降低內科加護病房病人導尿管相關泌尿道感染密度

Reducing the Catheter Associated Urinary Tract Infection Density in a Medical Intensive Care Unit

背景：導尿管相關泌尿道感染是醫療照護常見感染，會造成住院天數延長與疾病嚴重度加重。本單位2018年導尿管相關泌尿道感染密度5.2‰，高於醫學中心感染密度3.8‰，引發動機進行改善。
目的：導尿管相關泌尿道感染密度降至3.0‰以下。
方法：專案期間為2019年4月1日至2020年3月31日。經現況分析確認感染密度高主要導因為護理人員置放導尿管未遵守無菌、未儘早移除管路、未確實洗手、無實際操作課程、未定時更換倒尿杯、無置放流程稽核制度。透過制定導尿管置放及照護查核表、製作管路天數提醒標語、40秒洗手口訣小卡及計時沙漏、手部衛生競賽、螢光菌落試驗檢視手部清潔成效及倒尿杯顏色標記、專人稽核等多元策略進行改善。
結果：經專案推行多項組合式策略，成效達設定目標值，平均感染密度下降至2.4‰。結論：本專案運用團隊及組合式多項策略，確實降低導尿管相關泌尿道感染，進而提升護理人員預防感染照護知能及提升品質促進病人安全。

Background: Catheter associated urinary tract infection is a common infection in health care which results in the extension of hospital stay and the increase of disease severity. The catheter associated urinary tract infection density in our unit was 5.2‰in 2018, which was higher than 3.8‰in a medical center. Purpose: The project aimed to reduce the catheter associated urinary tract infection density to 3.0‰.
Methods: The project was conducted from 01 April, 2019 to 31 March 2020. After investigation, the reasons of high infection rate included nurses not following the aseptic procedures when inserting a urinary catheter, a urinary catheter not removing as early as possible, not washing hands clearly, a lack of practice courses, without changing the urine cup on schedule and a lack of an audit system. After literature review and team discussion, we conducted a series of strategies including a checklist of urinary catheter insertion and care, reminder slogans of a urinary catheter removal, 40-second mnemonic cards of handwashing and hourglass, hand hygiene competition, fluorescent colony test, color line on urine cup and an audit system.
Results: The infection density was then effectively decreased to 2.4‰.
Conclusions: A series of strategies we used in this project could reduce the catheter associated urinary tract infection density. It is expected that the results could enhance nurses’awareness of prevention of catheter associated urinary tract infection and also improve patient safety.