運用組合式照護措施降低神經內科加護病房導尿管相關泌尿道感染

Implementing Bundle Care Program to Reduce Catheter-Associated Urinary Tract Infection in Neurology Intensive Care Unit

泌尿道感染(urinary tract infection, UTI)為醫學中心常見醫療照護相關感染(healthcare-associated infections, HAIs)部位之一，約有80%以上與留置導尿管相關，導尿管相關泌尿道感染(catheter-associated urinary tract infection, CAUTI)不但會增加病人的併發症及死亡率，更會延長住院天數和提升醫療費用支出，2020年07-12月本院神經內科加護病房導尿管相關泌尿道感染密度為6.9‰，高於同儕醫學中心內科加護病房感染密度3.8‰，故於2021年07-12月推動導尿管相關泌尿道感染組合式措施(CAUTI Bundle）。
研究期間制訂病人入院導尿管照護標準流程、規劃教育訓練課程、新增警語提醒機制，顏色目視化管理及標準規範稽核等措施，研究實施後CAUTI認知問卷及導尿管查檢表平均正確率皆提升，導尿管相關泌尿道感染密度由6.9‰降至0.9‰，此外導尿管使用率也由75.9%降至64.9%，兩者均達統計意義，我們的推行經驗表示運用CAUTI Bundle是可以有效降低CAUTI。

Urinary tract infection (UTI) is one of the most common healthcare-associated infections in medical centers, and more than 80% cases are associated with indwelling urinary catheters. Catheter-associated UTI (CAUTI) will not only increase the risk of morbidity and mortality, but also prolong the length of hospital stay and increase medical cost. From July to December 2020, the rate of CAUTI in our neurology intensive care unit was 6.9‰catheter-days, which was higher than peer Medical Center Internal Medicine Intensive Care Unit at 3.8‰catheter-days. Therefore, the CAUTI bundle care program was promoted from July to December 2021.
The intervention measures included urinary catheter care standard procedures, staff education, new warning reminder mechanism, innovative color visualization management and standard audit. After the implementation of the program, the mean correct rate of CAUTI cognitive questionnaire and urinary catheter bundle care checklist both increased respectively. The incidence of CAUTI dropped from 6.9‰to 0.9‰catheter-days and catheter usage rate also decreased from 75.9% to 64.9% catheter-days, both statistically significant changes . Our implementation experience shows that the use of bundle care program can effectively reduce CAUTI.