Caabuqyada Kaadi-mareenka ee la Xidhiidha Tuumbada Macmalka ah ee Kaadi-saarka: Catheter-Associated Urinary Tract Infection (CAUTI)

Mohamed Abdi, MPH, MT (ASCP), CIC

Qeexda CAUTI

Caabuqa kaadi-mareenku wuxuu ku dhacaa xubnaha habdhiska kaadi-mareenka sida kelyaha, dhuumaha kaadida kasoo qaada kelyaha ee kusoo shuba kaadihaysta, kaadihaysta, ama dhuunta kaadida ka saarta kaadihaysta ee dibada jidhka uga saarta. Marka caabuqu ku dhaco bukaan la geliyey TMK ayaa waxaa la yidhaahadaa caabuqa-kaadimareenka ee la xidhiidha TMK ama Catheter-Associated UTI (CAUTI).

Qeexda TMK

Tuumbada macmalka ah ee kaadi-saarka (TMK) waa tuumbo caag ah oo jilicsan oo la geliyo ibta kaadidu ka soo baxdo oo dabadeedna dacalkeeda la  gaadhsiiyo kaadihaysta. TMK waxay kaadida ka soo dareerisaa kaadihaysta oo ay ku shubtaa kiish caag ah oo tuumbada kaga  xidhan dacalka kale oo ah jidhka qofka dibediisa. Tuumbadaasi waxay qokfa bukaanka ah ku jiri kartaa saacado, maalmo, iyo xataa bilo. 

Sababaha TMK loo geliyo bukaanka

Waxaa jira xaalado caafimaad oo muhiim ka dhiga in bukaanka la geliyo TMK. Xaaladaas oo aynu sharixi doono marka aynu sharaxayno xeeladaha lagaga hortago caabuqa, waxaa ka mid ah:

  1. Bukaanka ka lagu samaynayo qaliin qaadanaya saacado
  2. Bukaanka oo kaadidu ku istaagto
  3. Bukaanka oo ku jira xiliga sakaraadka

Caabuqa kaadimareenka ee la xidhiidha TMK wuxuu qofka ku dhici karaa marka caabuq-keene wasakheeyo TMK oo dabadeedna caabuq-keenuhu soo raaco TMK gudaheeda ama dusheeda dabadeedna ay u gudbaan xubnaha jidhka ee kaadimareenka, dabadeedna sababaan caabuqa kaadimareenka. Caabuqa kaadimareenka waxaa inta badan keena caabuq-keeneyaasha bakteeriyada iyo fangaska. Marka la eego halka ay ka yimaadaan, caabuq-keeneyaasha waxaa loo qaybiyaa laba nooc oo kala ah:<br /> Caabuq-keeneyaal ka yimaada qofka jidhkiisa gaar ahaan xubnaha taranka iyo futada<br /> Caabuq-keeneyaal ka yimaada gacmaha aan la nadiifin ee shaqaalaha caafimaadka oo wasakheeya TMK, gaar ahaan marka tuumbada la gelinayo ibta kaadidu kasoo baxdo ilaa kaadihaysta ama marka la daryeelayo ee la dayactirayo TMK.<br /> Waxaa jirta dariiqo sadexaad oo loo yaqaan biofilm oo caabuq-keeneyaashu ugu gudbi karaan xubnaha kaadimareenkaCaabuqa kaadimareenka ee la xidhiidha TMK wuxuu qofka ku dhici karaa marka caabuq-keene wasakheeyo TMK oo dabadeedna caabuq-keenuhu soo raaco TMK gudaheeda ama dusheeda dabadeedna ay u gudbaan xubnaha habdhiska  kaadimareenka, dabadeedna sababaan caabuqa. Caabuqa kaadimareenka waxaa inta badan keena caabuq-keeneyaasha bakteeriyada iyo fangaska. Marka la eego halka ay ka yimaadaan, caabuq-keeneyaasha waxaa loo qaybiyaa laba nooc oo kala ah:

  • Caabuq-keeneyaal ka yimaada qofka jidhkiisa gaar ahaan xubnaha taranka iyo futada
  • Caabuq-keeneyaal ka yimaada gacmaha aan la nadiifin ee shaqaalaha caafimaadka oo wasakheeya TMK, gaar ahaan marka tuumbada la gelinayo ibta kaadidu kasoo baxdo ilaa kaadihaysta ama marka la daryeelayo ee la dayactirayo TMK.
  • Waxaa jirta dariiqo sadexaad oo loo yaqaan biofilm oo caabuq-keeneyaashu ugu gudbi karaan xubnaha kaadimareenka

