降低內科加護病房導尿管相關泌尿道感染密度專案

Reducing the Incidence of Catheter-associated Urinary Tract Infection in Medical Intensive Care Units

楊鎮宇(Cheng-Yu Yang) ； 陳美均(Mei-Chun Chen) ； 邱曉莉(Xiao-Li Qiu) ； 楊曉菁(Hsiao-Ching Yang) ； 陳姮卉(Heng-Heuwi Cheng)

《榮總護理》 37卷1期 (2020/03) Pp. 34-42

https://doi.org/10.6142/VGHN.202003_37(1).0004

摘要

導尿管相關泌尿道感染（Catheter-associated urinary tract infection, CAUTI）易引發多種合併症，致醫療成本及住院天數增加。本內科加護病房於2018年4－6月CAUTI感染密度為千分之6.38高過全國區域醫院平均千分之3.26。分析原因為一、洗手遵從率及正確率低；二、未正確執行導尿管照護技術；三、預防CAUTI認知不足；四、集尿袋結構不良；五、隔離衣置放區未設洗手設備；六、未稽核導尿管相關技術及未舉辦在職教育；七、缺乏導尿管移除機制。本專案為降低CAUTI感染密度，透過在職教育、提示卡、張貼照護海報、拍攝技術影片、改善環境、常規稽核及於晨會討論需移除導尿管病人後，CAUTI感染密度降至千分之0.32；專案已達目標外亦增進人員預防CAUTI之知識及技能，同時提升病人之照護品質。

關鍵字

導尿管相關泌尿道感染 ； 組合式照護 ； 加護病房

並列摘要

Catheter-associated urinary tract infection (CAUTI) increases medical expenditure and prolongs hospital stays. The rate of CAUTI was (6.38 per mille) at our medical intensive care unit in the second quarter of 2018, which was higher than the average rate of (3.26 per mille) in regional hospitals in Taiwan. Data analysis indicated that the causes of CAUTI were as follows: low hand washing compliance rate, inadequate nursing techniques for indwelling urinary catheter, lack of knowledge about CAUTI, faulty design of urine bags, insufficient hand washing equipment, and lack of evaluation criteria for urinary catheter removal. We proposed solutions including organizing in-service education, designing posters for indwelling urinary catheter care, increasing hand washing equipment, enhancing access to catheterization care videos, establishing an audit system, and discussing cases during morning meetings and conducting daily audits. Implementing these measures reduced the rate of CAUTI from (6.38 per mille) to (0.32 per mille) . Thus, the proposed measures reduced the infection rate and CAUTI and improved health care quality.

並列關鍵字

catheter-associated urinary tract infection ； bundle care ； intensive care unit

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