LIST OF FIGURES AND TABLES Trang CONTENTS Trang INTRODUCTION Objectives of the study CHAPTER LITERATURE REVIEW 1.1 Nosocomial infections 1.1.1 Definition of nosocomial infections Nosocomial infections are infections acquired during hospital care of patients Infections occurring more than 48 hours after admission are usually considered nosocomial infections Nosocomial infections could be classified into different categories in terms of infectious sites These are derived from those published by the Centers for Diseases Control and Prevention (CDC) in the United States of America or during international conferences [28] and are used for surveillance of nosocomial infections Recently, about 50 types of nosocomial infections with biological and clinical characteristics are identified 1.1.2 Epidemiology of nosocomial infections .4 1.1.3 Types of nosocomial infection 1.2 Urinary tract infection As mentioned above, UTIs are one of the most frequent nosocomial infections According to Craven, UTIs account for about 40% of all nosocomial infections in US hospitals each year [17] UTIs often occur in ICU, outpatient or inpatient ward, and rehabilitation ward .7 The prevalence and mortality rate of UTIs vary among countries In US, according to CDC the prevalence of UTIs in 2002 was 17% of total cases of nosocomial infections; of these there were 10% deaths, 5% cases developed bacteraemia In European and Asian countries, the incidence of UTIs fluctuated from 3.5 to 9.9% each year [45] Most of UTIs are associated with the utilization of an indwelling urinary catheter In US, there are 80% UTIs related to catheterization in patients with prolonged hospital stay [37] In 2012, a review study investigated 4,109 studies worldwide showed that the attributable risk of CAUTIs could be about 79.3% [35] One study of Karina in Philippine found that the prevalence of CAUTIs in a General Hospital raised up to 54.4% [34] Mai Thi Tiet in her study in 2011 concluded that there were 26/41 patients (63.4%) acquired CAUTIs [8] The prevalence of CAUTIs at ICU was highest, followed by internal medicine ward and surgical ICU CAUTIs not only occur at hospital but at patient’s home after they are discharged from hospitals Beaver in his study in 2008 found that patients with indwelling urinary catheter at home had the risk of acquiring CAUTIs between 2.1 and 6.7 days/1000 days of catheterization [12] 1.3 Catheter-associated urinary tract infection 1.3.1 Etiology 1.3.2 Pathogenesis .9 1.3.3 Clinical manifestations of CAUTIs 1.3.5 Diagnosis of CAUTIs .11 1.4 Risk factors for CAUTIs .17 1.4.1 Demographic characteristics of patients 17 1.4.2 Factors related to health condition of patients 17 1.4.3 Factors related to patient’s illness 17 1.4.4 Factors related to catheterization 18 1.4.5 Factors related to catheter characteristics 19 1.5 Application of nursing theory on the present study .21 1.5.2 Application of Neuman’s model on the present study 22 Figure 1.1 Neuman theoretical model applied in the study .24 CHAPTER METHODOLOGY 25 2.1 Study design 25 2.2 Subjects .25 2.2.1 Target population 25 2.2.2 Selected population 25 2.3 Sample size 25 2.4 Sample collection 25 2.5 Sampling criteria 26 2.5.1 Inclusion criteria .26 2.5.2 Exclusion criteria 26 2.5.3 Sampling procedure 26 Figure 2.2 Sampling procedure in the study 27 2.6 Data collection method 27 2.6.1 Data collection technique 27 2.6.2 Data collection tools 29 2.6.3 Data collectors 30 2.6.4 Methods of controlling systematic errors 30 2.7 Data analysis 30 2.8 Definitions of variables .31 2.8.1 Demographic characteristics of patients 31 2.8.2 Enviromental factors 32 2.8.3 Catheterization techniques of nurses 33 2.8.5 Infectious condition of patients 34 2.9 Medical Ethics .35 CHAPTER RESULTS 36 Table 3.3 The place where patients treated (n = 46) 36 Table 3.4 Demographic profile of patients (n = 46) 36 Age (years) 37 Table 3.5 History of morbidity of sample (n = 46) 38 Table 3.6 Environmental factors affect the risk of acquiring CAUTIs (n = 46) 39 Table 3.7 Techniques of nurses before, during and after catheterization ( n = 46) 41 Table 3.8 Techniques of nurses for drainage system maintainace ( n = 46) 42 Table 3.9 Urine culture and Gram-stain smear results 43 after > 48h catheterization (n = 46) 43 Table 3.10 The association between demographic