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  • 學位論文

加護病房留置導尿管護理照護方式與醫療照護相關泌尿道感染相關因素探討

Relative Factors of Foley Care Mode In Intensive Care Unit and Healthcare-associated Urinary Tract Infection

指導教授 : 邱艶芬

摘要


本研究目的主要探討加護病房導尿管護理照護方式與醫療照護相關泌尿道感染之關係,以找尋可改善之空間。本研究將採描述性相關性研究設計,以台北市某醫學中心六個不同成人加護病房中留置導尿管的病人為對象,以立意取樣方式收集個案,採縱貫性追蹤方式,符合收案條件者,經簽屬同意書後以自擬之「病人基本資料調查表」、「導尿管使用與照護調查表」,無特定時間至單位,由直接觀察、護理記錄表單、詢問當班照護之護理人員及病歷記載收集資料,共收案180位。以SPSS 17.0套裝軟體進行資料分析與檢定,並以p<.05作為判斷意義之標準,本研究採用描述性統計、Mann-Whitney U、Fisher’s exact test、Chi-square分析有無發生醫療照護相關泌尿道感染兩組之差異,找尋影響的主要危險因子,並估計相對風險,以Multiple linear Regression估算預測力。 研究結果顯示加護病房導尿管留置原因與發生醫療照護相關泌尿道感染無統計上顯著差異(p>.05) ,而年齡≧70歲、無使用抗生素、平均排尿量<2000ml/day、腹瀉天數≧2day、接觸引流系統前後無洗手、排空引流系統有接觸收集容器,為發生醫療照護相關泌尿道感染危險因子(p<.05);以「排空引流系統是否接觸到收集容器」層面的預測力最佳,其解釋量為38%,其餘依次為「是否使用抗生素」、「腹瀉天數是否≧2day」層面,其解釋量分別為12%、8%,這三個聯合預測力達57%。此結果提供臨床護理照護品質改善的方向,更對於醫療照護相關泌尿道感染發生的高危險群,評估留置之必要性及早期移除之相關指標,期減少發生醫療照護相關泌尿道感染之機率。

並列摘要


The purpose of this research is to explore the relationships between the Foley care mode in intensive care units and healthcare-associated urinary tract infection in order to find a great improvement. This is in descriptive and correlation research design, taking six adult intensive care units in a Taipei medical center as an object. 180 Foley catheter possessed cases are collected by judgment sampling and longitudinal follow-up. The data were collected by patient information sheets and foley care information sheets from direct observation, healthcare records, inquiring on-duty healthcare nursing people and medical records. SPSS 17.0 is utilized for data analysis and statistical tests; p value set at 0.05. Descriptive statistics, Mann-Whitney U, Fisher's exact test, Chi-square were employed to analyze this significant test of urinary tract infection which happen or not, and seek main danger factors to evaluates the corresponding risk. A multiple linear regression analysis is carried out to predict the values of a dependent variable. The results shown there were no statistically significant (p< .05) between Foley catheter possessory and healthcare-associated urinary infection. Whether the patient older than or equal to 70 years old? Whether the patient taking antibiotic or not? Whether the average void volume less than 2000ml per day? Whether the patient having diarrhea more than or equal to 2 days? Whether the employ haven't disinfected hand before or after the shunts and drainage system? Whether the employ touched the container of the shunt system while falling? The risk factors of infection were list above, and the most predictable factor was "Whether the employ touched the container of the shunts and drainage system ", which represents 38%, next in sequence was "Whether the patient taking antibiotic or not?" and "Whether the patient having diarrhea more than or equal to 2 days?", which respectively represents 12% and 8%. These three factors had united predictive ability reached 57%. The results suggest the direction of clinical healthcare improvement, the index of the necessity of possessory of Foley catheter for the high-risk group, reducing the possibility of healthcare-associated urinary tract infection.

參考文獻


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張上淳、蘇秋霞、蘇美如、周偉惠、王立信、王復德等人(2008)•2007年台灣院內感染監視系統分析報告•感染控制雜誌,18(6),387-392。
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Alcaide, M. L., Lichtstein, D. M. (2004). Management of urinary tract infections in patients with urinary catheters. Hospital Physician , 8, 29-33.

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