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研究生:紀美滿
研究生(外文):Mei-Man Chi
論文名稱:應用「導尿管移除評估指標」對泌尿道感染之成效探討
論文名稱(外文):The Effect of an Indicator of Urinary Catheter Removal on the Urinary Tract Infection
指導教授:陳瑛瑛陳瑛瑛引用關係王凱微王凱微引用關係
指導教授(外文):Yin-Yin ChenKai-Wei Wang
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:護理學系暨研究所
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2009
畢業學年度:97
語文別:中文
論文頁數:47
中文關鍵詞:導尿管泌尿道感染導尿管移除指標危險因子
外文關鍵詞:Urinary CatheterUrinary Tract InfectionIndicator of Urinary Catheter RemovalRisk Factor of Urinary Infection
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  • 被引用被引用:1
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泌尿道感染是國內外醫療機構最常見的院內感染部位之ㄧ,而大部分泌尿道感染與導尿管留置有關。然而,醫護人員卻常忽略病人導尿管存在之必要性,也增加不必要的導尿管留置天數,而建立導尿管使用評估機制,移除病人不必要之導尿管,是降低病人泌尿道感染發生率及縮短住院天數的方法之ㄧ。因此,本研究目的在探討應用「導尿管移除評估指標」對病人泌尿道感染發生率及住院天數之影響。
本研究採實驗性研究設計法,樣本取自北部某醫學中心胸腔重症加護室及呼吸治療加護室自97年4月至97年11月之所有留置導尿管病人,共收案278人,實驗組於導尿管留置第7天,以「導尿管移除評估表」評估後移除導尿管,對照組則未給予任何介入措施。資料以SPSS 12.0統計軟體分別進行Intention-To-Treat (ITT) Analyses和Per-Protocol Analyses,並應用Multiple Logistic Regression探討泌尿道感染的相關危險因子。
研究結果顯示實施「導尿管移除評估指標」確實顯著降低泌尿道感染發生率19% (P=.004)及導尿管留置天數9天(P<.001),且對泌尿道感染的發生具有保護作用(OR 0.37, 95%CI 0.16-0.89, P=.026);雖然在縮短總住院天數方面未具統計上差異(P=.635),但縮短總住院天數5天。泌尿道感染相關危險因子包括女性發生泌尿道感染的風險較男性高2.3倍(P=.030)、重置導尿管者發生泌尿道感染之風險較未重置者高6倍(95%CI 2.45-15.42, P<.001)。
本研究以臨床實證資料,證實執行「導尿管移除評估指標」確實可早期移除導尿管有效降低泌尿道感染發生率,未來可推廣於加護病房,讓護理人員執行臨床照護時有所遵循,並可列入臨床照護常規,降低病人泌尿道感染率,提升臨床照護品質。
Urinary tract infection (UTI) is a common nosocominal infection affecting ICU patients and associated with the duration of urinary catheterization. Clinicians are often unaware that their patients have an indwelling urinary catheter; prolonged urinary catheterization increases the risk of catheter-associated bacteriuria. Early remove the unnecessary catheter through a systematic measure is thought to be an effective method to reduce the UTI rates and shorten the patients’ hospital stays. The aim of this study was to evaluate the efficacy of a nurse-generated ‘Urinary Catheter Removal Indicator’ on UTI rates and hospital stay.
In a experimental study designed, 278 patients were recruited from two ICUs in a medical center and randomly assigned into two groups; experimental group (n = 147) received an assessment by using ‘Urinary Catheter Removal Indicator’ after 7 days of urinary catheter insertion and removed unnecessary urinary catheter based on the assessment result, the control group (n = 131) received routine care. Data analysis was performed using SPSS version 12.0 (SSPS Inc, Chicago, Ill, USA). Statistical analyses were based on the Intention-To-Treat Analyses and Per-Protocol Analyses. Multiple logistic regression analysis was used to estimate association between risk factors and the UTI occurrence rates.
The study results revealed that the patients in the experimental group had significantly lower incidence of UTI (18.6% vs. 37.6%, p=.004) and fewer catheterization days (7days vs. 16.1days, p<.001) than control group. The ‘Urinary Catheter Removal Indicator’ had significant effect on the protection of the urinary tract infection (OR= 0.37, 95% C.I.= 0.16-0.89, P=.026). The patients in the experimental group stay in hospital were 5 days shorter than the control group, but did not statistically differ between the groups (P>.05). The female and recatheterization were identified as the risk factors associated with UTI. Female patients with urinary catheter had 2.3 time chances to develop UTI than male patients (95% C.I. =1.07-4.90, P=.030), urinary recatheterized patients had 6 time chances to develop UTI than single catheterized patients (95% C.I.=2.45-15.42, P<.001).
