運用組合性照護降低神經外科加護病房導尿管相關泌尿道感染密度

The Effect of Bundle Care on Catheter-Associated Urinary Tract Infection in Neurological Critical Unit

10.6647/CN.202003_27(1).0009

賴雯珍(Wen-Chen Lai)；陳寶如(Pao-Ju Chen)；簡伊辰(Yi-Chen Chien)；洪麗琴(Lin-Zin Hong)

組合性照護 ； 導尿管相關泌尿道感染 ； Bundle Care ； Catheter-Associated Urinary Tract Infection

彰化護理

27卷1期（2020 / 03 / 01）

62 - 73

繁體中文

單位2014年CAUTI感染密度平均為（千分之6.13），經原因分析發現導尿管組合式照護（Bundle Care）執行正確率低、導尿管插置技術不正確、護理人員CAUTI照護認知不足、缺乏CAUTI教育訓練，為降低感染密度故成立專案小組。專案成員定期稽核導尿管插置技術、導尿管Bundle Care執行情形、舉辦教育訓練、更換消毒劑、正確尿袋吊掛位置及床頭置放導管電子儀表版。專案實施後CAUTI密度由（千分之6.13）降為（千分之2.95），達目標值（千分之3.6）。因此，藉由CAUTI組合性照護，可降低導尿管感染密度，提升醫療照護品質。

In 2014, the infection rate of CAUTI was (6.13 per mille), the major reason was found the low accuracy in implementation of foley bundle care、insertion technique of foley catheter is incorrect、knowledge deficit、lack of CAUTI education and training. After the integration of reference and team members discussion, Build up the bundle care of CAUTI were to replace the antiseptic from 10% betadine to 2% CHG during foley insertion, using checklist on foley insertion and care, education training, early catheter removal assessment and applied bedside electronic dashboard. The results show the rate of the CAUTI was decreased from (6.13 per mille) to (2.95 per mille). achieving the target(3.6 per mille). therefore, applying the bundle care of CAUTI, could reduce the foley catheter infection and improving the quality of medical care.

1. Bui, L.,Badawi, N.,Swan, J.,Bersamin, J.(2013).Preliminary results of a randomized controlled trial comparing the incidence of nosocomial infections with chlorhexidine bathing versus standard bathing in the surgical intensive care unit.Journal of the american pharmacists association,53(2),82-83.
2. Centers For Disease Control and Prevention. (2014). Healthcare-associated infections. Retrieved from http://www.cdc.gov/HAI/ca_uti/uti.html
3. Chenoweth, C. E.,Saint, S.(2011).Urinary tract infections.Infections Disease Clinics of North America,25(1),103-115.
4. 王淑盈,張佳雯,王雅玲,李彩緣(2015)。組合式照護改善留置導尿管相關泌尿道感染密度成效專案。安泰醫護雜誌，21(1)，64-75。
5. 張簡品洳,趙雪嵐(2013)。Chlorhexidine是更優於Povidone Iodine、Sodium Hypochlorite的持續性抑菌劑。感染控制雜誌，23(6)，338-339。
6. 曾芷華,陳欣儀,沈湘芸,黃如敏,賴芊孝(2012)。降低住院病人導尿管感染率。領導護理，13(4)，81-90。
7. 劉舒涵,林秋貴,郭惠敏,李麗淑,鄭涵菁(2014)。運用組合式存留導尿管照護提升加護病房護理人員執行正確率。馬偕護理雜誌，8(1)，39-50。
8. 衛生福利部疾病管制署（ 2016 ， 1 月 5 日）‧院內感染監視通報系統統計分析 ‧取自https://www.cdc.gov.tw/File/Get/sqrAKrJg_Uq8Ki5B0HtO3g?path=CnlaIHGKJ04iFdYUI-q_4ORGB5fLplkAxHwTzgo-GVk_M7U5vW0u5SuT75OqkFRF&name=xlyKo3UBx_wL7yiJA4AxRWt2bMvW6Pejp17n6fXShtphQQFF2k-b8FXjvVI7lezXKsiEF9bob5dA3FYtnekezCVwRlciHKmzvvKpder7Gdw