改善內科病房泌尿道感染發生率之專案

Enhancing Urinary Tract Infection Prevention in an Internal Medicine Ward: A Quality Improvement Project

背景：泌尿道感染是醫療照護相關感染中最常見的類型之一，其與增加住院天數和醫療成本有關。本單位為醫學中心內科病房，2020年感染控制中發現泌尿道感染率上升至2.03‰，高於全院均值1.52‰，因此引發了專案的動機。
目的：針對泌尿道感染的問題，制定有效的解決方案，提高護理師和照顧者對泌尿道感染照顧的知識和技能，減少導尿管存留天數和環境感染源，從而降低泌尿道感染的發生率。
解決方案通過分析問題，發現護理師和照顧者對泌尿道感染照顧的知識和技能不足，導致感染的發生率增加。因此，制訂了泌尿道感染評估和標準化流程，規劃自學教材並定期考核，設計尿袋標語和錄製雙語會陰清潔影片，並研發減菌床秤減少感染源。
結果：在專案執行的六個月後，護理師和照顧者在泌尿道照護方面的正確率顯著提高。導尿管的存留天數平均為4.7天，泌尿道感染率下降至1.48‰，成功達到專案目標。
結論：建議將預防泌尿道感染的知識和技能納入職前訓練，推廣減菌床秤的使用，以進一步減少泌尿道感染的發生率。

Background & Problem: Urinary tract infection (UTI), one of the most common types of healthcare-associated infections, is associated with increased hospital stay durations and healthcare costs. Our unit is located in the internal medicine ward of a medical center. In 2020, infection control data revealed a rise in the UTI rate to 2.03‰, which was higher than the hospital-wide average of 1.52‰. This prompted the initiation of this improvement project.
Purpose: The aim of this study was to develop effective solutions to address UTI-related issues, improve the knowledge and skills of nurses and caregivers involved in UTI care, reduce indwelling catheter duration and environmental sources of infection, and, ultimately, decrease the incidence of UTIs in our ward.
Resolutions: Through problem analysis, nurses and caregivers were found to lack sufficient UTI-care-related knowledge and skills, leading to an increase in infection cases. A UTI assessment and standardized workflow were developed. Self-learning materials were provided, and regular assessments were conducted. Urine bag labels and bilingual perineal hygiene videos were designed. In addition, an antimicrobial bed scale was developed to reduce the potential sources of infection.
Results: Six months after project implementation, a significant improvement was found in the accuracy of UTI care among nurses and caregivers. The average indwelling catheter duration decreased to 4.7 days and the UTI rate dropped to 1.48‰, successfully achieving the project goals.
Conclusion: The authors recommend incorporating UTI-prevention knowledge and skills into pre-employment training and promoting the use of antimicrobial bed scales to significantly reduce the incidence of UTIs.