characteristics and infectiuous condition of patients (n = 46) .44 Urinary tract infection 44 (KTC 95%) 45 Yes 45 Age 45 Sex 45 Table 3.11 The association between infectious condition and history of morbidities of patients (n = 46) .46 Urinary tract infection 46 (KTC 95%) 46 Yes 46 Diabetes mellitus 46 Kidney failure 46 Table 3.12 The association between environmental factors and infectious condition of patients after > 48h catheterization (n = 46) 48 Urinary tract infection 48 (KTC 95%) 48 Yes 48 Place of catheter insertion 48 Reasons for catheterization 48 Urinary tract infection 49 (KTC 95%) 49 Yes 49 Catheter sizes 49 Health condition of patients 49 Table 3.13 The associations between technique of nurses before, during and after catheterization and infectious condition of patients (n = 46) 50 Urinary tract infection 50 (KTC 95%) 50 Yes 50 Table 3.14 The association between infectious condition and techniques of nurses for maintainance of the drainage system (n = 46) 52 Urinary tract infection 52 (KTC 95%) 52 Yes 52 CHAPTER DISCUSSION 53 REFERENCES CONTENTS Trang ABBREVIATIONS CAUTIs : Catheter-associated urinary tract infections CDC : Centers for Disease Control and Prevention CI : Confidence interval ICU : Intensive care unit PR : Prevalence ratio UTI : Urinary tract infections WHO : World Health Organization LIST OF FIGURES AND TABLES Trang CONTENTS Trang INTRODUCTION Objectives of the study CHAPTER LITERATURE REVIEW 1.1 Nosocomial infections 1.1.1 Definition of nosocomial infections Nosocomial infections are infections acquired during hospital care of patients Infections occurring more than 48 hours after admission are usually considered nosocomial infections Nosocomial infections could be classified into different categories in terms of infectious sites These are derived from those published by the Centers for Diseases Control and Prevention (CDC) in the United States of America or during international conferences [28] and are used for surveillance of nosocomial infections Recently, about 50 types of nosocomial infections with biological and clinical characteristics are identified 1.1.2 Epidemiology of nosocomial infections .4 1.1.3 Types of nosocomial infection 1.2 Urinary tract infection As mentioned above, UTIs are one of the most frequent nosocomial infections According to Craven, UTIs account for about 40% of all nosocomial infections in US hospitals each year [17] UTIs often occur in ICU, outpatient or inpatient ward, and rehabilitation ward .7 The prevalence and mortality rate of UTIs vary among countries In US, according to CDC the prevalence of UTIs in 2002 was 17% of total cases of nosocomial infections; of these there were 10% deaths, 5% cases developed bacteraemia In European and Asian countries, the incidence of UTIs fluctuated from 3.5 to 9.9% each year [45] 67 incontinence had higher risk of CAUTIs than those without, but these association were not statistically significant (p = 0.7 and p = 0.6 ) 4.5.2 The association between environmental factors and infectious condition In this study, we classified place of catheterization, catheter sizes, frequency of catheterization into group of environmental factors in the model of Neuman’s theory Catheter, place of catheterization can be considered as “stressors" (as in the definition of components of the Neuman’s model) resulted in UTIs in patients Although none of aboved factors had statistically significant associations with CAUTIs, but the results also had some important points that need to be concerned While exploring the association between place of catheterization and infectious condition, we found that Urology Sugery ward had a higher proportion of infected patients than operation room and other wards (25% compared with 6.7% and 20%) This result was similar to that in study of Nguyen Thi Tuyet Trinh in which the proportion of CAUTIs patients in the ICU was lower than other wards (13.3% vs 23.5%) There were several reasons to explain this difference: (1) in the operation room, patients were inserted catheter with strictly sterile techniques to prevent the risk of infection for patients during surgical trial Furthermore, catheter was withdrawn as soon as possible so as to minimize the risk of acquiring UTIs; (2) At Urology Surgery Ward in Nguyen Tri Phuong Hospital, as