依適應症提示移除尿管可降低內科病房導尿管相關尿路感染

Using an Indicator-Based Reminder of Catheter Removal to Effectively Decrease Catheter-Associated Urinary Tract Infections in General Medical Patients

背景：泌尿道感染是醫療照護機構常見的醫源性感染之一，導尿管相關尿路感染，可能導致敗血症、延長住院、增加醫院成本及病人死亡率。目的：本研究欲探討「依適應症提示移除尿管」對降低內科病人導尿管相關尿路感染之成效。方法　本研究為類實驗性設計，介入措施為每日施行「依適應症提示移除尿管」之流程與標準尿管照護，並對護理人員進行教育課程。收案條件為留置導尿管病人，若入院時已發生泌尿道感染者則排除。於北部某醫學中心的五個內科病房為研究單位，共收案75人，含對照組33位與實驗組42位病人。結果　實驗組發生泌尿道感染人數為7人（16.7%），對照組為15人（45.5%）此差異達顯著（p = .014）；實驗組導尿管留置天數11.0天，對照組12.9天，實驗組導尿管留置天數較控制組減少14.73%；實驗組感染密度為15.2‰，對照組感染密度則為35.3‰。結論／實務應用　本研究發現，「依適應症提示移除尿管」能降低泌尿道感染率及感染密度。臨床應用建議，內科病房醫護人員每日依適應症提示移除尿管，偵測不必要的導尿管留置，提早移除尿管，以減少感染發生。

Background: Urinary tract infections are a common iatrogenic infection in healthcare institutions. Catheter-associated urinary tract infections (CAUTIs) may result in sepsis, prolonged hospitalization, additional hospital costs, and mortality. Purpose: The study examined the efficacy of an indicator-based reminder of catheter removal in decreasing CAUTIs among patients in the general medical ward. Methods: A two-group, quasi-experimental design was used. The intervention strategies included daily implementation of the indicator-based reminder procedure and standardized Foley care and a teaching program for all staff nurses. All patients who received Foley during hospitalization were included, with the exception of those with CAUTI at admission. Seventy-five patients were enrolled from five wards in a medical center, with 33 assigned to the control group and 42 assigned to the experimental group. Results: CAUTIs were diagnosed in 7 participants (16.7%) in the experimental group and 15 participants (45.5%) in the control group. The differences were statistically significant (p = .014). The mean number of Foley days was 14.73% less in the experimental group, with 11.0 for the experimental group and 12.9 for the control group. The incidence density of CAUTIs was 15.2‰ for the experimental group and 35.3‰ for the control group. Conclusions: The present study supports that an indicator-based reminder of catheter removal decreases the incidence rate and incidence density of CAUTIs. Medical personnel in the general medical ward may use this reminder to detect unnecessary indwelling of urinary catheters and to remove Foley catheters as early as feasible in order to prevent CAUTIs.