縮短加護病患導尿管留置天數專案

A Project of Shortening Days of Indwelling Urinary Catheter for Patients in the Intensive Care Unit

導尿管每多留置一天即會有5%泌尿道感染的機會。因此本單位成立改善小組，希望藉此縮短導尿管留置天數，降低因導尿管多留置造成的泌尿道感染率之幅度。分析病患導尿管留置超期原因為：1.醫護人員對於導尿管留置的感控知識不足。2.無導尿管留置或拔除之相關的標準作業規範，致導尿管的置放、拔除皆由負責醫師個人之認知而定。本專案運用品管手法，針對以上缺失問題，執行改善措施：1.舉辦醫護人員泌尿道感染相關的在職教育。2.制定導尿管置放或拔除的標準作業：訂定導尿管置放或拔除的時機、天數及監測方法。結果顯示：病患導尿管留置天數由原來的7.1天縮短為4.5天；發生泌尿道感染率由原來之11.6‰降低至9.8‰，下降幅度為16個百分點。而抗生素使用之藥費亦由每月平均152,000元降至44,000元，是本專案的另一效益。

Urinary tract infections associated with the indwelling urinary catheters are the most common cause of nosocomial infections. Prolonged urinary catheterization for one more day is the most important risk factor for acquisition of a urinary tract infection with a relative risk of 5 % . The goal of this project was try to shorten the date of indwelling urinary catheters in order to reduce the catheter-associated urinary tract infections (CAUTI). We found that the causes of prolonged urinary catheterization were: 1) the knowledge of infection control relevant to the urinary catheterization is insufficient, 2) Lack of the standard operation procedure regarding the insertion or removal of urinary catheterization. In order to reduce CAUTI, we therefore developed measures to improve the situation of prolonged catheterization. The measures included a on-job training program related to urinary tract infection and setting up a standard operation procedure for the routine urinary catheterization. The results revealed that the duration of urinary catheterization was significantly reduced (from 7.1 to 4.5 days, p<0.001). The rate of CAUTI was also significantly reduced (from 11.6% to 9.8%). The monthly cost of antibiotics from CAUTI was reduced from 152,000 to 44,000 NT dollars. The later was an unexpected effect of our project. Conclusion: This study demonstrates that a simple measure instituted as part of a continuous quality improvement program significantly duration of urinary catheterization, rate of CAUTI, and additional costs of antibiotics to manage CAUTI.