the statistics showed previously, some sterile techniques were not performed and the height of patient’s bed was too low which contribute to increase the risk of CAUTIs in this ward compared with other wards 68 For catheter sizes, results of our study were contrast with other studies when it indicated that patients inserted with 16F catheter had a higher risk of acquiring CAUTIs than patients inserted with other cathter sizes This may be caused by a chance because of small sample size, but if this situation was eliminated, the result may be a new finding about the risk factors of CAUTIs in Nguyen Tri Phuong Hospital and other hospitals in the whole country That was because most hospitals in Vietnam were commonly used 16F catheter for adult patients with indication of catheterization To verify this hypothesis we need to conduct a study with case and control groups and follow them in long period of time The association between duration of catheterization and frequency of catheterization and infectious condition showed the same pattern as other studies Patients with catheterization > 48 h were likely to develop CAUTIs 2.6 times higher than patients with 48h catheterization Nguyen Viet Luong's study showed that the prevalence of CAUTIs in patients with catheterization > 120 hours was 12.6% that was times higher than patients with catheterization from to 48h (6.3%) [3] Patients with catheterization ≥ times were likely to develop CAUTIs 2.3 times higher than patients inserted once time However, like other associations analyzed previously, small sample sizes affected this association and we did not find statistical significance association (p> 0.05) 4.5.3 The association between catheterization technique of nurses and infectious condition Group of catheterization techniques of nurses, also known as component "nursing" in Neuman's model, played an important role in preventing CAUTIs in catheterized patients According to Neuman's model, the right practice of the 69 nurses could prevent the "stressors" from environment breaking balance of energy system of "human" and then help "human" maintain their "health" In eight catheterization techniques that nurses need to perform before, during and after catheter insertion, none of them had statistically significant associations with the infectious condition of patients (p > 0.05) However comparing the prevalence of CAUTIs between nurses with implimentation of these technique and nurses without, we saw that 7/8 techniques acted as a protective factors to patients in preventing CAUTIs In other words, if nurses performed these techniques properly, they can reduce the risk of acquiring CAUTIs for patients Handwash before catheter insertion have been proven to reduce the risk of CAUTIs in many studies worldwide, but in our stuydy it did not support that statement The explaination is that there had been bias during data collection, particulary observations of practices of nurses This was a drawback of the study and would be discussed more detail in the limitation section of this study Like catheterization techniques performed before, during and after catheterization, techniques performed during maintainance of drainage system did not have any significant associations with infectious condition of patients (p > 0.05) Three of four techniques including maintain unobstructed drainage system, maintain closed drainage system, and keep drainage bag not in contact with urine container were considered as protective factors to prevent development of CAUTIs The study of Nguyen Thi Tuyet Trinh showed that patients who were cleansed the genital area 6.05 times each day had less risk of CAUTIs than patient cleansed 1.8 times [10] In our study, this technique 70 conflicted with that of Nguyen Thi Tuyet Trinh and this also could be explained by bias during observation of practices of nurses 4.6 The strengths of the present study Although it was a descriptive cross-sectional study, but the design and implementation of research from the sampling procedure to the processing and analysis of data has always been tightly controlled in order to minimize the potiential error system The author herself participated in data collection so the data was more reliable The processing and analysis of information collected were done in a scientific