加護病房病人導尿管泌尿道感染相關因素探討

背景：導尿管泌尿道感染常發生在加護病房病人，導致病人住院天數、醫療花費、失能與死亡等情形的增加。目的：本研究目的為探討加護病房病人導尿管泌尿道感染相關因素。方法：本研究採次級資料分析法，回溯2017年1月1日至2017年12月31日南部某區域教學醫院成人加護病房病人導尿管泌尿道感染情形。資料分析包含獨立t檢定、卡方分析與羅吉斯迴歸，探討導尿管泌尿道感染的相關因素。結果：使用留置導尿管病人共1,120人，菌尿症330人，導尿管泌尿道感染的盛行率為29.5%，導尿管留置平均天數為6.55天（SD=4.89）。樣本平均年齡69.93歲（SD=15.19）；男性627人（56.0%），女性493人（44.0%）。結果顯示女性、糖尿病人、較長導尿管留置天數、大導尿管管徑及無法移除留置導尿管等變項與導尿管泌尿道感染的增加有顯著關係。結論／實務應用：本研究顯示女性與糖尿病病人為導尿管泌尿道感染的高危險族群，導尿管的使用應審慎，建議選用小管徑導尿管與降低使用天數。研究結果可應用於改善導尿管相關泌尿道感染情形，促進醫療照護品質。

關鍵字

留置導尿管；泌尿道感染；組合式照護；次級資料分析

並列摘要

Background: Catheter-associated urinary tract infection (CAUTI) commonly occurs in intensive care units (ICU) and is associated with longer hospital stays and higher healthcare costs, morbidity, and mortality. Purpose: The purpose of this study was to examine the factors associated with CAUTI in ICU patients. Methods: This study was a secondary analysis of data from a study on the usage of indwelling catheters in adult internal and surgical ICU patients at a teaching hospital in southern Taiwan conducted between January 1 and December 31, 2017. Descriptive analysis, the independent t test, chi-square test, and logistic regression were used to examine the factors associated with CAUTI. Results: Of the 1,120 patients with an indwelling urinary catheter in the ICU, 330 revealed a positive urine culture result, indicating a 29.5% prevalence of CAUTI. The average duration of indwelling urinary catheter usage was 6.55 (SD = 4.89) days. The participants averaged 69.93 years old (SD = 15.19 years), and 627 (56.0%) were men and 493 (44.0%) were women. Being female, having diabetes, having a large indwelling urinary catheter, having a longer duration of indwelling urinary catheter usage, and being unable to remove the indwelling urinary catheter during the ICU stay were found to be associated with a significantly higher risk of CAUTI. Conclusion/Implications for Practice: Women and patients with diabetes are particularly vulnerable to CAUTI. Thus, urinary catheters should be used with caution. Using smaller-sized urinary catheters and reducing the duration of urinary catheter use are suggested. The results of this study may be used to guide clinical practice to help reduce the incidence of CAUTI and enhance overall healthcare service quality.

並列關鍵字

indwelling urinary catheter ； urinary tract infection ； bundle care ； secondary data analysis

參考文獻

林玗萱、蕭昭俐、鍾淑貞、鍾幸枝（2017）．以膀胱組合式照護降低導尿管相關泌尿道感染之專案．榮總護理，34（1），78–85。[Lin, Y.-S., Hsiao, C.-L., Chuang, S.-C., & Chuang, H.-C. (2017). Reducing catheter-related urinary tract infections by combining treatment with bladder care. VGH Nursing, 34(1), 78–85.] https://doi.org/10.6142/VGHN.34.1.78

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Aljohi, A. A., Hassan, H. E., & Gupta, R. K. (2016). The efficacy of noble metal alloy urinary catheters in reducing catheter-associated urinary tract infection. Urology Annals, 8(4), 423–429. https://doi.org/10.4103/0974-7796.192099

Conway, L. J., Liu, J., Harris, A. D., & Larson, E. L. (2016). Risk factors for bacteremia in patients with urinary catheter-associated bacteriuria. American Journal of Critical Care, 26(1), 43–52. https://doi.org/10.4037/ajcc2017220

Cortese, Y. J., Wagner, V. E., Tierney, M., Devine, D., & Fogarty, A. (2018). Review of catheter-associated urinary tract infections and in vitro urinary tract models. Journal of Healthcare Engineering. https://doi.org/10.1155/2018/2986742

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