The results suggest that use of the ‘Urinary Catheter Removal Indicator’ reduces the unnecessary urinary catheterization and the risk of catheter acquired urinary tract infection. This clinical based indicator should be integrated as part of a continuous quality improvement program and the ICU nurses should assess the necessity of patients’’ urinary catheter on a regular-based to reduce the UTI rates.
致 謝 ii
中文摘要 iii
英文摘要 iv
目 錄 v
表目錄 vii
第一章 緒 論 1
第一節 研究動機及重要性 1
第二節 研究目的 2
第三節 研究問題與假設 2
第二章 文獻查證 4
第一節 導尿管使用沿革 4
第二節 導尿管相關感染致病機轉及菌種分佈 4
第三節 泌尿道感染的定義 5
第四節 泌尿道感染的相關因素 6
第五節 泌尿道感染管制臨床照護指引 10
第六節 導尿管移除之臨床指標 12
第七節 操作性定義 13
第八節 研究架構 14
第三章 研究方法 15
第一節 研究設計 15
第二節 研究對象 16
第三節 研究工具 16
第四節 資料收集方法 17
第五節 資料分析方法 18
第六節 研究對象的權益保護 19
第四章 研究結果 21
第一節 研究對象之基本屬性分佈 22
第二節 研究對象之泌尿道感染分佈 23
第三節 研究對象之導尿管使用特性分佈 23
第四節 研究對象之住院天數分佈 24
第五節 研究對象之菌種分佈 24
第六節 導尿管移除評估指標 25
第七節 泌尿道感染之相關危險因素分析 25
第五章 討 論 27
第一節 早期移除導尿管對泌尿道感染之影響 27
第二節 泌尿道感染徵象或症狀對泌尿道感染之影響 28
第三節 住院天數對泌尿道感染之影響 28
第四節 泌尿道感染分離出之菌種探討 29
第五節 泌尿道感染之危險因素探討 30
第六節 尿液檢驗時間對泌尿道感染之影響 31
第六章 結論與建議 32
第一節 結 論 32
第二節 建 議 33
第三節 研究限制 34
參考文獻 41
中文資料
台北榮總檢驗部(2005)�G尿液檢驗方法與儀器�G 2008年12月3日取自http://www.path.vghtpe.gov.tw/chinese/html/Division/genlab_07_03.htm.
江俊宜、林永崇、張峰義(2005)•探討蔓越莓在預防泌尿道感染的角色?•感染控制雜誌,15(6),374-378。
竺珍倫、王復德(2005)•長期留置導尿管相關尿路感染之探討•感染控制雜誌,15(5),301-306。
林金絲、黃忠智、許詩典、饒淳英、樊美知、葉玉蓉(2001) •加護中心住院病患使用相關導管引起的院內感染調查•感染控制雜誌,11,1-11。
林麗英(1994) •尿管留置病患的護理•護理雜誌,41(1),73-78。
施智源、陳瀅淳、劉美芳(2007) •美國疾病管制中心2004年院內感染定義中譯•感染控制雜誌,17(1),11-44。
姜杏芝、黃明喜、鄭芊芊(2008) •一位腦中風合併紫色尿袋症候群之居家護理經驗•護理雜誌,55(4),98-104。
班仁知、游文瓊(2001)•導尿管相關泌尿道感染之預防措施•感染控制雜誌,11(6),382-387。
陳盟榮、蔡宜貞(2002) •導尿管的處理•長期照護,5(2),108-111。
盧星華(1998) •泌尿道之院內感染•於許衍伸、陳光國、張心湜主編,生殖泌尿道學(143-149頁)•台北:九州。
張上淳、蔡佳倫、王振泰、黃高彬、呂學重、莊銀清、王立信、王復德、劉有增、劉清泉、周明淵、王敦正、陳國東(2004) •台灣醫學中心與區域醫院1999-2002年院內感染之概況•感染控制雜誌,14(1),1-11。
陳瀅淳、劉美芳、施智源(2006) •生物膜在泌尿道感染中所扮演的角色及相關處置•感染控制雜誌,16(1),43-46。
陳瀅淳、施智源、傅任云婕、劉美容、張綠娟、丘愛平、王凱君(2007) •導尿管使用之原因與留置天數分析•台灣醫學,11(4),345-351。
陳淑媛(2001) •呼吸加護病房提早拔除導尿管措施效果之評估•彰化醫學,6(4),246-250。
陳淑惠、趙玉玲、張玉雯(2003)•南部某區域醫院院內感染調查分析•感染控制雜誌,13,346-353。
陳姿玲、王琪珍、吳秀麗、楊月嬌、吳怡慧(1997) •尿管留置病患發生院內泌尿道感染之危險性探討•護理研究,5(3),259-266。
廖張京隸(2002).最新實用內外科護理.台北:永大。
簡素娥、郭國基、黃情川、林水龍(2001)•南部某區域教學醫院加護中心與普通病房之院內感染比較•感染控制雜誌,11(6),365-374。
簡素娥、陳姿君、黃情川、黃瑞明、簡聰健(2004) •品質指標運用於導管感染之成效•感染控制雜誌,14(4),212-222。
衛生署(2005) •院內感染監視通報系統•臺灣地區傳染病統計暨監視年報,93,36-41。
英文資料
Blenkharn (1986). Acquired urinary tract infection in ICU patients. Critical Care Medicine, 14, 172-173.