manner by using appropriately statistical techniques All these efforts were reflected by most of the results in this study have many similarities with the results of other studies in the world and Vietnam This study was different with other studies by applying nursing theory to explore risk factors related to CAUTIs The theory used in our study is the model of Betty Neuman The distribution of studied factors into group of components such as "demographic characteristics" "environmental factors" and "catheterization technique" based on components of Neuman’model ("man", "environment", and “nursing") helped the author invetigated the factors related to CAUTIs in a systematic, scientific and comprehensive manner Another strength of this study is the ability of practical application Results showed that several practices of catheterization have not been followed strictly and this could lead to high risk of CAUTIs acquisition Based on these results, the director board of Nguyen Tri Phuong Hospital could produce new policies that were more effective to improve the situation Research results also showed that some groups of patient such as patients with diabetes, hypertension 71 medication and other drugs should be received more nursing care, especially in catheterization 4.7 The limitations of the study One drawback of this study is the small sample size With the inclusion criteria were patients ≥ 48 h catheterization and the period of studying did not too long (5/2013-9/2013), the number of patients enroled in the study only 46 cases It resulted in many associations could not be calculated the PR values because the number of infected patients in groups with and without risk factors were extremly small As described in the discussion, some catheterization techniques of nurses (hygienic handwash, daily cleanse genital area) were considered as risk factors of CAUTIs and that conflicted with conclusions from other studies worlwide The contradiction was mainly due to errors in observation of practices of nurses Indeed, because the time of observation of the author was randomly, so in some cases nurses had already washed their hands before the observation of the author In these cases, nurses were considered as did not perform this technique Furthermore, at a given time of observation the author did not record nurses’s performance in cleansing genital, although they did perform at other time All of errors resulted in the proportion of patients with CAUTIs in group of nurses perfoming these two techniques higher than that in group of nurses not performing 72 CONCLUSION The study conducted from May to September 20013 at Nguyen Tri Phuong Hospital enroled 46 catheterized patients to investigate the prevalence of CAUTIs and risk factors and the results could be summarized as follows: The prevalence of CAUTIs in patients with catheterization > 48h was 17.4 % A total of 31 factors were explored to find out the association with infectious condition There were 03 factors had significant associations with infectious condition including: − History of morbidity and infection condition: patients with diabetes mellitus had a risk of CAUTIs of 3.6 times higher than patients without (p = 0.03) − Number of commorbidities and infectious condition: patients with condition had a risk of CAUTIs of times higher than patients did not any condition and patients with ≥ conditions had a risk of CAUTIs of 36 times higher than patients did not any condition (p < 0.05) − Hypertension drug intake and infectious condition: Patients with hypertension drug intake had a risk of CAUTIs of 3.6 times higher than patient without 73 RECOMMENDATIONS With the results obtained in the study, we propose the following recommendations: Strengthening annual trainning courses on catheterization techniques for nurses to raise awareness of the importance of these techniques in preventing patients from CAUTIs so that nurses will implement these techniques more regularly and properly Enhance the monitoring of performing sterile catheterization techniques in wards in Nguyen Tri Phuong Hospital Currently, each shift has only one chief nurse responsible for nursing work, so he or she could not closely supervise the practice of sterile techniques of nurses We recommend to modify one more chief nurse for each shift