- 期刊
降低重症單位留置導尿管發生泌尿道感染率專案
Reduction of Catheter-associated Urinary Tract Infection
摘要
存留導尿管相關尿路感染（Catheter-Associated Urinary Tract Infection; CA-UTI）是加護病房常見的院內感染之一，若照護不正確，極容易造成泌尿道感染，導致病人延長住院天數及醫療成本的增加。本單位2009年泌尿導感染發生率為4.02千分之一，尿管使用率為78%，因此，成立專案小組，期望透過專案提升實證知能及照護正確率並降低感染率。經分析發現原因為（一）未儘早評估拔除尿管；（二）病人解便後未用水清洗；（三）護理人員會陰清潔與留置導尿管技術不正確。故針對上述問題制定導尿管放置天數登錄表及可移除導尿管的適應症、規定病人解便後一律用水沖洗及針對人員進行會陰沖洗護理與存留導尿之標準技術教育。在專案執行半年後（2010年4月至2010年9月），病人尿管使用率已下降為58%，且泌尿道感染率從2010年6月至8月皆維持零感染率的成效。專案結果不僅增加護理人員照護技能，亦為病人照護品質帶來最大褔祉。
並列摘要
Catheter-Associated Urinary Tract Infection (CAUTI) is one of the most common nosocomial infections in intensive care units (ICUs). CAUTI can lead to increases in both healthcare costs and length of patient hospital stays. In the ICU of the hospital in Taiwan, where the author works, the CAUTI rate was 4.02% and the use rate of urinary catheters for urinary tract problems was 78% in 2009. The purpose of this project is to reduce the infection rate among patients with retained urinary catheter by implementing evidence-based clinical nursing practice. Based on the data analysis, the causes of CAUTI included prolonged use of indwelling urinary catheter without removal, missed cleaning after each bowel movement, and inadequate nursing techniques performed for cleaning of patient perineum and indwelling urinary catheter. To solve the stated problems, a set of nursing standards for indwelling urinary catheter placement and care were developed. These standards included recording the date of indwelling urinary catheter placement following indicators for catheter removal, cleaning patient perineum right after each bowel movement, and reinforcing nursing skills regarding cleaning of patient perineum and indwelling urinary catheter. After implementation of the project from April 2010 to September 2010, the use rate of indwelling urinary catheters dropped to 58% and CAUTI rate was maintained at zero from June to August, 2010. This project improved not only nursing skills but also quality nursing care with the ultimate result of the enhancement of patient well-being.
延伸閱讀
- 吳美華、藍敏方、范圭玲（2018）。降低導尿管相關泌尿道感染之計畫。台灣醫學，22(6)，646-656。https://doi.org/10.6320/FJM.201811_22(6).0011
- 王淑盈、張佳雯、王雅玲、李彩緣（2015）。組合式照護改善留置導尿管相關泌尿道感染密度成效專案。安泰醫護雜誌，21(1)，64-75。https://www.airitilibrary.com/Article/Detail?DocID=18111955-201506-201508110005-201508110005-64-75
- 鄭惟雅、謝美妃、趙建銘、陳彥如、陳家容（2016）。組合式照護措施降低留置導尿管相關尿路感染率。澄清醫護管理雜誌，12(1)，55-60。https://www.airitilibrary.com/Article/Detail?DocID=18136702-201601-201601080015-201601080015-55-60
- 薛錡蔚、曾惠美、陳亭均、高綺吟（2023）。降低內科加護病房病人導尿管相關泌尿道感染密度。彰化護理，30(2)，52-63。https://doi.org/10.6647/CN.202306_30(2).0008
- 陳姍婷、程瓊嬅、范麗桂（2019）。A Project for Improving the Completion Rate of Bundle Care on Catheter-Associated Urinary Tract Infection。台大護理雜誌，15(1)，218-232。https://doi.org/10.6740/NTUHJN.201901_15(1).0019