Bregenzer, T., Frei, R., Widmer, A. F., Seiler, W., Probst, W., Mattarelli, G.., & Zimmerli, W. (1997). Low risk of bacteriuria during catheter replacement in patients with long-term urinary catheters. Archives of Internal Medicine, 157(5), 521-525.
Chen, Y. Y., Chou, Y. C., & Chou, P. (2005). Impact of nosocomial infection on cost of illness and length of stay in intensive care units. Infection Control And Hospital Epidemiology, 26(3), 281-287.
Dieckhaus, K. D., & Garibaldi, R. A., (1998). Prevention of Catheter-Associated Urinary Tract Infection. In E. Abrutyn (Ed.). Saunders Infection Control Reference Service (1nd ed., pp.169-179). Philadelphia: W.B. Saunders Company.
Dumigan, D. G., Kohan, C. A., Reed, C. R., Jekel, J. F., & Fikrig, M. K. (1998). Utilizing National Nosocomial infection surveillance system data to improve urinary tract infection rates in three intensive-care units. Clinical Performance and Quality Health care, 6(4), 172-178.
Edward (1981). Guidelines for prevention of catheter-associated urinary tract infections. Guidelines for prevention and control of nosocomial infections. Atlanta: Centers for Disease Control.
Eggimann, P., & Pittet, D. (2001). Infection control in the ICU. Chest,120, 2059-2093.
Ersoz, M., Ulusoy, H., Oktar, M. A., & Akyuz M. (2007).Urinary tract infection and bacteriurua in stroke patients. Am J. Phys. Med. Rehabil, 86, 734-741.
Fernandez, R. S., & Griffiths, R. D. (2005). Clamping short-term indwelling catheters: a systematic review of the evidence. Journal of Wound, Ostomy, and Continence Nursing, 32(5), 329-336.
Garibaldi, R. A. Burke, J. P., Dickman, M. L. & Smith, C. B. (1974). Factors Predisposing to bacteriuria during indwelling urethral catheterization. The New England Journal of Medicine, 291(5), 215-219.
Graves, N., Tong, E., Morton, A. P., Halton, K., Curtis, M., Lairson, D., & Whitby, M. (2007). Factors associated with health care-acquired urinary tract infection. American Journal of Infection Control ,35, 387-392.
Graves, N., Weinhold, D., Tong, E., Birrella, F., Doidge, S., Ramritu, P., Halton, K., Lairson, D., & Whitby, M. (2007). Effect of healthcare-acquired infection on length of hospital stay and cost. Infection Control And Hospital Epidemiology, 28, 280-292.
Gray, M. (2004). What nursing interventions reduce the risk of symptomatic urinary tract infection in the patient with an indwelling catheter?. Journal of Wound, Ostomy, and Continence Nursing , 31(1), 3–13.
Grover M. L., Bracamonte, J.D., Kanodia, A.K., Bryan, M. J., Donahue, S. P., Warner, A. M., Edwards, F. D., & Weaver, A.L. (2007). Assessing adherence to evidence-based guidelines for the diagnosis and management of uncomplicated urinary tract infection. Mayo Clinic proceedings, 82(2):181-185.
Harris, A. D., Castro, J., Sheppard, D.C., Carmeli, Y., & Samore, M. H. (1999). Risk factors for nosocomial candiduria due to Candida glabrata and Candida albicans. Clinical Infectious Diseases, 29, 926–928.
