降低急性病房留置導尿管相關泌尿道感染密度之專案

留置導尿管相關泌尿道感染（Catheter- Associated Urinary Tract Infection, CAUTI）是醫療機構常見的議題，不僅會延長住院天數及增加醫療成本，也會提高病人疾病的嚴重度。本單位因2015年1～6月的留置導尿管相關泌尿道平均感染密度高居急性病房之首，分析其原因為醫師未能主動評估導尿管是否需要移除、未遵守以無菌技術執行留置導尿管技術、未確實執行手部衛生、未落實每日導尿管照護及檢查、尿袋口與地面未保持適當距離、缺乏留置導尿管技術常規稽核及缺乏合適的集尿桶等因素，故成立專案小組進行分析與探討。自2015年8月1日至2016年9月30日，導入醫策會之留置導尿管組合式照護模式，配合舉辦在職教育、培訓手部衛生種子、運用護理創新物品收納尿袋及常規性稽查導尿技術等措施，評值6個月結果為留置導尿管相關泌尿道感染密度由平均（千分之0.84）降至（千分之0.15），且效果延續6個月皆為（千分之0.00），同時在平均留置天數亦由8.7天降至4.1天；顯示本專案之改善策略成效卓著，藉由分享期望能提升臨床相關單位及病人的照護品質。

關鍵字

泌尿道感染；組合式照護模式；護理創新

並列摘要

Catheter- associated urinary tract infection (CAUTI) is the most common issue in medical institutions. It not only increases hospital stays and medical costs, but also increases the severity of patients' illnesses. From January to June 2015, the average incidence of catheter-associated urinary tract infection was ranked first in the acute ward of hospitals. The factors we found that may cause this high incidence included: the physicians failed to actively assess whether the catheter needs to be removed, the staff failed to comply with aseptic technique for performing indwelling catheter technology, didn't execute proper hand hygiene, didn't execute the daily examination and care of catheter, didn't keep the appropriate distance between the opening of urine collection bags and the ground, and the lack of routine examination for catheterization and appropriate urine collection barrels. We established the project team in order to analyze and explore the rationale. From 2015/8/1 to 2016/9/30, we introduced the ＂CAUTI Bundle Care＂ mode from the Joint Commission of Taiwan. This was done through holding in-service education, introducing and passing on hand hygiene routines, using nursing innovation supplies such as urine collection bags, regular examination of the catheterization, and so on. The six month evaluation indicated that the average incidence of catheter-associated urinary tract infection decreased from (0.84 per mille) to (0.15 per mille), the effect maintained (0.00 per mille) for 6 months, and the average urinary catheter-days decreased from 8.7 to 4.1. Overall, the project resulted in excellent improvements. The quality of care of clinically relevant units and patients can be further improved by sharing expectations.

並列關鍵字

urinary tract infection ； bundle care ； nursing innovation

參考文獻

李歡芳、江惠英（2015）．組合式照護概念．源遠護理，9（3），14-19。doi:10.6530/YYN/2015.5.09

紀美滿、陳瑛瑛（2013）．應用「導尿管移除評估指標」對降低泌尿道感染之成效．台灣醫學，17（3），238-245。doi:10.6320/FJM.2013.17(3).02

黃明喜、黃子庭、陳志道、劉玉玲、吳待芬、江宏彬（2016）．長期留置導尿管相關泌尿道感染高危險因子評估量表的發展與測試．長期照護雜誌，20（2），149-165。doi:10.6317/LTC.20.149

Caljouw, M. A., den Elzen, W. P., Cools, H. J., & Gussekloo, J. (2011). Predictive factors of urinary tract infections among the oldest old in the general population. A popula-tion-based prospective follow-up study. BMC Medicine, 9, 57. doi:10.1186/1741-7015-9-57

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降低急性病房留置導尿管相關泌尿道感染密度之專案

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