針對高風險單位運用組合式留置導尿管之實證照護與健康照護指引降低泌尿道感染及提高管理效能

Application of Clinical Care Guidelines of Bundle Care on Catheter-Associated Urinary Tract Infection to Reduce Urinary Tract Infections and Improve Management Efficacy in High Risk Unit

鄭真佳(Chen-Chia Cheng) ； 薛佩寧(Pei-Ning Shiue) ； 趙家伶(Jia-Ling Jhao) ； 許玫琪(Mei-Chi Hsu)

《健康促進研究與實務》 3卷1期 (2020/01) Pp. 42-52

https://doi.org/10.29442/HPRP.202001_3(1).0005

摘要

目的：感染管制是提升醫療品質和健康促進的過程中受到廣泛討論的議題，與導尿管相關泌尿道感染在醫療照護相關感染中是常見的，尤其是在高風險單位。本神經外科加護病房導尿管相關泌尿道感染，年平均感染密度高達9.43，期藉本研究運用組合式留置導尿管之實證照護與健康照護指引降低泌尿道感染及提高健康促進管理效能。方法：研究執行期間2015年3月1日至2015年12月31日進行問題處理和改善，建立完善的處理架構、管理與流程改進，明訂清楚階段目標，以問卷調查法、技術查核、實地觀察、標準化稽核、常模比較以及審核規範、程序等方法進行資料收集，運用特性要因圖和決策矩陣分析找出重要影響因素，擬訂可行之對策。結果：彙整後確認問題為護理人員照護行為不確實及導尿管照護健康促進認知不足、未修訂導尿管照護標準步驟及流程、未訂定完整統合的導尿管照護稽核制度、缺乏組合式導尿管照護教育訓練和照護系統無資訊化建置。藉由明確策略，修訂加護病房特殊狀況之照護標準、實施在職教育訓練、建置資訊化系統、並執行稽核等，落實方案執行。評值策略之成效，導尿管相關泌尿道感染密度降至（千分之4.31），執行組合式留置導尿管照護正確率由65.6%提升為98.5%，導尿管照護健康促進認知正確性由68.7%提升到100%。結論：此研究成效明顯，有效提昇專業照護品質。透過跨領域團隊共同照護的合作模式、創新的想法、查核和監測機制、物料的更換、臨床技能之正確性及建構資訊化系統等，有效率的整合資源，強化健康促進專業知識。

關鍵字

管理效能 ； 組合式留置導尿管照護 ； 導尿管相關泌尿道感染 ； 加護病房 ； 健康促進

並列摘要

Objectives: Infection control has been a widely discussed issue in the context of improvement of health care quality and health promotion. Catheter-associated Urinary Tract Infections (CAUTI) are the most common type of healthcare-associated infection, especially in high-risk units. The average annual infection rate of CAUTI in this intensive care unit is as high as (9.43 per mille). Thus, the aims of this study were to decrease urinary tract infection and improve management efficacy by applying the evidence based clinical guidelines of the bundle care on indwelling catheter. Methods: The method of study was applied to establish a comprehensive study processing framework, improve management process, clearly define objectives by phases, discuss and review the possible strategies. Survey, skill examination, observation, standardized audit, norm comparison and reviews of clinical practice guidelines were used to collect data and analyze and find the possible causes. Cause and effect analysis diagram and decision-making matrix were also used to identify important influencing factors, and formulate feasible strategies. Results: The significantly influencing factors were confirmed which were related to elements of nursing care activities left incomplete and lack of awareness of catheter care by nurses which contributing to task incompletion, the unrevised catheter care standardized procedures, lack of an integrated clinical audit of urinary catheter cares, and lack of bundle catheter care and construction of related information systems. Educational training and care systems are not information-based. The schemes for problem-solving were developed and included strategies of revision of the clinical standards of the intensive care unit for the special conditions, implementation in-service training programs, establishment of an information system of the bundle care, and carrying out audits. The rate of CAUTI decreased to (4.31 per mille). Nurses' accuracy of indwelling catheter bundle care of nurses increased from 65.6% to 98.5%, and the awareness of catheter care increased from 68.7% to 100% after implementing the study. Conclusions: This study has achieved a remarkable effect and improved efficiently the quality of professional care. Through a multidisciplinary team work and cooperative model, innovative ideas, audit and monitoring system, material replacement for clinical practice, accuracy of clinical skills, and construction of an information system, effective resource integration is achieved and the improvement of professional capacity is gained.

並列關鍵字

management efficacy ； bundle care on indwelling catheter ； catheter-associated urinary tract infection(CAUTI) ； intensive care unit ； health promotion