輸尿管內視鏡碎石術後泌尿道感染之改善專案

The Improvement Plan for Urinary Tract Infecti on After Endoscopic Ureterolithotripsy

張麗珍

《秀傳醫學雜誌》 10卷1&2期 (2011/06) Pp. 13-18

摘要

落實院內感染管制為病人安全目標之一。本專案依據2006 年泌尿科病房的泌尿道年平均感染率為0.38%。於2007 年1 月泌尿科病房泌尿道感染率驟增至1.81%，故引發調查及改善之動機。藉由流行病學的觀點進行系統性調查，發現病患皆是行輸尿管內視鏡碎石術及置放雙J 輸尿管導管，而感染源確定來自手術室的內視鏡。經要因分析查檢表，發現內視鏡的消毒未完全，其原因包括：1. 未正確遵循消毒時間2. 無確實檢測消毒溶液3. 器械管腔未確實清洗4. 器械不足未達泡消時根據要因作改善：1. 嚴格執行高程度消毒劑泡消時間2. 修定消毒溶液有效濃度之檢測3. 落實器械清洗流程4. 增設器械。進行改善措施後，病房行輸尿管內視鏡碎石術及置放雙J 輸尿管導管泌尿道感染由1.81% 降至0.0%，因而減少病人住院天數及醫療的浪費。

關鍵字

泌尿道感染 ； 輸尿管內視鏡碎石術 ； 高程度消毒

並列摘要

The practice of nosocomial infection control is one of the targets for maintaining patients’ safety. Due to the average annual infection rate of urological wards dramatically increasing recently (0.38% in 2006 vs. 1.81% in 2007, respectively), this plan was established and carried out. With the epidemiological investigation, we found all patients with nosocomial infection had undergone an endoscopic ureterolithotrispy and placement of double J ureteral catheter. The endoscope in the operation room was suspected to be the infection source. With the checklist of causative analysis, we found the disinfection of endoscope was incomplete. The potential causes might be: 1. the disinfection time is not enough; 2. the disinfection solution has not been properly checked; 3. the tube and cavity of the instruments have not been thoroughly cleaned; 4. the time for immersion disinfection is insufficient due to the shortage of instruments. According to the causative analysis, the improvement measures might be: 1. strictly comply with the time of immersion and disinfection for high-level disinfectant; 2. revise the checkup for the effective concentration of the disinfection solution; 3. fully adhere to the correct procedure for cleaning the instruments; 4.increase the number of available instruments. For the patients who underwent endoscopic ureterolithotrispy and placement of double J ureteral catheter, the urinary tract infection rate decreased from 1.81% to 0.0% following implementation of the improvement measures. Therefore, the length of hospital stay and unnecessary medical cost could be diminished.

並列關鍵字

urinary tract infection ； endoscopic ureterolithotrispy ； high-level disinfection