留置導尿管之組合式照護與消毒之新進展

New progress in Bundle Care and Disinfection of Indwelling Urinary Catheters

泌尿道感染是最常見的醫療照護相關感染之一，且其中有相當高的一部份皆為導尿管相關泌尿道感染，因此導尿管置放以及每日照護的過程中，應該如何避免或降低導尿管相關泌尿道感染的發生率，是院內感染管制工作的重要議題，也能夠避免留置管路的病人發生額外的抗生素使用、延長住院、併發症乃至於死亡的風險。目前我國與國外針對導尿管相關泌尿道感染的組合式照護建議，均著重於如何在放置時和日常照護時維持無菌操作和封閉系統，以避免細菌進入管路中，另外如何避免細菌透過常見的侵入的途徑進入泌尿道系統，以及減少管路留置的時間這三項重要的方向；然而，在臨床指引中，對於清潔與消毒步驟使用的溶液或殺菌方式，仍有相當的不確定性。本文將探討導尿管相關泌尿道感染的流行病學資料、微生物入侵的可能途徑、組合式照護的重點工作以及目前對於不同步驟中消毒溶液的使用證據為何。

Urinary tract infections (UTIs) are among the most common healthcareassociated infections, with a significant portion attributed to urinary catheters. Preventing catheter-associated urinary tract infections (CAUTIs) helps mitigate the risks associated with indwelling catheter use, such as additional antibiotic use, extended hospital stays, in-hospital comorbidities, and mortality. Current local and international guidelines for bundle care of CAUTIs emphasize employing aseptic techniques during catheter insertion and maintaining a closed system during routine care to prevent bacterial entry into the urine drainage system. However, considerable uncertainty persists in clinical guidelines regarding the solutions or sterilization methods used for cleaning and disinfecting steps. This study aimed to explore the epidemiological data on catheter-associated urinary tract infections, potential routes of microbial invasion, key tasks in bundle care, and the current evidence for the use of disinfectants in various steps of bundle care.