- 期刊
加護病房泌尿道感染相關危險因子探討
Risk Factors of Urinary Tract Infection in an Intensive Care Unit
摘要
泌尿道感染是醫療機構最常見的感染部位之一，本研究探討加護病房導尿管病人泌尿道感染危險因子，提供臨床照護的參考。研究採用前瞻性研究設計，以某醫學中心胸腔重症加護室及呼吸治療加護室2008年4月至11月間留置導尿管的病人為研究對象，但排除入加護病房已發生泌尿道感染者。資料收集後進行描述性與卡方統計分析，達統計相關變項者進一步以多變項邏輯式迴歸分析。研究結果顯示154位研究對象泌尿道感染發生率為29.9%，單變項檢定後發現女性泌尿道感染的風險較男性高2.3倍，一般病房置入導尿管的風險較加護病房置入者風險高3倍、在加護病房置入導尿管具保護作用，重置導尿管的風險較未重置者高7.3倍，而病人發燒、尿道口有分泌物、導尿管阻塞泌尿道感染的機會較高。以多變項邏輯式迴歸分析，顯示重置導尿管病人之風險為未重置者的4.96倍、導尿管每多留置一天泌尿道感染的風險會增加5%。本研究結果可讓臨床醫護人員瞭解並落實感染管制，期降低泌尿道感染發生率，縮短住院天數，提升病人照護品質。
並列摘要
A urinary tract infection (UTI) is a common nosocominal infection that affects intensive care unit (ICU) patients. The aim of this study was to investigate the risk factors of UTI among patients in the ICU. A prospective observational study design was conducted in two Respiratory ICUs in a medical center. All patients with urinary catheters and admitted to the ICUs were enrolled between April and November 2008, excluding those with UTI symptoms. Data were collected by chart review-determined demographic characteristics and clinical data; urine routine and bacterial organisms were examined on every3rd catheter day and the day of catheter removal in the ICUs. Among 154 patients, the incidence rate of UTI was 29.9%, and the result of single variable analysis showed that the patients who were female (Odd ratio=2.29, CI=1.07-4.90), had the catheterization performed at general wards (Odd ratio=3.58, CI=1.17-10.99), and re-catheterized (Odd ratio=7.32, CI=3.27-16.40) had significantly higher chances of UTI. The study found, by multivariate logistic regression analysis, that the catheterization day and re-catheterization were significant predictors. The odds being re-catheterized were 4.96 times (CI=1.93-12.78) higher than those not re-catheterized; and those catheterized one more day got chance of contracting UTI by 5% (CI=1.01-1.09). The study results demonstrated the risk factors regarding urinary catheter use and urinary tract infection. Efforts are needed to translate catheter-related knowledge into good clinical practice.