Horan, T. C., & Gaynes, R. P. (2004). Surveillance of nosocomial infections. In C.G. Mayhall (Ed.) Hospital Epidemiology and Infection Control (3nd ed., pp. 1659-1702). Philadelphia: Lippincott Williams & Wilkins.
Huang, W. C., Wann, S. R., Lin, S.L., Kunin, C. M., Kung, M. H., Lin, C.H., Hsu, C.W., Liu, C. P., Lee, S. J., Liu, Y. C., Lai, K. H., & Lin, T. W. (2004). Catheter-associated urinary tract infections in intensive care units can be reduced by prompting physicians to remove unnecessary catheters. Hospital Epidemiology, 25, 974-978.
Jain, P., Parada, J. P., David, A., & Smith, L. G. (1995). Overuse of the indwelling urinary tract catheter in hospitalized medical patients. Archives of internal medicine, 155, 1425-1429.
Laupland, K. B., Zygun, D. A., Davies, H. D., Church, D. L., Louie, T. J., & Doig C. J. (2002). Incidence and risk factors for acquiring nasocomial urinary tract infection in the critically ill. Journal Critical Care, 17(1), 50-57.
Leone, M., Albanese, J., Garnier, F., Sapin,C., Bimar, M. C., Barrau, K., & Martin, C. (2003). Risk factors of nosocomial catheter-associated urinary tract infection in a polyvalent intensive care unit. Intensive Care Medicine, 29(7), 1077-1080.
Loeb,M., Hunt, D., Halloran, K., Carusone, S. C., Dafoe, N., & Walter, S. D. (2008). Stop order to reduce inappropriate uinary catheterization in hospitalized patients: a randomized controlled trial. Journal Gen Inter Med, 23(6), 816-820.
Madigan, E., & Neff, D. (2003). Care of patients with long-term indwelling urinary catheters. Online Journal of Issues in Nursing, 8(3), 7-17.
Mehta, A., Rosenthal, V. D., Mehta, Y., Chakravarthy, M., Todi, S. K., Sen, N., Sahu, S., Gopinath, R., Rodrigues, C., Kapoor, P., Jawali, V., Chakraborty, P., Raj, J. P., Bindhani, D., Ravindra, N., Hegde, A., Pawar, M., Venkatachalam, N., Chatterjee, S., Trehan, N., Singhal, T., & Damani, N. (2007). Device-associated nosocomial infection rates in intensive care units of seven Indian cities. Findings of the international nosocomial infection control consortium (INICC). Journal of Hospital Infection, 67, 168-174.
Nicolle, L. E. (2001). The Chronic Indwelling Catheter and Urinary Infection in Long-Term–Care Facility Residents. Infection Control And Hospital Epidemiology, 33, 316-321.
Piechota, H.J., & Pannek, J. (2003). Catheter drainage of the urinary tract. Status of the technique and prospects. Der Urologe. Ausg. A, 42, 1060-1069.
Reilly, L., Sullivan, P., Ninni, S., Fochesto, D. Williams, K. & Fetherman, B. (2006). Reducing Foley Catheter Device Days in an Intensive Care Unit: Using the Evidence to Change Practice. AACN Advanced critical care, 17(3), 272-283.
Richards, M. J., Edwards, J. R., Culver, D. H., Gaynes, R. P. & NNIS. (2000). Nosocomial infections in combined medical-surgical intensive care units in the United States. Infection Control and Hospital Epidemiology, 21, 510-515.
Rupp, M. E., Fitzgerald, T., & Marion, N. (2004). Effect of silver-coated urinary catheters: Efficacy, cost-effectiveness, and antimicrobial resistance. American Journal of Infection Control, 32, 445-450.
Salgado, C. D., Karchmer, T. B., & Farr, B. M. (2003). Prevention of Catheter-Associated Urinary Tract Infection. In R. P. Wenzel (Ed.). Prevention and Control of Nosocomial Infection (4nd ed., pp.297-311). Philadelphia: Lippincott Williams & Wilkins.
Saint, S. & Benjamin, A. (1999). Preventing Catheter-Related Bacteriuria Should We? Can We? How?. Archives of internal medicine. 159, 800-808.
Saint, S., Wiese, J., Amory, J. K., Bernstein, M. L., Patel, U. D., Zemencuk, J. K., Bernstein, S. J., Lipsky, B. A., & Hofer, T. P. (2000). Are Physicians Aware Of Which of Their Patients Have Indwelling Urinary Catheters?. The American Journal of Medicine, 109(6), 476-480.
