降低內科加護病房導尿管相關泌尿道感染密度改善專案

Project for Reducing the Incidence of Catheter Associated Urinary Tract Infections in a Medical ICU

郭乃瑜(Nai-Yu Kuo) ； 黃怡真(Yi-Chen Huang) ； 葉慧玲(Hui-Ling Ye) ； 陳育婷(Yu-Ting Chen)

《澄清醫護管理雜誌》 13卷4期 (2017/10) Pp. 63-72

摘要

目的：重症單位裡導尿管是常見的侵入性管路，若照護不確實易造成泌尿道感染，使病人延長住院天數及醫療成本增加。本單位2014年1～3月導尿管相關泌尿道感染密度為千分之15.70，超過全國加護病房平均值千分之4.20，故成立專案小組針對導尿管相關感染深入探討分析，將導尿管相關感染密度降至千分之4.20以下。方法：經由文獻查證與改善策略：解決辦法：一、落實組合式導尿管照護；二、全面審核導尿管置入技術認證；三、舉辦導尿管相關感染教育課程及數位課程；四、增加書面及電腦E化拔除導尿管提醒機制。結果：導尿管相關感染密度由2014年1～3月千分之15.70降至2014年10～12月份千分之3.84，導管使用率由75.50％下降為48.00％，尿管留置也由13天下降為6天。結論：希望藉此專案的成果與分享能持續的降低導尿管相關感染密度，亦希望提升護理人員照護技能及病人照護品質最大福祉。

關鍵字

導尿管相關泌尿道感染 ； 組合式導尿管照護 ； 導尿管留置

並列摘要

Purposes: The urinary catheter is one of the most common invasive devices used in the hospital. When patients develop a urinary tract infection, they have longer stays in the hospital and increased medical costs. The catheter-associated urinary tract infections rate was 15.70 per mille in medical intensive care units (ICUs), which is higher than the average in Taiwan. Therefore, we set up a team for decrease the UTI rate through the strategy after this project to incidence of UTI fell below 4.20 per mille. Methods: We reviewed the literature and implemented a cause analysis of efforts in care processing. The following are our improvements: 1. implementation of urinary catheter bundle care, 2. certification of the insertion skill of indwelling urinary catheters, 3. lecture courses about catheter-associated urinary tract infections and 4. development of a reminder system to minimize urinary catheter use and duration of use in all patients. Results: The catheter-associated urinary tract infection rate declined from 15.70 per mille implementation to 3.84 per mille after implementation since 2014. In addition, the indwelling urinary catheter using rate decreased from 75.50% to 48.00% and the duration of catheter using decreased from 13 days to 6 days. Conclusions: This project, we successfully reduced rate of catheter-associated urinary tract infection, promoted our nursing skills, and enhanced the quality of nursing care.

並列關鍵字

Catheter-associated urinary tract infections ； Urinary catheter bundle care ； Urethral catheter indwelling