組合式照護措施降低留置導尿管相關尿路感染率

The Impact of Bundle Care on the Rate of Catheter-Associated Urinary Tract Infection

目的：研究推動組合式照護措施對於留置導尿管相關尿路感染率及其他醫療照護相關感染的影響。方法：本研究在一神經外科加護病房執行，期間為2013年6月至2014年7月，依現況分析結果，自2013年8月針對「置入導尿管技術」及「每日照護導尿管」採取具實證基礎之組合式照護措施，包含（一）置入導尿管技術方面：介入措施包含（1）訂定置放導 管適應症指引、（2）依洗手五時機強化導尿管置入前之正確洗手、（3）修訂導尿管置入前會陰部清潔執行方便性，將乾洗潔膚液（CavilonTM No-Rinase Skin Cleanser）放置於病室內隨手可得；及（二）每日照護導尿管方面：介入措施包含（1）每日由醫師進行拔管評估、（2）依洗手五時機強化導尿管照護前後之正確洗手、（3）檢視集尿袋不可超過八分滿、（4）固定導尿管在大腿或腹部、（5）護理師每2小時翻身時檢查引流系統維持密閉無菌，且避免扭曲或壓折，並運用洗手五時機帶動單位感染控制文化塑造。結果：執行後，留置導尿管相關尿路感染發生率部分，由改善前為2.80‰降低為改善後的2.23‰。同時間，中心導管相關血流感染率由改善前為3.06‰，改善後降低為1.92‰；呼吸器相關的肺炎率由改善前為4.10‰，改善後降低為2.90‰。另在單位總醫療照護相關感染密度方面，由改善前為8.37‰，改善後降低為4.91‰。結論：推動組合式照護措施可有效降低留置導尿管相關尿路感染及其他醫療照護相關感染。

Purposes: This study investigates the effect of bundle care on the rate of catheter-associated urinary tract infection (CAUTI) and other healthcare-associated infections (HCAI). Methods: After retrospective analysis of the status of CAUTI in a neurosurgery intensive care unit, in August 2013, we introduced evidence-based bundle cares to reduce the rate of CAUTI. The bundle includes several components including hand hygiene, ensuring that there are the indications for urinary catheter insertion, use of aseptic technique by trained healthcare providers, maintainence of a sterile closed drainage system, keeping the drainage bag below the level of bladder, daily review the indications for the urinary catheter, and early removal of unnecessary catheters. Results: After the implementation of the bundle care, the rate of CAUTI significantly decreased from 2.80‰ during the pre-intervention period to 2.23‰ during the post-intervention period. Meanwhile, the rates of central line-associated bloodstream infections and ventilatorassociated pneumonia were reduced from 4.10‰ to 2.90‰, and 3.06‰ to 1.92‰, respectively. Overall, the rate of HCAIs was also reduced from 8.37‰ to 4.91‰. Conclusions: The implementation of bundle care can effectively reduce the rate of CAUTI and other HCAIs.