運用組合式照護於某地區醫院加護病房導尿管相關泌尿道感染成效分析

The Evaluation of Care Bundle at Catheter-Associated Urinary Tract Infections in Intensive Care Units of a District Hospital

凌正華(CHENG-HUA LING)

指導教授 ： 葉德豐

中臺科技大學/管理學院/醫療暨健康產業管理系碩士班/碩士(2019年)

摘要

目的：本研究主要探討南投縣某地區醫院加護病房2015年至2018年使用導尿管病人發生導尿管相關泌尿道感染的趨勢及危險因子。以及不同階段推行「導尿管組合式照護」對於導尿管相關泌尿道感染密度之影響，進而應用於臨床照護，提供病人安全的醫療環境及醫療品質。方法：本研究為縱斷性研究，由感控室收集2015年5月至2018年12月放置導尿管之加護病房病人為研究對象，共計收案2,132人次。以描述性統計、卡方檢定及多元羅吉斯迴歸分析探討個案的人口學資料、住院資料及導管使用資料，是否與發生導尿管相關泌尿道感染有所關聯；並分析推行「導尿管組合式照護」不同階段之導尿管相關泌尿道感染密度趨勢變化。結果：本研究經卡方檢定與多元羅吉斯迴歸分析結果發現較長的住院天數與加護病房住院天數，以及使用18號以上導尿管等因素與加護病房導尿管泌尿道感染有顯著關聯。在實施「導尿管組合式照護」後，平均感染密度由準備期3.17‰(SD=2.61)，在執行期及自主期分別下降至2.33‰(SD=0.35)及2.43‰(SD=0.54)，可看出感染密度的平均值與標準差均縮小，顯示感染密度及其變異性有縮小的趨勢。結論：本研究結果發現住院天數、加護病房住院天數與導尿管留置天數愈長、導尿管管徑愈大，發生導尿管相關泌尿道感染的機會愈高，因此降低住院天數、加護病房住院天數以及使用較小管徑之導尿管可減少發生導尿管相關泌尿道感染之風險。實施「導尿管組合式照護」有降低導尿管相關泌尿道感染並縮小變異性的趨勢，對於降低綜合科加護病房導尿管相關泌尿道感染有所助益。

關鍵字

導尿管相關泌尿道感染 ； 導尿管組合式照護

並列摘要

Purpose:This study mainly discussed the trend and risk factors of catheter- associate urinary tract infection among patients using urinary catheters in the intensive care units of a district hospital in Nantou County from 2015 to 2018. It also discussed the catheter-associate urinary tract infection rate in different "catheter associated care bundle" stages, which can then provide a safe medical environment and quality of care for patients.Methods:This is a longitudinal study which patients was placed catheters in the intensive care unit from May 2015 to December 2018 were collected by the sensory control room. A total of 2,132 cases were collected. Descriptive statistics, Chi-square test and multiple logistic regression analysis were used to identify whether demographic data, hospitalization data and catheter usage data of the cases were related to catheter-associate urinary tract infection. The trend of catheter-related urinary tract infection rate in different stages of implementing "catheter associated care bundle" was also analyzed.Results:Chi-square test and multiple logistic regression analysis showed that the longer hospitalization days and the more days in the intensive care unit, as well as the use of over size 18 catheters were significantly related to catheter-associated urinary tract infection in the intensive care units. After the implementation of "catheter associated care bundle", the average infection rate decreased from 3.17‰(SD=2.61) in the preparation period to 2.33‰(SD=0.35) and 2.43‰(SD=0.54) in the execution period and the autonomous period, respectively. The average and standard deviation of infection rate decreased showed a decreasing trend of infection rate and its variability.
Conclusions:
The results showed that the longer the hospitalization days, the longer days in the intensive care units, the longer indwelling days of the catheter, and the larger the catheter diameter, the higher the chance of catheter-associated urinary tract infection. Therefore, reducing the hospitalization days and the days in the intensive care unit, and using catheter with a smaller diameter can decrease the risk of catheter-associated urinary tract infection. Implementing "catheter associated care bundle" has a tendency of reducing urinary tract infection rate and its variability, which is helpful to decrease catheter-associated urinary tract infection in the intensive care units.

並列關鍵字

CAUTI ； UTI CARE BUNDLE

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