醫療品質專欄降低導尿管相關泌尿道感染之計畫

The Project of Reducing Catheter-Associated Urinary Tract Infection

導尿管相關泌尿道感染是醫療照護中常見的問題之一，而嚴重的泌尿道感染可能引發全身性感染，導致延長住院或病人死亡。藉由事件的分析及品質改善，發現導尿管相關泌尿道感染率高的原因是未正確執行導尿管留置護理、製作集尿器過程染污、缺乏採集檢體標準流程、缺乏在職教育與稽核制度等。此次品質改善活動期望能將兒科加護病房導尿管相關泌尿道感染率由3.8％。降至2.85％。改善策略包含監測導尿管留置護理完成率、制訂自製集尿器製作標準流程及採集檢體標準流程，實施在職教育及建立稽核制度。評值改善策略之成效，導尿管相關泌尿道感染率由3.8％。降低至2.1％。導尿管留置護理完成率由85.6％提升至98.3％，有效降低導尿管相關泌尿道感染率及提升照護品質。 Urinary catheter related urinary tract infection is one of the most common problems in medical care, and severe urinary tract infection may cause systemic infection, which prolongs hospitalization or contributes to the death of patients. By a quality improvement process to analyze the causes of increased incidence of catheter-associated urinary tract infection. We found that the major causes included improper implantation of urinary catheters, contamination during urine collecting process, and lack of standardized procedures of urine collection, education, and audit system. We conducted the quality improvement process and expect a decrease catheter-associated urinary tract infection rate from 3.8%o to 2.85%o in out pediatric intensive care unit. The intervention include monitoring the completion rate of catheter indwelling nursing, developing the standard procedure of self-made urine collecting device and the standard procedures of urine collecting, implementing in-service education, and establishing an audit system. As a result of the effectiveness evaluation strategies, the catheter-associated urinary tract infection rate decreased from 3.8% to 2.1%, and the completion rate of catheter indwelling nursing increased from 85.6% to 98.3%, which effectively reduced urinary tract infection rate and improved the quality of care.