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題名：依適應症提示移除尿管可降低內科病房導尿管相關尿路感染
書刊名：護理雜誌
作者：王佩琮／林湘玉／林意純／辛文蕙／簡莉盈／林小玲
作者(外文)：Wang, Pey-tsung／Lin, Hsiang-yu／Lin, Yi-tsun／Shin, Wen-huey／Chien, Li-yin／Lin, Shirling
出版日期：2017
卷期：64:1
頁次：頁70-79
主題關鍵詞：依適應症提示移除尿管；導尿管相關尿路感染；內科病人；Indicators-based reminder of catheter removal；Catheter-associated urinary tract infections；General medical patients
原始連結：連回原系統網址new window
相關次數：
  • 被引用次數被引用次數:期刊(1) 博士論文(0) 專書(0) 專書論文(0)
  • 排除自我引用排除自我引用:1
  • 共同引用共同引用:4
  • 點閱點閱:3
背景:泌尿道感染是醫療照護機構常見的醫源性感染之一，導尿管相關尿路感染，可能導致敗血症、延長住院、增加醫院成本及病人死亡率。目的:本研究欲探討「依適應症提示移除尿管」對降低內科病人導尿管相關尿路感染之成效。方法　本研究為類實驗性設計，介入措施為每日施行「依適應症提示移除尿管」之流程與標準尿管照護，並對護理人員進行教育課程。收案條件為留置導尿管病人，若入院時已發生泌尿道感染者則排除。於北部某醫學中心的五個內科病房為研究單位，共收案75人，含對照組33位與實驗組42位病人。結果　實驗組發生泌尿道感染人數為7人（16.7%），對照組為15人（45.5%）此差異達顯著（p = .014）；實驗組導尿管留置天數11.0天，對照組12.9天，實驗組導尿管留置天數較控制組減少14.73%；實驗組感染密度為15.2‰，對照組感染密度則為35.3‰。結論／實務應用:本研究發現，「依適應症提示移除尿管」能降低泌尿道感染率及感染密度。臨床應用建議，內科病房醫護人員每日依適應症提示移除尿管，偵測不必要的導尿管留置，提早移除尿管，以減少感染發生。
Background: Urinary tract infections are a common iatrogenic infection in healthcare institutions. Catheter-associated urinary tract infections (CAUTIs) may result in sepsis, prolonged hospitalization, additional hospital costs, and mortality. Purpose: The study examined the efficacy of an indicator-based reminder of catheter removal in decreasing CAUTIs among patients in the general medical ward. Methods: A two-group, quasi-experimental design was used. The intervention strategies included daily implementation of the indicator-based reminder procedure and standardized Foley care and a teaching program for all staff nurses. All patients who received Foley during hospitalization were included, with the exception of those with CAUTI at admission. Seventy-five patients were enrolled from five wards in a medical center, with 33 assigned to the control group and 42 assigned to the experimental group. Results: CAUTIs were diagnosed in 7 participants (16.7%) in the experimental group and 15 participants (45.5%) in the control group. The differences were statistically significant (p = .014). The mean number of Foley days was 14.73% less in the experimental group, with 11.0 for the experimental group and 12.9 for the control group. The incidence density of CAUTIs was 15.2‰ for the experimental group and 35.3‰ for the control group. Conclusions: The present study supports that an indicator-based reminder of catheter removal decreases the incidence rate and incidence density of CAUTIs. Medical personnel in the general medical ward may use this reminder to detect unnecessary indwelling of urinary catheters and to remove Foley catheters as early as feasible in order to prevent CAUTIs.
期刊論文
1.Oman, K. S.、Makic, M. B. F.、Fink, R.、Schraeder, N.、Hulett, T.、Keech, T.、Wald, H.(2012)。Nurse-directed interventions to reduce catheter-associated urinary tract infections。American Journal of Infection Control，40(6)，548-553。  new window
2.Chen, Y. Y.、Chi, M. M.、Chen, Y. C.、Chan, Y. J.、Chou, S. S.、Wang, F. D.(2013)。Using a criteria-based reminder to reduce use of indwelling urinary catheters and decrease urinary tract infections。American Journal of Critical Care，22(2)，105-114。  new window
3.Meddings, J.、Rogers, M. A. M.、Macy, M.、Saint, S.(2010)。Systematic review and meta-analysis: Reminder systems to reduce catheter-associated urinary tract infections and urinary catheter use in hospitalized patients。Clinical Infectious Diseases，51(5)，550-560。  new window
4.Umscheid, C. A.、Mitchell, M. D.、Doshi, J. A.、Agarwal, R.、Williams, K.、Brennan, P. J.(2011)。Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs。Infection Control and Hospital Epidemiology，32(2)，101-114。  new window
5.李允吉、劉建衛(20100600)。導尿管相關的菌尿和尿路感染。感染控制雜誌，20(3)，163-172。  延伸查詢new window
6.Elpern, E. H.、Killeen, K.、Ketchem, A.、Wiley, A.、Patel, G.、Lateef, O.(2009)。Reducing use of indwelling urinary catheters and associated urinary tract infections。American Journal of Critical Care，18(6)，535-541。  new window
7.紀美滿、陳玉枝、周幸生、陳瑛瑛(20101200)。加護病房泌尿道感染相關危險因子探討。榮總護理，27(4)，328-336。new window  延伸查詢new window
