降低亞急性呼吸照護病房之導尿管相關泌尿道感染密度

Reduce Occurrence of Catheter Associated Urinary Tract Infection in Sub-acute Respiratory Care Ward

導尿管相關泌尿道感染密度上升，不僅增加醫療費用、延長住院天數且死亡率亦上升高達10%。本單位2020／1／1 ~ 10／31之導尿管相關泌尿道感染密度由3.58‰上升至7.04‰，故引發專案動機。分析原因：醫師未落實導尿管拔管評估；護理師留置導尿管技術與照護認知不足、未確實執行導尿管組合式照護措施；缺乏留置導尿管組合式照護在職教育、缺乏定期稽核留置導尿管技術，及缺乏引流管固定工具。故藉由跨團隊會議、製作管路看板、舉辦多媒體教育、定期稽核、製作引流管固定工具等改善措施，導尿管相關泌尿道感染密度由7.04‰降至3.33‰。運用跨團隊合作及視覺管理降低導尿管相關泌尿道感染密度，以提升病人安全及照護品質。

Catheter-associated urinary tract infection not only increases medical expenses and prolongs the length of a patient’s hospital stay but also increases the mortality rate by up to 10%. The density of catheter-related urinary tract infections in our unit rose from 3.58% to 7.04% from January 1 to October 31, 2020, which served as motivation for the project presented herein. Several factors potentially contributed to this issue. Physicians may have neglected to perform catheter extubation evaluations, nurses may have lacked sufficient awareness of indwelling catheter technology, and they may not have consistently implemented comprehensive care measures related to urinary catheters. In addition, our units lacked continual on-the-job education relating to indwelling catheter care, regular audits of indwelling catheter practices, and proper tools for securing drainage tubes. To address these challenges and reduce the incidence of catheter-related urinary tract infections, we implemented various measures such as conducting cross-team meetings, creating urinary catheter care instructional boards, holding multimedia education, performing regular audits, and developing drainage tube fixing tools. The density of catheter-related urinary tract infections declined from 7.04% to 3.33%. By promoting cross-team collaboration and implementing visual management strategies, we substantially enhanced patient safety and the quality of care in our unit, considerably reducing the risk of catheter-related urinary tract infection.