Khataraha sababa in bukaanku qaado caabuqa kaadimareenka ee la xidhiidha TMK

  • TMK oo mudo dheer ku jirta bukaanka kaadimareenkiisa. Maalinkasta oo TMK kusii jirto kaadimareenka qofka waxay kor u qaadaa khatarta uu qofku ku qaadi karo caabuqa 3% ilaa 7%. Sidaas daraadeed, waxaa muhiim ah in TMK laga saaro qofka marka ugu horeeysa ee la xaqiijoyo in aanu qofku baahi caafimaad u qabin isticimaalka TMK.
  • Qofka bukaanjiifka ah ee isticimaalaya TMK oo dumar ah
  • Qofka oo da’ weyn
  • Iyada oo la furo halka ay TMK kaga xidhan tahay tuumbada kale ee kaadida ku shubta kiishka bacda ah.

Calaamadaha lagu garto caabuqa kaadi-mareenka 

Qofka qaada caabuqa kaadimareenku wuxuu yeelan karaa calaamadaha soo socda qaarkood ama dhamaantood.

  • Xumad
  • Qofka oo ay badado inta jeer ee uu kaajayaa
  • Qofka oo doona inuu markiiba kaajo haddii kaadi yari qabato
  • Kaadi-haysta iyo dhuunta kaadida saarta oo olola, gaar ahaan marka qofku kaajayo
  • Gumaarka oo damqada
  • Dhabar dhinaceedka hoose oo qofka xanuuna

Mudada ay ku qaadato in calaamada caabuqu soo if-baxaan

Mudadu waxay ku xidhan tahay nooca caabuq-keenaha. Inta badan bakteeriyada keenta caabuqa kaadimareernku sida bakteeriyada E coli waxay ku qaadataa 3 ilaa 8 maalmood in calaamadaha cudurku soo ifbaxaan

Xeeladaha lagaga hortago caabuqka kaadimareenka ee la xidhiidha TMK

Xeeladaha lagaga hortago caabuqa kaadimareenka ee la xidhiidha TMK waxaa loo kala saari karaa la qaybood oo kala ah:

  • Xeeladaha aasaasiga ah oo loo baahan yahay in cusbitaal kasta oo daryeel deg deg ah bixiyaa uu dhaqan geliyo.
  • Xeelado gaar ah oo loogu talo galay in la isticimaalo marka xeeladaha aasaasiga ahi ay wax ka qaban waayaan ka hortagga iyo hakinta caabuqyada kaadimareenka ee la xidhiidha TMK. 

Xeeladaha aasaasiga ah
waxaynu u qaybinaynaa afar qaybood oo kala ah: 1) shaqaalaha caafimaad oo la siiyo tababar la xidhiidha TMK; 2) in la cadeeyo xaaladaha caafimaad ee TMK loo geliyo bukaanka; 3) in la raaco xeeladaha haboon ee gelinta TMK; iyo 4) in la xaqiijio in si wanaagsan loo dayac tiro TMK. 

  • Waa in shaqaalaha caafimaadka la siiyaa tabobar ku saabsan sida TMK loo geliyo, daryeelo, loona dayactiro TMK. Tabobarka la siinayo shaqaalaha waa in ay ka mid ahaadaan, in shaqaalaha caafimaadka la baro xalalka kale ee lagaga maarmi karo TMK, habka loo geliyo TMK, sida loo maareeyo TMK marka ay ku jirto bukaanjiifka, iyo sida TMK looga saaro bukaanjiifka.
  • Waa in marmar la qiimeeyaa aqoonta iyo kartida shaqaalaha caafimaadku u leeyihiin gelinta, daryeelka, iyo dayactirka TMK.
  •  Shaqaalaha caafimaad ee TMK gelinaya bukaanjiifku waa in ay leeyihiin karti iyo aqoon ku saabsan sida loo geliyo TMK bukaanjiifka. Waa in shaqaaluhu haystaan agabka muhiimka u ah in si caabuq-keene la’aan ah loo geliyo TMK bukaanjiifka.