Saint, S., Kaufman, S. R., Thompson, M., Rogers, M. A., & Chenoweth, C. E. (2005). A reminder reduces urinary catheterization in hospitalized patients. Joint Commission Journal on Quality and Patient Safety, 31(8), 45-62.
Saint, S., Kaufman, S.R., Rogers, M.A., Baker, P.D., Boyko, E.J., & Lipsky, B. A. (2006). Risk factors for nosocomial urinary tract–related bacteremia: A case-control study. American journal of infection control , 34, 401-407.
Shah, P.S., Cannon, J.P., Sullivan, C.L., Nemchausky, B., & Pachucki, C.T. (2005). Controlling antimicrobial use and decreasing microbiological laboratory tests for urinary tract infections in spinal-cord-injury patients with chronic indwelling catheters. American journal of health-system pharmacy, 62(1), 74-77.
Shapiro, M., Simchen, E., Izraeli, S., & Sacks, T. G. (1984). A multivariate analysis risk factors for acquiring bacteriuria in patients with indwelling urinary catheters for longer than 24 hours. Infection Control, 5(11), 525-532.
Tambyah, P. A., Knasinski, V., & Maki, D. G. (2002). The Direct Costs of Nosocomial Catheter-Associated Urinary Tract Infection in the Era of Managed Care. Infection Control and Hospital Epidemiology, 23(1), 27-31.
Tambyah, P. A. (2004). Catheter-associated urinary tract infections:diagnosis and prophylaxis. International Journal of Antimicrobial , 24, 44-48.
Tissot, E., Limat, S., Cornette, C. & Capellier, G. (2001). Risk Factors for Catheter-Associated Bacteriuria in a Medical Intensive Care Unit. European Journal of Clinical Microbiology & Infectious Diseases, 20, 260-262.
Thibon, P., Coutour, L. X., & Leroyer, R. (2000). Randomized multicentre trial of the effects of a catheter coated with hydrogel and silver salts on the incidence of hospital-acquired urinary tract infection. Journal Hospital Infection, 45, 117-124.
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1. 江俊宜、林永崇、張峰義(2005)•探討蔓越莓在預防泌尿道感染的角色?•感染控制雜誌,15(6),374-378。
2. 江俊宜、林永崇、張峰義(2005)•探討蔓越莓在預防泌尿道感染的角色?•感染控制雜誌,15(6),374-378。
3. 竺珍倫、王復德(2005)•長期留置導尿管相關尿路感染之探討•感染控制雜誌,15(5),301-306。
4. 竺珍倫、王復德(2005)•長期留置導尿管相關尿路感染之探討•感染控制雜誌,15(5),301-306。
5. 林麗英(1994) •尿管留置病患的護理•護理雜誌,41(1),73-78。
6. 林麗英(1994) •尿管留置病患的護理•護理雜誌,41(1),73-78。
7. 施智源、陳瀅淳、劉美芳(2007) •美國疾病管制中心2004年院內感染定義中譯•感染控制雜誌,17(1),11-44。
8. 施智源、陳瀅淳、劉美芳(2007) •美國疾病管制中心2004年院內感染定義中譯•感染控制雜誌,17(1),11-44。
9. 姜杏芝、黃明喜、鄭芊芊(2008) •一位腦中風合併紫色尿袋症候群之居家護理經驗•護理雜誌,55(4),98-104。
10. 姜杏芝、黃明喜、鄭芊芊(2008) •一位腦中風合併紫色尿袋症候群之居家護理經驗•護理雜誌,55(4),98-104。
11. 張上淳、蔡佳倫、王振泰、黃高彬、呂學重、莊銀清、王立信、王復德、劉有增、劉清泉、周明淵、王敦正、陳國東(2004) •台灣醫學中心與區域醫院1999-2002年院內感染之概況•感染控制雜誌,14(1),1-11。
12. 張上淳、蔡佳倫、王振泰、黃高彬、呂學重、莊銀清、王立信、王復德、劉有增、劉清泉、周明淵、王敦正、陳國東(2004) •台灣醫學中心與區域醫院1999-2002年院內感染之概況•感染控制雜誌,14(1),1-11。
13. 陳瀅淳、劉美芳、施智源(2006) •生物膜在泌尿道感染中所扮演的角色及相關處置•感染控制雜誌,16(1),43-46。
14. 陳瀅淳、劉美芳、施智源(2006) •生物膜在泌尿道感染中所扮演的角色及相關處置•感染控制雜誌,16(1),43-46。
15. 陳淑媛(2001) •呼吸加護病房提早拔除導尿管措施效果之評估•彰化醫學,6(4),246-250。