8.Loeb, M.、Hunt, D.、O'halloran, K.、Carusone, S. C.、Dafoe, N.、Walter, S. D.(2008)。Stop orders to reduce inappropriate urinary catheterization in hospitalized patients: A randomized controlled trial。Journal of General Internal Medicine，23(6)，816-820。  new window
9.陳瑛瑛、王復德(20131000)。導尿管相關泌尿道感染之管制策略。感染控制雜誌，23(5)，261-270。  延伸查詢new window
10.黃萬翠、王復德、陳瑛瑛、孫淑美(20140300)。應用電腦提醒拔除導尿管機制對導尿管使用及尿路感染之影響。護理暨健康照護研究，10(1)，70-77。new window  延伸查詢new window
11.Gould, C. V.、Umscheid, C. A.、Agarwal, R. K.、Kuntz, G.、Pegues, D. A.(2010)。Guideline for prevention of catheter-associated urinary tract infections 2009。Infection Control and Hospital Epidemiology，31(4)，319-326。  new window
12.Nadelman, R. V.、Nadelman, D. A.、Montecalvo, M. A.(2015)。A computer-based automated reminder increases the percentage of urinary catheters justified by an order and increases urinary catheter discontinuation orders。American Journal of Infection Control，43(6)，647-649。  new window
13.王淑盈、張佳雯、王雅玲、李彩緣(20150600)。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。  延伸查詢new window
14.鄭惟雅、謝美妃、趙建銘、陳彥如、陳家容(20160100)。組合式照護措施降低留置導尿管相關尿路感染率。澄清醫護管理雜誌，12(1)，55-60。  延伸查詢new window
15.Apisarnthanarak, A.、Thongphubeth, K.、Sirinvaravong, S.、Kitkangvan, D.、Yuekyen, C.、Warachan, B.、Fraser, V. J.(2007)。Effectiveness of multifaceted hospitalwide quality improvement programs featuring an intervention to remove unnecessary urinary catheters at s tertiary care center in Thailand。Infection Control and Hospital Epidemiology，28(7)，791-798。  new window
16.Clarke, K.、Tong, D.、Pan, Y.、Easley, K. A.、Norrick, B.、Ko, C.、Stein, J.(2013)。Reduction in catheter-associated urinary tract infections by bundling interventions。International Journal for Quality in Health Care，25(1)，43-49。  new window
17.Conway, L. J.、Carter, E. J.、Larson, E. L.(2015)。Risk factors for nosocomial bacteremia secondary to urinary catheterassociated bacteriuria: A systematic review。Urologic Nursing，35(4)，191-203。  new window
18.Hamasuna, R.、Takahashi, S.、Yamamoto, S.、Arakawa, S.、Yanaihara, H.、Ishikawa, S.、Matsumoto, T.(2011)。Guideline for the prevention of health care-associated infection in urological practice in Japan。International Journal of Urology，18(7)，495-502。  new window
19.Jeong, I.、Park, S.、Jeong, J. S.、Kim, D. S.、Choi, Y. S.、Lee, Y. S.、Park, Y. M.(2010)。Comparison of catheter-associated urinary tract infection rates by perineal care agents in intensive care units。Asian Nursing Research，4(3)，142-150。  new window
20.Lo, E.、Nicolle, L. E.、Coffin, S. E.、Gould, C.、Maragakis, L. L.、Meddings, J.、Pegues, D. A.、Pettis, A. M.、Saint, S.、Yokoe, D. S.(2014)。Strategies to prevent catheter-associated urinary tract infections in acute care hospitals: 2014 update。Infection Control and Hospital Epidemiology，35(5)，464-479。  new window
21.Meddings, J.、Rogers, M. A. M.、Krein, S. L.、Fakih, M. G.、Olmsted, R. N.、Saint, S.(2014)。Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: An integrative review。BMJ Quality & Safety，23(4)，277-289。  new window
22.Saint, S.、Greene, M. T.、Kowalski, C. P.、Watson, S. R.、Hofer, T. P.、Krein, S. L.(2013)。Preventing catheter-associated urinary tract infection in the United States: A national comparative study。JAMA Internal Medicine，173(10)，874-879。  new window
23.Tenke, P.、Kovacs, B.、Johansen, T. E. B.、Matsumoto, T.、Tambyah, P. A.、Naber, K. G.(2008)。European and Asian guidelines on management and prevention of catheter-associated urinary tract infections。International Journal of Antimicrobial Agents，31(1, Suppl.)，68-78。  new window
24.Yatim, J.、Wong, K. S.、Ling, M. L.、Tan, S. B.、Tan, K. Y.、Hockenberry, M.(2016)。A nurse-driven process for timely removal of urinary catheters。International Journal of Urological Nursing，10(3)，167-172。  new window
圖書
1.Dawson-Saunders, Beth、Trapp, Robert G.(1990)。Basic and Clinical Biostatistics。Appleton & Lange。  new window
單篇論文
1.Lam, T. B. L.，Omar, M. I.，Fisher, E.，Gillies, K.，MacLennan, S.(2014)。Types of indwelling urethral catheters for short-term catheterisation in hospitalized adults(9, Art. No.: CD004013)。  new window
 
 
 
 
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