改善腹膜透析病患發生腹膜炎之認知與技能專案

Decreasing the Incidence of Peritonitis in Peritoneal Dialysis Patients: By Improving the Recognition and Technique

本專案目的為改善腹膜炎病患的認知及換液操作技術。由現況發現單位內腹膜炎感染率2006年突然升高，經整理分析結果40.5%(51/126)病患所得菌種與換液操作接觸污染有關，因此，病患的學習重要性再次被強調，而學習三大原則為認知、技能與情意，本組針對此三方面進行調查，發現病患對造成腹膜炎的認知程度及換液操作技能的正確率均低，因此提出海報宣導、修訂居家透析手冊腹膜炎內容、製作衛教單張與DVD、增設認知與技能再教育追蹤機制等改善方案。結果顯示，病患認知由55.9分提升至99.7分，換液操作技術正確率由17.6%提升至80.8%，均有改善，盼日後可降低腹膜炎發生率，並提供臨床改善參考。

Peritonitis is a common and potentially lethal complication in peritoneal dialysis (PD) patients. It mainly results from malpractice of dialysate exchange. The purpose of our study is to improve the recognition and aseptic technique in PD patients. The infection rate of PD peritonitis in our center obviously increased during 2006. According to our analysis, 40.5% of pathogens are related to the contamination experienced while exchanging dialysate. Therefore, we wished to emphasize once again the importance of patient learning. The principle of learning included recognition, technique and emotions. Our investigation revealed poor recognition and low technique accuracy in PD peritonitis patients. Our improvement methods comprised poster handouts, revising the PD home care manual, education medium (handouts and DVD) advocating, and reinforcing the follow-up system. Our results revealed better recognition (from 55.9% to 99.7%) and a more accurate aseptic technique (from 17.6% to 80%). In our opinion, the infection rate of PD peritonitis will be lowered even further by reinforcing patient education.