導入組合式照護模式降低內科加護病房之導尿管相關泌尿道感染

Introducing Bundle Care to Reduce Catheter Associated Urinary Tract Infection in the Medical Intensive Care Unit

陳秋芬(Chiu-Fen Chen) ； 陳秀玲(Hsiu-Ling Chen) ； 陳姵妏(Pei-Wen Chen) ； 許嘉宏(Chia-Hung Hsu)

《醫學與健康期刊》 8卷2期 (2019/09) Pp. 85-98

摘要

本文旨在降低內科加護病房導尿管相關泌尿道感染率，依據本院2016年度感染報表統計，單位導尿管相關泌尿道感染密度第一季平均為（千分之4.19），4月為（千分之4.77），而5月驟升至（千分之15.27），故成立專案小組。經分析確立問題為：護理師對導尿管相關泌尿道感染認知不足、執行導尿管置放技術與每日照護正確率偏低。研擬解決方案包括：安排多元化的在職教育訓練、根據導尿管組合式照護模式修訂導尿管置放作業及制定導尿管每日照護作業指導書、修訂導尿管拔除後評估流程規範，減少重新置放情形並持續稽核與落實每天評估導尿管留置之必要性。實施改善措施後，單位導尿管相關泌尿道感染密度降至（千分之2.71），成效顯著，期能作為相關照護單位之參考。

關鍵字

組合式照護模式 ； 導尿管相關泌尿道感染 ； 泌尿道感染

並列摘要

In this hospital-based project, we aimed to decrease catheter-associated urinary tract infections in our intensive care unit. According to the 2016 annual surveillance data of our hospital, our average rate of catheter-associated urinary tract infections was (4.19 per mille) in the first quarter followed by (4.77 per mille) in April. The rate rose significantly to (15.27 per mille) in May. Analyzing the problem, we found that nurses had insufficient knowledge of catheter-associated urinary tract infection, low compliance with recommended procedures for inserting catheters and low compliance with instructions for daily care. Solutions included arrangement for multidimensional in-service education, establishment of guidelines for catheter insertion and urinary catheter daily care, revision of the evaluation process of catheter removal, reduction in the unnecessary urinary catheter re-insertions, and daily review of the indications for the urinary catheter. After the implementation of this bundle care project, the rate of catheter-associated urinary tract infection decreased to (2.71 per mille). Authorities can use this report as reference for daily care.

並列關鍵字

Bundle care ； Catheter associated urinary tract infection ； Urinary tract infection

參考文獻

陳瑛瑛、王復德：導尿管相關泌尿道感染之管制策略。感染控制雜誌 2013；23：261-70。Yin-Yin Chen, Fu-Der Wang：An Infection-control Strategy for Catheter-associated Urinary Tract Infection. Infection Control Journal 2013;23:261-70. [In Chinese: English abstract]

蔡青晏、劉建衛：導尿管相關之泌尿道感染預防。感染控制雜誌 2013；23：35-40。Ching-Yen Tsai, Jein-Wei Liu：Prevention of Catheter-Associated Urinary Tract Infection. Infection Control Journal 2013;23:35-40. [In Chinese：English abstract]

衛生福利部疾病管制署：院內感染監視通報系統統計分析。http://www.cdc.gov.tw/professional/list.aspx?treeid=3F2310B85436188D&nowtreeid=E40FC8C198042767。引用2/17/2017。Centers for Disease Control, Ministry of Health and Welfare (R.O.C.). Nosocomial Infections Surveillance System. Available at: http://taqm.epa.gov.tw/taqm/en/Pm25.Index.aspx. Accessed February 17, 2017. [In Chinese]

洪淑貞、鄷玲玲、林淑卿、劉彩娥、劉惠瑚：降低呼吸照護病房病患之泌尿道感染密度。醫學與健康期刊2013；2：89-99。Shu-Chen Hung, Ling-Ling Feng, Shu-Chin Lin, Tsai-Er Liu, Hui-Hu Liu: Reduction of the Urinary Tract Infection Density in the Respiratory Care Ward. Journal of Medicine and Health 2013;2:89-99. [In Chinese: English abstract]

財團法人醫院評鑑暨醫療品質策進會：台灣臨床成效指標系統。http://www.jct.org.tw/FrontStage/page.aspx?ID=D8ADC4BA-00B0-45AD-8B37-29519C30B821。引用3/24/2017。Joint Commission of Taiwan. Taiwan Clinical Performance Indicator. Available at: http://www.jct.org.tw/FrontStage/page.aspx?ID=D8ADC4BA-00B0-45AD-8B37-29519C30B821. Accessed March 24, 2017. [In Chinese]