運用多元策略降低腹膜透析腹膜炎發生率

Using multiple strategies to reduce the incidence of peritonitis on peritoneal dialysis

腹膜透析發生腹膜炎不僅會影響透析效果，嚴重時需終止腹膜透析治療，佔腹膜透析病人致死因素的15%。專案期間為2019年4月1日至9月30日，目標在改善腹膜炎發生率。經現況分析發現腹膜炎發生率高的原因有:病人及主要照顧者未正確執行換液技術、認知不足；未明確增加技術稽核時機、缺乏相關衛教指導、提醒標語以及多元衛教輔助工具。藉由修訂腹膜透析換液技術標準，提升換液技術正確率、加強腹膜炎相關認知、增加技術稽核時機、製作相關衛教單張及提醒標語、使用多元衛教輔助工具等改善對策後，腹膜炎發生率由3.62次/100人月降至1.55次/100人月。本專案運用多元策略降低腹膜炎發生，提高腹膜透析治療的自我照顧認知與技巧，進而提升腹膜透析醫療照護品質。

 

Peritonitis will not only influence the efficacy of peritoneal dialysis (PD), but it is necessary to terminate PD treatment in severe cases. It has been reported that peritonitis-related deaths account for 15% of the mortality of PD patients. The project period is from April 1st to September 30th, 2019. The goal of this project is to implement multiple strategies to reduce the incidence of peritonitis. According to our present analysis, we found that the high incidence of peritonitis is due to incorrect execution and under-cognition of fluid exchange technique by the patient and main caregiver, no well-established timing of technical audits, lack of relevant health education guidance, reminder slogans and various health education aids. By revising the technical standards for PD fluid exchange, improving the accuracy of exchange technique, strengthening the awareness of peritonitis, increasing the timing of technical audits, making relevant health education leaflets and reminder slogans, using various health education aids and other improvement measures, the occurrence of peritonitis events dropped from 3.62 times/100 person-months to 1.55 times/100 person-months. In conclusion, this project used multiple strategies to reduce the occurrence of peritonitis, enhance self-care awareness and skills in PD treatment, and thereby improve the quality of PD care.