- 學位論文
「降低導尿管相關泌尿道感染專案」對醫療照護相關泌尿道感染之影響
The Impact of ' Reducing Catheter Associated Urinary Tract Infections Project ' for Healthcare-Associated Urinary Tract Infection
摘要
目的: 本研究目的主要描述臺大醫院成人內、外科加護病房2002年至2010年醫療照護相關泌尿道感染密度、導尿管相關泌尿道感染密度變化趨勢。比較成人內、外科加護病房有無實施「降低導尿管相關泌尿道感染專案」及導尿管使用率及泌尿道感染密度之影響。藉由時間趨勢分析「降低導尿管相關泌尿道感染專案」及不同階段感染控制介入措施對於成人內、外科加護病房泌尿道感染密度影響。 方法: 本研究為一回溯性研究，以2002年至2010年臺大醫院感染控制中心前瞻性主動監測成人內外科加護病房導尿管相關醫療照護相關泌尿道感染個案為研究對象。分別以環境因素(導尿管使用率、SARS疫情、季節效應)及感控介入措施(手部衛生、內科加護病房降低導尿管相關泌尿道感染專案、Bundle care)為自變項，成人內外科加護病醫療照護相關泌尿道感染密度、導尿管相關泌尿道感染密度為依變項，利用卜瓦松迴歸進行多變項分析及自我相關模式分析、預測，p <0.05視為統計顯著差異。 結果: 成人內、外科加護病房由於泌尿道感染基礎期之趨勢不同、而感控介入措施及落實程度不同，故影響的結果不同。2004年4月推動「手部衛生」因素對於降低成人內科加護病房醫療照護相關泌尿道感染及導尿管相關泌尿道感染是有顯著性 (p < 0.0183)。以成人外科加護病房來看，2010年推動之「Bundle」對於降低成人外科加護病房醫療照護相關泌尿道感染及導尿管相關泌尿道感染是有顯著性。而隨著時間變化，成人內科加護病房醫療照護相關泌尿道感染密度及成人外科加護病房醫療照護相關泌尿道感染密度、導尿管相關泌尿道感染密度皆有下降趨勢。 結論: 「降低導尿管相關泌尿道感染專案」對於降低導尿管使用率有顯著影響，無論單位自主改善專案或是感控介入措施，對於成人內外科加護病房降低導尿管相關泌尿道感染都是有助益的。
並列摘要
Purpose The purpose of this thesis is to describe the trends of incidence of healthcare-associated urinary tract infection (HA-UTI) and catheter-associated urinary tract infection(CA-UTI) in adult intensive care units (ICUs ) at National Taiwan University Hospital, from 2002 to 2010. In addition, time series analysis was used to investigate the impacts of various infection control programs on the incidences of HA-UTI and CA-UTI in adult ICUs. Method This is a retrospective study. The study population was patients developing HA-UTI, includind CA-UTI while staying in adult ICUs at NTUH from 2002 to 2010. To identified the independent factors associated with HA-UTI and/or CA-UTI, environmental factors (catheter utilization, severe acute respiratory syndrome, seasonal effects), and infection control interventions (hand hygiene, the project of reducing catheter- associated urinary tract infection, Bundle care) were treated as independent variables; incidence densities of HA-UTI and CA-UTI were treated as the dependent variable. Time series analysis using Poisson regression model was used to evaluate the potential effects of independent variables on dependent variable. A p value less than 0.05 were considered as statistically significantly. Result Because the baselin incidence rates of HA-UTI and CA-UTI were different in surgical and medical ICU, and also the infection control interventions as well as the adherence of healthcare workers to these interventons, the impact of the results are different. Since April 2004, hand hygiene campaign were implemented. It reduced the HA-UTI and CA-UTI significantly (p< 0.0183). For adult surgical intensive care unit, promotion of the "Bundle care" intervention reduced the HA-UTI and CA-UTI significantly (p< 0.002) . Both HA-UTI and CA-UTI decrease in adult medical and surgical ICUs with time. Conclusion This study showed that the impact of various projects on reducing CA-UTI is significant, In addition, self-improvement project and infection control interventions were also helpful for decreasing HA-UTI and CA-UTI.
參考文獻
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延伸閱讀
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