Speaker for Nursing Conference 2019- Wan-Chi Hsu

Title: The Impact of Bundle Care on the Rate of Catheter-Associated Urinary Tract Infection

Wan-Chi Hsu

National Cheng Kung University Hospital ,Taiwan


The researcher completed a bachelor’s degree from the National Taipei University of Nursing and Health Sciences in 2006. She currently serves as a head-nursing in the National Cheng Kung University Hospital. She has published one paper in the journal and participated in five academic posters.


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.
In the neurological ward, the top ten diseases of the unit are diagnosed as: intracranial hemorrhage, subdural hemorrhage, head injury, lumbar disc displacement (including cervical vertebrae), subarachnoid hemorrhage, and unexplained tumors of the brain, with an average of 242 people per month. The patient underwent urinary catheter placement. The current catheters used were 14 to 18 Fr rubber catheters. Common causes of indwelling catheters were: neurological urinary retention, postoperative surgery, and comfort.
The number of urinary tract infections in the statistical unit was 17 in 104, the number of urinary tract infections was 8 in 105, and the number of urinary tract infections in 106 was 10. The number of infected cases decreased, but the prevention of urinary tract infection became One of the businesses that the unit can't ignore, it is expected to improve the authenticity of the caregiver's combined care and nursing guidance for catheter-related urinary tract infections, thereby reducing the incidence of urinary tract, improving the quality of care and satisfaction with medical care.
By actually monitoring the medical team to perform urinary tract care technology, it was found that the medical team did not perform hand cleaning according to the standard. The physician and the nursing staff did not evaluate the necessity of urinary catheter retention daily. The nursing staff did not confirm the urinary catheter care precautions. In patients with bed rest or long-term bed rest, urinary retention often causes urinary tract infections, and the reason that the urine bag mouth touches the ground may lead to an increase in infection density. Therefore, the "correct rate of combined urinary tract infection combined with urinary tract infection" is listed as the ward quality monitoring indicator, and the quality control team members conduct irregular monitoring.
1. The newly-developed "correction rate of combined management of urinary tract infections related to urinary catheters by the medical team" is divided into two items:
  The first item, the placement of catheters, a total of 11 items including:
(1) Compliance with appropriate placement reasons.
(2) Wash your hands before placing the catheter.
(3) Spread the treatment towel to enlarge the sterile surface and prepare the material with aseptic technique.
(4) Wear sterile gloves and spread a sterile towel.
(5) Disinfect the disinfectant directly around the urethra.
(6) Properly performed on a sterile basis.
(7) Use a sterile technique to properly connect the catheter and urine bag.
(8) The catheter is fixed in the correct way.
(9) The urine bag is properly fixed below the bladder.
(10) Wash your hands properly after the catheter is placed.
(11) Check the form correctly.
In the second item, 7 items of daily catheter indwelling care assessment include:
(1) Hand hygiene.
(2) Whether the catheter is fixed in position.
(3) The urethra is clean.
(4) Whether the catheter drainage bag exceeds 8 points.
(5) The catheter drainage bag is lower than the bladder.
(6) The outlet of the urine bag is not drooping.
(7) The evaluation form is filled in correctly.
Sensing external auditors about four to five times a month, to the unit to see the placement of personnel (including physicians, nurses, specialists, etc.), whether the placement of the catheter is in compliance with the inspection content.
1. In 106 years, the correct rate of the combination of urinary tract infection and urinary tract infection in the medical team was 93.61%, which reached the threshold of >89%.
2. The sensory center report: 105 years of ward hospital urinary tract infection density of 0.6 ‰, 106 years of ward hospital urinary tract infection density of 0.7 ‰, 107 years from January to September ward urinary tract infection density of 0.5 ‰.
3. External audit (sensory center) The number of samples per month is 10, and the auditing of 6 items. The compliance rate of the combined daily care of the catheter in the 8C ward in 106 years is 100% (720/720).