Waa in cusbitaalku leeyahey xeer si cad u qeexaya xaaladaha lagamamaarmaanka u ah in TMK la geliyo bukaan-jiifka ah. Xarunta CDC waxay qortay shuruudo kooban oo lagamamaarmaan ka dhigaya in TMK la geliyo bukaanka. Shuruudahaas waxaa ka mid ah:

  1. Iyada oo ay muhiim tahay in la cabiro xadiga kaadida ee ka baxaysa qofka jidhkiisa.
  2. Iyadoo bukaanka lagu samaynayo qaliin qaadanaya saacado
  3. Iyadoo ay muhiim tahay in qofku dareemo rafaad la’aan xiliga uu ku jiro gunaanadka noloshiisa
  4. Qofka oo kaadidu ka iman weydo
  5. Iyadoo ay muhiim tahay in ay bugsadaan boogaha ku yaal maqaarka ku hareeraysan xubnaha taranka, futada, iyo halka ugu hoosaysa lafdhabarta.
  6. Iyadoo ay caafimaad ahaan muhiim tahay in qofku aanu samayn wax dhaq-dhaqaaq ah inta uu sariita jiifo, sida qofka oo ka jabay laf-dhabarta ama ay soo gaadheen dhaawacyo badan oo kale oo damqanaya haddii qofku dhaqdhaqaaqo.
  • TMK waa in la geliyaa oo keliya marka uu bukaanjiifku buuxiyo ugu yaraan mid ka mid ah shuruudaha kor ku xusan ee lagamamaarmaanka u ah in la geliyo TMK.
  • Isticimaal habab kale oo lagu maarayn karo kaadihaysta bukaankiifka oo lagaga maarmi karo isticimaalka TMK. Hababkaas kale waxaa ka mid ah habka gelinta kooban oo ah in TMK la geliyo bukaanjiifka mudo yar oo kooban oo aan ka badnayn inta kaadida ku jirta kaadihaystu ay ka soo dareerayso kaadihaysta. Marka kaadidu kasoo dhamaatana islamarkiiba TMK laga saaro bukaanjiifka. Habkan waxaa afka qalaad lagu yidhaahdaa “intermitent cathererization”.
  • Shaqaalaha caamimaadku waa inay gacmahooda nadiifiyaan kahor marka ay gelinayaan TMK. Sidoo kale, waa inay gacmahooda nadiifiyaan kahor iyo kabacdi markasta oo ay dayactirayaan ama maareeyaan TMK ee ku jita bukaanjiifka. Shaqaalaha caafimaadku waa inay raacaan talooyinka iyo xeerarka gacmo nadiifinta ee uu diyaariyey Ururka Caafimaadka Aduunka (WHO)
  • Waa in la geliyaa TMK iyada oo la raacayo habka caabuq-keene la’aanta, islamarkaana la isticimaalaa qalab si buuxda uga nadiifsan caabuq-keeneyaasha.
  • Dhamaan agabka iyo qalabka (gacmogashiga, gogosha, burushyada, iwm) loo isticimaalayo gelinta TMK waa inay ahaadaan kuwo ka madhan caabuq-keeneyaal oo loo soo nadiifiyey qaabka steerilisayshanka.
  • Haday suurtogal tahay waa in bukaanjiifka la geliyaa TMK dhumuceedu dhuuban yahay si looga hortago in bukaanjiifka xubnihiisa/heeda kaadimareenka aan dhaawac kasoo gaadhin TMK ee dhumuceedu balaadhan yahay. 
  • TMK si wanaagsan ugu xidh jidhka si aanay u dhaq-dhaqaaqin oo u xoqin una dhaawicin xubnaha kaadimareenka.
  • Waa in la ilaaliyaa isku-xidhnaanta TMK oo aan marnaba lakala furin halka ay tuumbadu kaga xidhan tahay tuumbada kale ee kaadida ku shubta kiishka bacda ah.
  • Waa in TMK la bedelaa oo mid cusub la geliyaa bukaan-jiifka haddii ay dhacdo in la furay isku-xidhnaanta TMK, ama shaqaalaha caafimaadku raaci waayeen habka caabuq-keene la’aanta, ama tuumbada macmalka ee kaadi-saarka ay daaciso ama si khaldan u dareeriso kaadida.
  • Haddii la doonayo in kaadi laga qaado bukaanjiif ay ku jirto TMK, waa in kaadida laga shubaa halka loo yaqaan cannula adaptor ee ku taala TMK. Waa inaan kaadida sambalka ah ee loo dirayo shaybaarka laga qaadin kiishka bacda ah ee TMK kaadida ku shubto. Hubi arimaha soo socda:
  • Waa in aanay marnaba jirin wax hakiya dareerka kaadida
    1. Kiishka bacda ah ee kaadidu ku dareertaa waa in uu marwalba ka hooseeyaa kaadihaysya bukaanjiifka. Islamarkaana, kiishka bacda ah waa in aan la dhigin dhulka oo laga laalaadiyaa meel dhulka ka saraysa sida sariirta dhinaceeda.
    2. TMK iyo tuumbada dheer ee kaadida ku sii dhubta kiishka caaga ah waa in laga ilaaliyaa laablaab iyo isku guntamid.
