某醫學中心留置導尿管相關感染管制措施執行之探討

Evaluation of Infection Control Strategy in Indwelling Urinary Catheter in a Medical Center

本研究目的為瞭解臨床單位留置導尿管相關泌尿道感染管制措施之執行情形，利用查核計畫，並舉辦「預防院內感染」系列活動週，以探討活動週介入前後留置導尿管相關泌尿道感染率、感染管制措施執行正確率之分析比較。實施查核計劃時間為2005年7月至12月，活動週介入期間為2005年的月3日至7日；共27個加護及一般病房參與，查核項目分為留置導尿管照護、導尿管放置及尿液標本採集三大頂，內含18子項；查核2,752人，活動週介入前7-9月1,382人（50..2%），介入後10-12月1370人（49.8%）。活動週介入前後比較查核結果，經卡方檢定正確率有顯著改善之項目為尿壺或尿杯使用後清潔（99.5% vs 100%，P = 0.016）；活動週介入後執行正確率反降之項目為正確會陰清潔相關衛教與回覆示教（97.6% vs 96.7%，P = 0.413） 。參與查核病房院內泌尿道感染發生率由2.74‰降至2.41‰，留置導尿管相關泌尿道感染發生率由2.85‰降至2.62‰。活動週之介入雖只能些微降低院內泌尿道感染發生率，但經由活動之進行及在職教育之宣導，得以再次提醒醫療人員及病人主要照顧者相關感染管制措施之執行。（感控雜誌 2009: 19: 205-13）。

The purpose of the research is to understand the practice of the guidelines for prevention of catheter-associated urinary tract infections. By using survey as well as holding intervention activities of prevention of nosocomial infections, we explored and compared the catheter-associated urinary tract infection rates, the efficiency before and after the intervention activities. The period of survey started from July 2005 through December 2005, while the intervention activities scheduled to be Oct. 03 through Oct 07, 2005. Totally 27 units had participated in the surveillance, including intensive care unit and general wards. The 3 items being surveyed: Care of indewelling uninary catheters, inserting of the indewelling uninary catheter and colleting of urine samples, which included 16 sub-items. Totally 2,752 patients being surveyed, of which 1,382 (50.2%) were surveyed before the intervention activities from July through September, while the other 1,370 (49.8%) patients being surveyed after the intervention activities from October through December. We compared the result of survey before and after the intervention activities by Chi-square test. Those showing improvements, including cleaning after usage of jordan or urine cap (99.5% vs 100%, p = 0.016). Those showing practice accurate rate lower was health education and demonstration of perineum care (97.6% vs 96.7%, p = 0.413). Those wards participating in the surveillance, their nosocomial urinary tract infection rates lowered to be 2.41% from 2.74%, and the catheter-associated urinary tract infections rates downed to be 2.85% from 2.62%. The result of the intervention activities showed that it could only decrease a little bit of nosocomial urinary tract infection rates. However, through the intervention activities and promotion of the health education, we take the opportunities to remind the health workers as well as the care takers the importance of practicing the guidelines for infection control. (Infect Control J 2009;19 :205-13).