護理之家住民泌尿道感染發生密度及菌種探討

Urinary Tract Infections Among Residents in Nursing Homes: Incidence Density and Bacteria Character

背景：導尿管留置引起泌尿道感染亦易造成病人致病性、死亡率及醫療資源耗費。而護理人員是主要的照護提供者，其照護行為受照護認知之影響。目的：探討護理之家住民泌尿道感染發生密度、感染菌種及照護人員泌尿道感染預防照護認知。方法：採描述相關性研究，以隨機抽樣方式抽取某市11 家護理之家為對象，資料收集包括：病歷查閱、實驗室檢查數據及照護人員泌尿道感染預防照護認知之問卷調查。結果：共503 位住民受訪，其中病歷記載曾有導尿管留置泌尿道感染發生密度最近一個月、三個月、六個月依序為2.56‰、3.21‰及3.08‰。訪問當日81位住民使用存留導尿管，導尿管留置率平均20.56%（範圍分布2.22%~41.46%），當場送檢尿液常規檢查及尿液培養的結果發現導尿管相關的菌尿症發生密度為29‰，分離菌種以大腸桿菌最多。照護人員泌尿道感染預防照護認知平均正確率77.18%。結論／實務應用：本研究結果能提供後續住民照護或介入性措施規劃的參考，期能降低住民泌尿道感染發生率，提升照護品質。

Background: Catheter-associated urinary tract infection (CAUTI) leads to significant morbidity, mortality and excessive utilization of resources. Nurses and nurse aides are the main care providers. Care behavior is influenced by nursing staff’s knowledge.
Purpose: This study was conducted to examine the incidence density and bacteria character of UTI, and the knowledge affecting CAUTI prevention in health care providers of nursing homes.
Methods: A descriptive research design with a random sample of 11 nursing homes was used for this study. The data collection included: medical records, laboratory tests, and preventive knowledge of urinary tract infection among health care providers.
Results: 503 residents participated in this study. By using the participants’ chart review, the incidence densities of UTI in catheterized residents were 2.56% , 3.21% and 3.08% in the last one, three and six months. The average catheterization rate was 20.56% among 81 residents with indwelling urinary catheters. By using fresh urine routine testing and urine culture examination, the incidence density of bacteriuria was 29‰ on the day of the interview. Escherichia coli was the most frequent. The average accuracy rate was 77.18% that prevent UTI knowledge of the nursing staff in 11 nursing homes.
Conclusion/Implications for Practice: These results may become the foundation for intervention guidelines to decrease the incidence of CAUTI, and to promote quality of care in nursing homes.