    3. Waa in kiishka caaga ah si joogto ah loo faaruqiyaa oo kaadida laga shubaa iyada oo la isticimaalayo baaldi gaar u ah bukaanjiifka. Naaska kaadiddu ka baxayso ee kiishka caagu waa in aanu taaban baaldiga.
  • Waa in si joogto ah loo nadiifiyaa hareeraha ibta xubinta taranka ee bukaanjiifka. Muhiim maaha in la isticimaalo milanka lid-jeermiska marka la nadiifinayo hareerta ibta xubinta taranka. saabun iyo biyo ayaa lagu nadiifin karaa. 
  • Samee khatar-qiimayn ku saabsan heerka uu caabuqa kaadi-mareenka ee la xidhiidha TMK ugu dhacay0 qaybaha kala duwan ee bukaan-jiifka ama qaybaha cusbitaalka sida qaybta kansarka, caruurta, daryeelka halista ah, IWM. Haddii khatar-qiimayta lagu ogaado in caabuqa kaadi-mareenka ee la xidhiidha TMK uu si heer sare ah ugu dhacayo qayb ama qaybo ka mid aha bukaan-jiifka, waa in la dhaqangeliyaa oo la isticimaalaa xeeladaha gaarka ah ee soo socda:
  • Samee oo dhaqangeli mashruuc cusbitaalka oo dhan khuseeya oo lagu ogaanayo tirada bukaan-jiifka ay ku jirto TMK. Mashruucaas oo fududaynaya in TMK laga saaro kadib islamarkiiba marka aanu bukaan-jiifku u baahnayn TMK.
  • Isticimaal tuseyaal shaqaalaha caafimaadka ugu yaraan hal mar maalintii xusuusinaya in bukaan-jiifka ay ku jirto TMK islamarkaana muujiyanaya baahida caafimaad ee TMK ugu sii jiriayso bukaan-jiifka
  • Shaqaale caafimaad oo ka kooban dakhtar iyo kalkaaliyeyaal waa in ay maalintii hal mar ku wareegaan qaybaha bukaan-jiifka oo ay ka go’aamiyaan in TMK laga saaro bukaan-jiifka, iyo haddii kale sababta caafimaad ee ay TMK ugu sii jireyso bukaanka.
  • Samee oo dhaqangeli xeerar lagu maareeyo bukaan-jiifka qaliin ay galeen daraadeed kaadidu ku istaagtay. Xeerarkan waxaa ka mid noqon kara in kalkaaliyeyaasha caafimaadku ay awood u lahaadaan go’aaminta iyo isticmaalka habka gelinta kooban ee TMK. Waxaa kale oo xeerarkan ka mid ah in la isticimaalo sawir-qaadaha kaadihaysta (bladder scanner) si loo eego in kaadiyi ka buuxdo kaadihaysta.
    1. Diiwaangeli sababta loo isticimaalay sawir-qaadaha kaadihaysta, si ku haboon u nadiifi sawir-qaadaha kaadihaysta, islamarkaana tabobar sii shaqaalaha caafimaad sida loo isticimaalo sawir-qaadaha kaadihaysta.
  • Si joogto ah ha u isticimaalin TMK gudaheeda lagu dheehay maadoohinka lidka ku ah noolaha ili-maqabatyga ah ama dila caabuq-keeneyaasha.
  • Ha baadhin oo muunad kaadi ah oo loo diro shaybaarka haka qaadin bukaanjiifka ay ku jirto TMK ee aanay ka soo ifbixin ama aan lahayn calaamadaha lagu garto caabuqyada ku dhaca habdhiska kaadimareenka.
  • Ha dawayn bukaanjiifka ay ku jirto TMK ee aanay kasoo ifbixin calaamadaha caabuqa kaadimareenku laakiin kaadidooda lagu arko bakteeriyo.
  • Haku degdegin biyo-raacinta TMK.
    1. Waa in aanay noqon xeelad si joogto ah loogaga hortago caabuyada kaadimareenka in kaadihaysta bukaanjiifka si xidhiidh ah loo waraabiyo oo la biyo-raaciyo iyada oo la isticimaalayo maadooyinka lidka ku ah caabuq-keeneyaasha.
    2. Haddii ay dhacdo in la isticimaalo biyo-raacinta xidhiidhka ah si loo looga hortaggo in TMK ay xidhanto oo kaadida dareerin weydo, waa in aan marnaba la furin halka ay iskaga xidhan yihiin TMK iyo tuumbada dheer ee kaadidada ku shubta kiishka caaga ah.
  • Bukaanjiifka ay ku jirto TMK ha u qorin oo ha siin dawooyin ujeedadoodu tahay in lagaga hortaggo caabuqyada kaadimareenka.
  • Si joogto ah ha u bedbedelin TMK. Taas macnaheedu waxa weeye in haddii TMK ay si caadi ah u shaqaynayso oo aanay jirin khatar horseedi karta natiijo aan la jeclaysan, muhiim maaha in TMK laga saaro bukaanjiifka haddii uu/ay weli baahi caamifimaad u qabo TMK.

