The Effectiveness of Interventions to Reduce Catheter-associated Urinary Tract Infections

• Main Authors: Hsing-Chi Chung, 鍾幸枝
• Other Authors: Yung-Yu Su
• Format: Others
• Language: zh-TW
• Published: 2017
• Online Access: http://ndltd.ncl.edu.tw/handle/9w6vrg

碩士 === 美和科技大學 === 護理系健康照護碩士班 === 105 === Purpose Several factors will cause Healthcare-associated urinary tract infections. The main purpose of this research is to elucidate the density variation of catheter-associated urinary tract infections whether patients in intensive care units were introduced the care bundle beyond controlling the patient factors (sex, age and illness severity) and catheter factors (material and diameter of catheter). Method Data collection is retrospective and longitudinal follow-up. A total of 2461 catheter possessed cases were aimed at adult intensive care units (included internal Medical, surgical and neurological department) in specific medical center located in the south of Taiwan from Jan. 1 2012 to Dec. 31 2015. The detailed data were collected by patient information sheets and catheter care information sheets from healthcare records, inquiring healthcare nursing people and medical records. We compared the density variation of catheter-associated urinary tract infections among years whether patients in intensive care units were introduced the bundle care beyond controlling the patient factors (sex, age and illness severity) and catheter factors (material and diameter of catheter). Descriptive statistics, ANOVA, Chi-square and Cox regression were employed to test the hypothesis. Results Significant variation of the density of catheter-associated urinary tract infections after patients in intensive care units introduced the care bundles were found among years. After executing the care bundle to patients in various adult intensive care units from 2013, the density of catheter-associated urinary tract infections significantly decreased in 2014 and 2015, the values reduced from 15.9‰ in 2013 to 8.4‰ in 2014 (HR=0.53, 95% confident interval 0.37-0.76, p=.001) and to 8.6‰ in 2015 (HR=0.57, 95% confident interval 0.39-0.83, p=.003); The decline rates for 2014 and 2015 were about 47.2% and 45.9%, respectively. The risk of catheter-associated urinary tract infections before introducing care bundle was higher 1.76-1.89 time than the one after executing care bundle. Conclusion and Suggestion Most catheter possessed patients in intensive care units were severe and not stable in haemodynamics. Thus, more invasive medical facilities were necessary to utility and cure for them. Once they got infection and the time infection extended, the days they stayed in hospital will increase. Therefore, it is more important to exactly assess the indication and care for catheter possessed patient. We found the density of catheter-associated urinary tract infections after introducing the care bundle was much lower. However, after health care removed the catheter from our objects according to the assessment for indication of catheter possessed patient, 24% patients were essential to be reset the catheter (but only 15% patients were really necessary to be reset) because of lack of objective equipment to measure the residual urine volume. Therefore, we suggest that introduction of objective equipment, like as Bladder ultrasound machine is essential to lower the reset rate of catheter to reduce the density of catheter-associated urinary tract infections. Keywords: urinary tract infections, care bundle, catheter -associated urinary tract infections