導入組合式照護模式降低內科加護病房之導尿管相關泌尿道感染

Introducing Bundle Care to Reduce Catheter Associated Urinary Tract Infection in the Medical Intensive Care Unit

本文旨在降低內科加護病房導尿管相關泌尿道感染率，依據本院2016年度感染報表統計，單位導尿管相關泌尿道感染密度第一季平均為4.19‰，4月為4.77‰，而5月驟升至15.27‰，故成立專案小組。經分析確立問題為：護理師對導尿管相關泌尿道感染認知不足、執行導尿管置放技術與每日照護正確率偏低。研擬解決方案包括：安排多元化的在職教育訓練、根據導尿管組合式照護模式修訂導尿管置放作業及制定導尿管每日照護作業指導書、修訂導尿管拔除後評估流程規範，減少重新置放情形並持續稽核與落實每天評估導尿管留置之必要性。實施改善措施後，單位導尿管相關泌尿道感染密度降至2.71‰，成效顯著，期能作為相關照護單位之參考。

In this hospital-based project, we aimed to decrease catheter-associated urinary tract infections in our intensive care unit. According to the 2016 annual surveillance data of our hospital, our average rate of catheter-associated urinary tract infections was 4.19‰in the first quarter followed by 4.77‰in April. The rate rose significantly to 15.27‰in May. Analyzing the problem, we found that nurses had insufficient knowledge of catheter-associated urinary tract infection, low compliance with recommended procedures for inserting catheters and low compliance with instructions for daily care. Solutions included arrangement for multidimensional in-service education, establishment of guidelines for catheter insertion and urinary catheter daily care, revision of the evaluation process of catheter removal, reduction in the unnecessary urinary catheter re-insertions, and daily review of the indications for the urinary catheter. After the implementation of this bundle care project, the rate of catheter-associated urinary tract infection decreased to 2.71‰. Authorities can use this report as reference for daily care.