so as to they can directly monitor and supervise the implementation of sterile techniques more effectively The study showed that some groups of patients such as patients with diabetes, patients with hypertensive drug intake have higher risk of CAUTIs than other groups Thus, improving their health condition, applying sterile techniques in catheterization and utilizing proper catheter equipment are crucial actions needed to be done to prevent them from developing CAUTIs The results also showed that the proportion of CAUTIs at Urology Sugery ward is higher than other wards Therefore, it is necessary to conduct an infection risk assessment and then make a detailed plan to control these risks to reduce the rate of CAUTIs at this ward REFERENCES Vietnamese studies Nguyễn Trường An (2008) "Tình hình nhiễm trùng tiết niệu bệnh nhân sỏi tiết niệu khoa ngoại bệnh viện trường đại học Y Dược Huế" Đề tài cấp sở bệnh viện đại học Y Dược Huế Trần Thị An, Vũ Hoàng Anh, Đinh Ngọc Sơn (2011) "Đánh giá tình trạng nhiễm khuẩn tiết niệu bệnh nhân chấn thương cột sống có liệt tủy Khoa phẩu thuật cột sống Bệnh viện Hữu Nghị Việt Đức" Lê Viết Lượng (2009) "Nhiễm trùng niệu bệnh nhân có đặt thơng tiểu Bệnh viện Việt Nam - Cuba Đồng Hới" Lê Thị Anh Thư (2011) Giáo trình kiểm sốt nhiễm khuẩn bệnh viện, Lê Thị Anh Thư, Phạm Hồng Trường, Trần Thị Thanh Nga, Nguyễn Trường Sơn (2011) "Tình hình viêm phổi liên quan thở máy Khoa Hồi Sức Tích Cực, Bệnh viện Chợ Rẫy" Tạp chí Y học thực hành, Bộ Y Tế, 831, 5-8 Trương Anh Thư, Nguyễn Quốc Anh, Nguyễn Gia Bình (2009) "Tỉ lệ mắc hậu nhiễm khuẩn phổi bệnh viện Khoa Hồi sức tích cực Bệnh viện Bạch Mai, 2008 – 2009" Đề tài cấp sở Đoàn Phước Thuộc (2012) "Tình hình nhiễm khuẩn bệnh viện sử dụng kháng sinh bệnh viện đa khoa tỉnh Bình Định năm 2010" Y học thực hành, 7, (834), 95-98 Mai Thị Tiết (2011) "Tình hình nhiễm khuẩn bệnh viện yếu tố liên quan bệnh viện đa khoa Đồng Nai năm 2011 " Báo cáo tổng kết năm 2011 Mai Thị Tiết, Bùi Văn Dũng Anh, cộng (2011) "Tình hình nhiễm khuẩn bệnh viện yếu tố liên quan Bệnh viện Đa khoa Đồng Nai" Tạp chí Y học thực hành, Bộ Y Tế, 831, tr 64-68 10 Nguyễn Thị Tuyết Trinh (2009) "Liên quan thời gian lưu ống thông tiểu với nhiễm khuẩn đường tiết niệu" Luận văn tốt nghiệp thạc sĩ điều dưỡng, Đại Học Y Dược TP.HCM, tr.5 International studies 11 APIC (2008) "Guide to the Elimination of Catheter-Associated Urinary Tract Infections" pp 34-56 12 Beaver M (2008) "CMS reimbursement changes put spotlight on prevention of catheter-related infections" Infection Control Magazine, pp 48-75 13 Billote-Domingo K, Mendoza M, Tan TT (1998) "Catheter-related Urinary tract infections: Incidence, Risk Factors and Microbiologic Profile" pp 12-34 14 Carpeti EA, Bentley PG, Andrews SM (1994) "Randomized study of sterile versus non-sterile urethral catheterization" Annals of the Royal College of Surgeons of England, 76, 59–60 15 CDC (2013) "July 2013 CDC/NHSN Protocol Clarifications CatheterAssociated Urinary Tract Infection (CAUTI) Event" pp 7.4-7.7 16 CMS (2005) CMS guidance for revised F-Tag 315 17 Cravens DD, Zweig S (2000) "Urinary catheter management" American Family Physician, 61, 369–376 18 Darouiche RO, Goetz L, Kaldis T, et al (2006) "Impact of StatLock securing device on symptomatic catheter-related urinary tract infection: A prospective, randomized, multicenter clinical trial." American Journal of Infection Control, 34, (9), 555–560 19 Dennis GM, Paul AT (2001) "Engineering Out the risk for infection with urinary catheter" (2), 342 20 Giacometti A, Cirioni O, et al (2000) "Epidemiology and Microbiology of surgical wound infections" J.Clin.Microbiol, 38, (2), 918 21 Givens CD, Wenzel RP (1980) "Catheter-associated urinary tract infections in surgical patients: a controlled study on the excess morbidity and costs" J Urol, 124, 646–648 22 Golob JFJ, Claridge JA, Sando MJ, et al (2008) "Fever and leukocytosis in critically ill trauma patients: it’s not the urine." Surg Infect (Larchmt), 9, 49–56 23 Gray M (2006) "Does the construction material affect outcomes in long-term catheterization?" Journal of Wound, Ostomy and Continence Nursing, 33, (2), 116–120 24 Gray M (2008) "Securing the indwelling catheter" American Journal of Nursing, 108, (12), 44–50 25 Green MS, Rubinstein E, Amit P (1982) "Estimating the effects of