長期留置導尿管相關泌尿道感染高危險因子評估量表的發展與測試

Development and Testing of a Risk Assessment Scale for Long-term Indwelling Catheterization-induced Urinary Tract Infections

背景：長期留置導尿管之居家護理病人存有許多危險因子影響泌尿道感染產生，因缺乏篩檢易感染之高危險群評估工具為依據，並在健保給付內選定個別性與專屬性的導尿管照護。目的：發展與測試「長期留置導尿管相關泌尿道感染之高危險因子評估量表」。方法：採回溯性研究法，於北部某醫學中心居家護理所接受長期存置導尿管病人為對象，收集2012年149人的資料，建構出評估量表，再以2013年141人資料驗證泌尿道感染（urinary tract infection, UTI）危險因子評估工具之功能，且在建構量表同時進行信效度檢測。結果：結構效度發展量表共13題，經ROC、Youden index最佳切分點檢定，總分≥8分即為高危險群病人。此量表效標關聯效度AUC為0.759、敏感度為0.730、特異度為0.701、內容效度CVI為0.86；項目間內在一致性（Cronbach’s α=0.96, p=0.000）、再測信度（ɤ =0.95, p=0.000）與評估者間一致性（ICC=0.94），具良好信效度。結論/實務應用：有效預測與篩檢易罹患泌尿道感染之長期留置導尿管高危險群居家病人，具專業準則以正確地幫助病人選擇合適導尿管照護，降低感染的發生，提升居家照護品質。

Background: Home care patients with long-term indwelling catheters have many risk factors influencing the occurrence of urinary tract infections. There is no tool to assess infection high risks, and help nurses to select the care model in National Health Insurance benefits. Purpose: To develop and test the risk assessment scale for long-term indwelling catheterization induced urinary tract infections. Methods: This retrospective study used the data on 149 patients in 2012 and 141 patients in 2013 from the home care division at a medical center in northern Taiwan to construct an assessment scale and perform reliability and validity tests. Results: Thirteen questions were developed for the assessment scale. The receiver operating characteristic (ROC) curve and Youden index found the optimal cut-point; a total score ≥8 points indicated the patient was at high risk. This assessment scale had excellent validity; criterion-related validity AUC was 0.759, sensitivity was 0.730, specificity was 0.701, content validity was 0.86, and it had item internal consistency (Cronbach’s α=0.96, p=0.000), test-retest reliability (g=0.95, p=0.000), and evaluator consistency (ICC=0.94). Conclusion/practical applications: Effective prediction and screening of home care patients with long-term indwelling catheters at high risk for urinary tract infections and professional criteria to accurately help patients select appropriate catheter care in order to reduce the occurrence of infection and improve the quality of home care.