研究背景: 導尿管相關泌尿道感染(Catheter-Associated Urinary Tract Infection, CAUTI)為醫療照護相關感染中最常見且具高度可預防性之感染類型之一。根據衛生福利部疾病管制署《2023 年醫療照護相關感染監視年報》，地區醫院加護病房(ICU)泌尿道感染個案中約 85.9% 與導尿管留置相關，其 CAUTI 發生密度約介於 3–8/1,000 catheter-days 。 而，本院 ICU 與整合病房基準線稽核結果顯示，導尿管平均留置時間為 12.7 天，CAUTI 發生密度達 13.1/1,000 catheter-days，高於全國監測範圍，顯示導尿管留置時間管理與拔管決策流程仍具改善空間。
研究目的: 本研究旨在運用實證導向之多重介入策略，以降低 ICU 與整合病房長期臥床病人之 CAUTI 發生密度，縮短導尿管平均留置天數，提升照護人員導尿管照護知能與流程遵循度，並建立具制度化與可永續推廣之導尿管照護模式。
研究方法: 本研究採單組前後測準實驗設計，以 JBI Evidence Implementation Framework 作為介入架構，於南部某地區醫院 ICU 與整合病房（共 19 床）進行。研究前進行六個月基準線稽核，蒐集 CAUTI 發生密度、導尿管平均留置天數及照護流程遵循度等資料；其後透過 JBI PACES 與 GRiP 工具進行情境與障礙分析，並導入多重介入策略，包括分層教育訓練、專科護理師主導拔管流程、每日導尿管必要性評估制度、電子病歷提醒機制及視覺化工具。介入後進行後期稽核，並以描述性統計比較介入前後之變化趨勢。
研究結果：基準線期間 CAUTI 發生密度為 13.1/1,000 catheter-days，導尿管平均留置天數為 12.7 天。介入後，CAUTI 發生密度下降至 9.7/1,000 catheter-days（下降 25.9%，IRR = 0.74），導尿管平均留置天數下降至 6 天（下降 52.8%）。照護人員知識測驗平均得分由 84.6 分提升至 97.1 分，及格率由 58.3% 提升至 100% ；整導導尿管照護流程遵循率由 66% 提升至 85%。
結論：本研究顯示，透過結合 JBI 實證實施架構之多重介入策略，並建立制度化之專科護理師主導拔管流程與持續稽核回饋機制，可有效縮短導尿管留置時間並降低 CAUTI 發生密度。制度化決策權轉移與實證轉譯流程為改善成效之關鍵因素。本研究建立之導尿管管理模式具臨床可行性與永續推廣潛力，可作為地區醫院 ICU 與整合病房感染管制品質改善之參考。

Background: Catheter-associated urinary tract infection (CAUTI) is one of the most common and preventable healthcare-associated infections. According to the 2023 Taiwan CDC annual surveillance report, approximately 85.9% of urinary tract infections in regional hospital intensive care units (ICUs) are catheter-related, with an incidence density ranging from 3–8 per 1,000 catheter-days. However, baseline data from our ICU and integrated ward revealed a mean catheter duration of 12.7 days and a CAUTI incidence density of 13.1 per 1,000 catheter-days, exceeding the national surveillance range. These findings indicated substantial room for improvement in catheter duration management and decision-making processes for catheter removal.
Purpose: This study aimed to implement an evidence-based multi-component intervention to reduce CAUTI incidence density, shorten catheter duration, improve healthcare staff knowledge and compliance with catheter care practices, and establish a sustainable and institutionalized catheter management model in an ICU and integrated ward setting.
Methods: This study employed a single-group pre–post quasi-experimental design using the JBI Evidence Implementation Framework and was conducted in the ICU and integrated ward (19 beds) of a regional hospital in southern Taiwan. A six-month baseline audit was conducted to collect data on CAUTI incidence density, average catheter duration, and compliance with catheter care practices. Situational and barrier assessments were performed using the JBI PACES and GRiP tools. Multiple implementation strategies were then introduced, including tiered education and training, a nurse-driven catheter removal protocol, daily catheter necessity assessment, electronic medical record reminders, and visual reminder tools. Follow-up audits were conducted after implementation, and descriptive statistics were used to compare pre- and post-intervention outcomes.
Results: During the baseline period, the incidence of CAUTI was 13.1 per 1,000 catheter-days, and the average catheterization duration was 12.7 days. After intervention, the incidence of CAUTI decreased to 9.7 per 1,000 catheter-days (a decrease of 25.9%, IRR = 0.74), and the average catheterization duration decreased to 6 days (a decrease of 52.8%). The average score on the caregiver knowledge test improved from 84.6 to 97.1, and the pass rate increased from 58.3% to 100%; the overall catheterization care protocol compliance rate increased from 66% to 85%.
Conclusion: The integration of a multi-component intervention guided by the JBI Evidence Implementation Framework, together with a formally institutionalized nurse-driven catheter removal protocol and continuous audit-feedback mechanisms, effectively reduced catheter duration and lowered CAUTI incidence density. Institutionalized clinical decision authority and structured implementation processes were critical in translating evidence into sustainable practice change. This model demonstrates feasibility and scalability for infection control quality improvement in regional hospital ICU and integrated ward settings.

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