La socodka heerka caabuqa kaadi-mareenka ee la xidhiidha TMK

  • Khatar-qiimayn ku xaqiiji inay muhiim tahay in lala socdo caabuqyada kaadi-mareenka ee la xidhiidha TMK ee ku dhacaya bukaan-jiifka.
  • Raac sharciga haddii dowladu waajib ka dhigtay in lala socdo caabuqyada kaadi-mareenka ee la xidhiidha TMK.
  • Waa in la ogaadaa nooca bukaan-jiifka iyo qaybaha cusbitaalka ee aadka u isticimaala TMK iyo kuwa khatatka ugu jira caabuqa kaadimareenka ee la xidhiidha TMK.
NHSN
National Healthcare Safety Network waa hoyga xeerarka iyo hageyaasha sida loola socdo caabuqyada la xidhiidha daryeelka caafimaad.
Guji
La soco heerka caabuqa
Cusbitaal kasta oo bixiya daryeelka deg-dega ah (acute care hospital) waa in uu leeyahay qorshe lagula socdo heerka caabuqa kaadi-mareenka ee la xidhiidha TMK ee ku dhacaya bukaan-jiifka qaybta daryeelka bukaan-jiifka halista ah (ICU) iyo waadhadhka kale ee cusbitaalka.
Bil kasta xisaabi heerka caabuqa
Marka war la helo ayaa talo la helaa

Tixraac: References 

  1. CDC Catheter-Associated Urinary Tract Infections. CAUTI Guidelines | Guidelines Library | Infection Control | CDC. Accessed September 22, 2021.
  2. SHEA. Strategies to Prevent Catheter-associated Urinary Tract Infections in Acute Care Hospitals: 2014 Update. Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals: 2014 Update | Infection Control & Hospital Epidemiology | Cambridge Core. Accessed: September 23 2021.
  3. NHSN. Urinary Tract Infection (Catheter-Associated Urinary Tract Infection [CAUTI] and Non-Catheter-Associated Urinary Tract Infection [UTI]) Events. Urinary Tract Infection (cdc.gov). Accessed: September 23, 2021.
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  6. Pathophysiology, Treatment, and Prevention of Catheter-Associated Urinary Tract Infection. Top Spinal Cord Inj Rehabil. Summer 2019;25(3):
  7. Nicolle LE. Catheter-associated urinary tract infections. Antimicrob Resist Infect Control. 2014;3:23.
  8. O’Brien VP, Hannan TJ, Nielsen HV, Hultgren SJ. Drug and vaccine development for the treatment and prevention of urinary tract infections. Microbiol Spectr. 2016;4(1)
  9. Menegueti MG, Ciol MA, Bellissimo-Rodrigues F, Auxiliadora-Martins M, Gaspar GG, Canini SRMDS, Basile-Filho A, Laus AM. Long-term prevention of catheter-associated urinary tract infections among critically ill patients through the implementation of an educational program and a daily checklist for maintenance of indwelling urinary catheters: A quasi-experimental study. Medicine (Baltimore). 2019 Feb;98(8)
  10. Patel PK, Gupta A, Vaughn VM, Mann JD, Ameling JM, Meddings J. Review of Strategies to Reduce Central Line-Associated Bloodstream Infection (CLABSI) and Catheter-Associated Urinary Tract Infection (CAUTI) in Adult ICUs. J Hosp Med. 2018 Feb 1;13(2)