提升加護病房導管相關泌尿道感染組合式照護完整率

Improving the Completion Rate of Bundle Care on Catheter-Associated Urinary Tract Infection in the Intensive Care Unit

吳碧娥(Pi-O Wu) ； 陳雅惠(Ya-Huei Chen) ； 黃惠美(Hui-Mei Huang) ； 詹明澄(Ming-Cheng Chan)

《志為護理-慈濟護理雜誌》 20卷1期 (2021/02) Pp. 122-133

摘要

導管相關泌尿道感染是加護病房重要感染之一，病人一旦發生感染即會延長住院天數，甚至引發全身感染而致命。本單位2017年第一季導管相關泌尿道感染密度由2016年的2.40升高至4.62，故引發成立專案之動機。本專案目的在提升加護病房導管相關泌尿道感染照護完整率，經問題分析原因為：優碘消毒時間未足2分鐘、無菌用物溢出無菌面、未每日評估拔管、未落實查核。解決辦法包括：改用水溶性2％CHG消毒、使用加大型無菌洞巾、使用管路警示電子看板與e化執行每日照護流程、落實查核機制。專案實施後照護完整率達100％。經分析單位的組合式照護缺失並介入措施，有效降低感染密度至2.20，亦水平推展至其它加護單位，期望做為臨床照護之參考。

關鍵字

加護病房 ； 導管相關泌尿道感染 ； 組合式照護

並列摘要

Catheter-associated urinary tract infection (CAUTI) is one of the important infections in the intensive care unit (ICU). Patients might face a deadly systemic infection and will need to extend their stay in hospitals. The density of CAUTI in the first quarter of 2017 has increased from 2.40 of 2016 to 4.62, thus becoming a huge motivation to this project. The purpose of this project is to improve the completeness of care for CAUTI in the ICU. The analyses of the problem revealed the following: The iodine disinfection time is less than 2 minutes, sterile material spilled sterile surface, the day of extubation is not evaluated, and checks are not performed certainly. To solve the abovementioned problems, we have switched to the water-soluble 2% CHG disinfection, used large-sized asepsis hole towels, installed pipeline electronical warning boards, used daily care procedures with electronic processes, and complied to the verifications. After the implementation of this project, the complete rate of care reaches 100%. The combined care and intervention measures of the analysis unit can effectively reduce the infection density to 2.20, and is able to promote to other nursing units. The result of the project is expected to be used as a reference for future clinical care.

並列關鍵字

bundle care ； CAUTI ； ICU

參考文獻

林蔚如、洪靖慈、鄭宇辰、陳彥旭、盧柏樑(2017)．預防導尿管相關泌尿道感染組合式照護．內科學誌，28(1)，12-17。http://doi.org/10.6314/JIMT.2017.28(1).03。

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Gould, C. V., Umscheid, C. A., Agarwal, R. K., Kuntz, G., & Pegues, D.A. (2010). Guideline for prevention of cath-eter-associated urinary tract infections 2009. Infection Control & Hospital Epidemiology, 31 (04), 319-326. http://doi.org/https://doi.org/10.1086/651091。