nosocomial infections on the length of hospitalization." J Infect Dis, 145, 667– 672 26 Haley RW, Schaberg DR, Crossley KB, et al (1981) "Extra charges and prolongation of stay attributable to nosocomial infections: a prospective interhospital comparison " Am J Med 70, 51–58 27 Hataiwan R, Sanit W, Sasinuch R (2006) "Catheter-associated Urinary Tract Infection: Pathogenosis, Diagnosis, Risk factors and prevention" Infect Dis Antimicrob Agents, 23, (149-59) 28 Horan TC, et al (1992) "CDC definitions of nosocomial surgical site infections: a modification of CDC definition of surgical wound infections." Am J Infect Control, 13, 606–608 29 Jacobsen SM, Stickler DJ, Mobley HLT, Shirtliff ME (2008) "Complicated Catheter-Associated Urinary Tract Infections Due to Escherichia coli and Proteus mirabilis" Clinical Microbiology Reviews, 21, (1), 26–59 30 James WPT, Chen C, Inoue S (2002) "Appropriate Asian body mass indices? " Obesity Review, 3, (139) 31 Jans B (2009) Results of the 2009 pilot study for the European HCAI (HALT) study in long-term care facilities., Personal Communication 32 Johnson JR, Kuskowski MA, Wilt TJ (2006) "Systematic review: Antimicrobial urinary catheters to prevent catheter-associated urinary tract infection in hospitalized patients" Annals of Internal Medicine, 144, 116–126 33 Joon HL, Sun Wook Kim, Byung Il Yoon, U-Syn Ha, Dong Wan Sohn, YongHyun Cho (2012) "Factors That Affect Nosocomial Catheter-Associated Urinary Tract Infection in Intensive Care Units: 2-Year Experience at a Single Center" Korean J Urol, 54, 59-65 34 Karina Billote-Domingo, Myrna TM, Tessa TT (1999) "Catheter-related Urinary Tract Infections: Incidence, Risk Factors and Microbiologic Profile " Phil J Microbiol Infect Dis, 28, (4), 133-138 35 King C, et al (2012) "Risk factors for healthcare-associated urinary tract infection and their applications in surveillance using hospital administrative data: a systematic review" Journal of Hospital Infection () 82 219 - 226 36 Koskeroglu NG, Durmaz MB, et al (2004) "The role of meatal disinfection in preventing catheter-related bacteriuria in an intensive care unit: A pilot study in Turkey" Journal of Hospital Infection, 56, (3), 236–238 37 Lo E, Nicolle L, Classen D, et al (2008) "Strategies to prevent catheter associated urinary tract infections in acute care hospitals" Infection Control and Hospital Epidemiology, 29, (1), s41–50 38 Maki DG, Tambyah PA (2001) "Engineering out the risk of infection with urinary catheters" Emerging Infectious Disease, 7, (2), 1–6 39 Maki DG, Knasinski V, Tambyah PA (2000) "Risk factors for catheterassociated urinary tract infection: a prospective study showing the minimal effects of catheter care violations on the risk of CAUTI" Infect Control Hosp Epidemiol 21, 165 40 Matsumoto T, Sakumoto M, Takahashi K, et al (1997) "Prevention of catheter-associated urinary tract infection by meatal disinfection" Dermatology, 195, (2), 7377 41 Mohammadzadeh M, Behnaz Fatemah (2012) "Incidence and risk factorys of catheter-associated urinary tract infectionin Yazd-Iran" International Journal of Urological Nursing The journal of the Baun, 6, (2), 60-65 42 Neuman B (2002) The Neuman systems model., In B Neuman & J Fawcett Upper Saddle River, NJ: Prentice Hall, 3–34 43 Nickel JC, Costerton JW, McLean RJ, Olson M (1994) "Bacterial biofilms: influence on the pathogenesis, diagnosis and treatment of urinary tract infections" J Antimicrob Chemother, 33, (A), 31-41 44 Parker D, Callan L, Harwood J, et al (2009) "Nursing interventions to reduce the risk of catheter-associated urinary tract infection: Part 1: Catheter selection" Journal of Wound, Ostomy and Continence Nursing, 36, (1) 45 Peter T, Bela K, Truls EBJ, Tetsuro M, Paul AT, Kurt GN (2008) "European and Asian guideline on management and prevention of catheter - associated urinary tract infections " International Journal of Antimicrobial Agents, 68 - 78 46 Pickard WG, Grundy DJ (1996) "A comparison of methods of sterile urethral catheterization in spinal cord injured adults" Paraplegia, 34, 30–33 47 Platt R, Polk BF, Murdock B, et al (1982) "Mortality associated with nosocomial urinary-tract infection." N Engl J Med, 307, 637–642 48 Saint S (2000) "Clinical and economic consequences of nosocomial catheterrelated bacteriuria." Am J Infect Control, 28, 