降低泌尿科病房泌尿道院內感染率之改善專案

Reduction the Incidence of Nosocomial Urinary Tract Infection in a Urologic Ward

泌尿道感染的主要原因85％是由於留置導尿管所引起的。由該院之院內感染率及部位分佈報表得知，2001年至2003年院內感染率平均為0.45％，其中以泌尿道感染佔0.16％最高。自現況發現該病房手術後，有90％的病患存有留置導尿管，且該病房2003年泌尿道院內感率由2001年0.06％及2002年0.07％，提升至0.14％達一倍之多，因此成立專案小組，希望藉此降低泌尿道感染機率。根據調查該病房泌尿道院內感染率高的主要原因為：1.護理人員對導尿管照護規範認知不足及忽略感染管控重要性。2.護理人員衛教不完整。3.缺乏專科性照護標準及持續性監測作業。4.缺乏便利性洗手設備及共用集尿桶。針對以上缺失執行改善方案，其措施包括：1.加強人員在職訓練。2.制定專科性照護標準及監測方法。3.建構便利性洗手設備及於病患入院時給予個人集尿桶使用。結果顯示：泌尿道感染率由0.14％降至0.09％。然而因為一些可控及不可控因素未達目標0.07％，故本專案仍依照標準化持續進行改善中。

Eighty-five percent of urinary tract infection is caused by retained urinary catheterization. According to the annual infection control report in this hospital, the nosocomial infection rate during 2001 to 2003 was 0.45% and the leading category was urinary tract infection (0.16%). In our observation, Foley urethral catheter was placed in around 90% patients after surgery in urology ward. Moreover, the incidence of nosocomial urinary tract infection in this ward rose from 0.06% in 2001 and 0.07% in 2002 to 0.14% in 2003, which was a two-fold increment. Base on this observation, we carried out a project to decrease the urinary tract infection rate in this ward. According to our observation and analysis, we found that the causes of high occurrence of UTI included: 1. Ignorance or innocence of standard operation procedures (SOP) of Foley care and infection control of nursing staff. 2. Inadequate patient education about lowering the possibility of hospital-acquired infection. 3. Insufficient protocol of monitoring catheter-associated infection and even lack of SOP of Foley care. 4. Inadequate handwashing environment and use of common urinary barrel (not individualized). Aiming at these problems, we proposed three methods: 1. Reeducation of our nursing staff, 2. Establishment of SOP in Foley care and monitoring of catheter-related infection 3.Setting up more washrooms and providing individualized urinary barrel during patient admission. The incidence of UTI reduced to 0.09%, although did not reach our goal of 0.07%. Uncontrollable factors were discussed and continuous monitoring was proceeding.