68–75 49 Saint S, Chenoweth CE (2003 ) "Biofilms and catheter-associated urinary tract infections." Infect Dis Clin North Am, 17, (2), 411-32 50 Sands K, Vineyard G, Platt R (1996) "Surgical site infections occurring after hospital discharge." J Infect Dis, 173, 963–970 51 Selden R, Lee S, Wang WLL, et al (1971) "Nosocomial Klebsiellainfections: intestinal colonization as a reservoir" Ann Intern Med 74, 657-64 52 Smyth ET, McIlvenny G, et al (2008 ) "Four country healthcare associated infection prevalence survey 2006: overview of the results" J Hosp Infect, 69, (3), 230-48 53 Somwang D, Chertsak Dhiraputra, Rachada Cherdrungsi, et al (2005) "Catheter-Associated Urinary Tract Infection" J Med Assoc Thai, 88 (10), S2630 54 Stamm WE (1993) "Management of urinary tract infection in adults " N Engl J Med, 1993, (329), 1328-34 55 Talaat M, Hafez S, Saied T, et al (2010) "Surveillance of catheter-associated urinary tract infection in intensive care units at Alexandria university hospitals in Egypt" Am J Infect Control, 38, 222-228 56 Tambyah PA, Maki DG (2000) "Catheter-associated urinary tract infection is rarely symptomatic: a prospective study of 1,497 catheterized patients" Arch Intern Med, 160, 678–682 57 Tambyah PA, Knasinski V, Maki DG (2002) "The direct costs of nosocomial catheter-associated urinary tract infection in the era of managed care " Infect Control Hosp Epidemiol, 23, 27–31 58 Tissot E, Limat S, Cornette C, Capellier G (2001) "Risk factors for catheterassociated bacteriuria in a medical intensive care unit." Eur J Clin Microbiol, 20, 260-262 59 Toshie Tsuchida, et al (2008) "Relationship between catheter care and catheter-associated urinary tract infection at Japanese general hospitals: A prospective observational study" International Journal of Nursing Studies, 45 352–361 60 Tsuchida T, Makimoto K, Ohsako S, et al, 352–361 (2008) "Relationship between catheter care and catheter-associated urinary tract infection at Japanese general hospitals: A prospective observational study" International Journal of Nursing Studies, 45, (3) 61 Tsuchida T, Makimoto K, Ohsako S, Fujino M, Kaneda M, Miyazaki T, Fujiwara F, Sugimoto T (2004) "Relationship between catheter care and catheter- associated urinary tract infection at Japanese general hospitals : A prospective observational study" International Journal of Nursing Studies, 357 62 Vanhems P, Baratin D, Voirin N, et al (2008) "Reduction of urinary tract infections acquired in an intensive care unit during a 10-year surveillance program" Eur J Epidemiol, 23, 641-645 63 Webster J, Hood RH, Burridge CA, et al (2001) "Water or antiseptic solution for periurethral cleaning before urinary catheterization: A randomized controlled trial" American Journal of Infection Control, 29, 389–394 64 WHO expert consultation (2004) "Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies." The Lancet, 157-163 65 Wilde MH (2003) "Urinary tract infections in people with longterm urinary catheters." Journal of Wound Ostomy Continence Nurses, 30 (6), 314–323 66 Willson M, Wilde M, Webb M, et al (2009) "Nursing interventions to reduce the risk of catheter associated urinary tract infection Part 2." Journal of Wound, Ostomy and Continence Nursing, 36, (2) 67 WOCN Clinical Practice Continence Subcommittee (2009) "Catheter associated urinary tract infection: Fact sheet." Journal of Wound, Ostomy and Continence Nursing, 36, (2) 68 Wong ES, Hooton TM (1981) "Guideline for Prevention of Catheterassociated Urinary Tract Infections" 69 World Health Organization (2002) "Prevention of hospital – acquired infections" 70 World Health Organization (2002) Prevention of hospital-acquired infections: A practical guide - 2nd edition WHO - Geneva ... hospitals in 2004 showed that the prevalence of UTIs in catheterized patients was 57% [61] A work of Nguyen Thi Tuyet Trinh found that the safe duration of catheterization was about five days [10]... General Hospital (14.8%) [9] According to an initial survey of Department of Infection Control at Nguyen Tri Phuong Hospital, the prevalence of nosocomial infections in 2011 was 11.96%, of those... scarce Separately from the initial survey, there are not any studies on risk factors of CAUTIs in Nguyen Tri Phuong Hospital Hence, conducting a study to identify the prevalence of CAUTIs and its