62 Knowledge of CAUTI 2001 CAUTI CAUTI CAUTI Willson et al., 2009 CAUTI CAUTI 2009 2009 Willson et al., 2009 CAUTI CAUTI 2008 55% CAUTI CAUTI CAUTI ㈠

61 光 碟 教 學 對 改 善 長 照 機 構 護 理 人 員 在 導 尿 管 相 關 泌 尿 道 感 染 知 識 之 成 效 陳 美 雪 1 林 淑 媛 2* 1 嘉 義 長 庚 紀 念 醫 院 護 理 部 護 理 長 2 高 雄 醫 學 大 學 護 理 學 系 助 理 教 授 泌 尿 道 感 染 為 長 照 機 構 常 見 感 染 之 一, 尤 其 導 尿 管 相 關 泌 尿 道 感 染 (catheter-associated urinary tract infection, CAUTI) 是 引 起 機 構 感 染 的 主 因 之 一 對 許 多 獨 立 型 的 長 照 機 構 而 言, 因 資 源 受 限 而 影 響 了 機 構 內 護 理 人 員 對 相 關 泌 尿 道 感 染 防 護 的 認 知 比 較 有 無 接 受 多 媒 體 影 音 光 碟 教 學 及 光 碟 教 學 介 入 前 後, 長 照 機 構 護 理 人 員 在 導 尿 管 相 關 泌 尿 道 感 染 知 識 之 改 變 程 度 採 雙 組 前 後 測 之 類 實 驗 設 計, 進 行 時 間 為 2010 年 4 月 至 6 月, 以 高 雄 市 24 家 獨 立 型 養 護 中 心 及 1 家 醫 院 附 設 護 理 之 家 之 72 位 護 理 人 員 為 對 象, 依 參 加 機 構 主 管 意 願 分 派 為 實 驗 組 及 控 制 組,37 位 實 驗 組 接 受 一 個 月 的 多 媒 體 影 音 光 碟 教 學,35 位 控 制 組 則 無 接 受 光 碟 教 學, 兩 組 人 員 均 接 受 導 尿 管 相 關 泌 尿 道 感 染 知 識 量 表 之 前 測 與 後 測 實 驗 組 與 控 制 組 在 知 識 前 測 得 分 無 顯 著 差 異 (p =.18), 多 媒 體 影 音 光 碟 教 學 介 入 後, 實 驗 組 與 控 制 組 在 知 識 後 測 有 顯 著 差 異 (p <.01), 以 知 識 前 測 得 分 及 婚 姻 年 齡 和 工 作 年 資 當 作 共 變 項, 發 現 實 驗 組 在 知 識 後 測 仍 與 控 制 組 有 顯 著 差 異 (p <.01) 多 媒 體 影 音 光 碟 教 學 可 增 進 護 理 人 員 在 導 尿 管 相 關 泌 尿 道 感 染 的 知 識, 透 過 知 識 的 提 升 可 能 會 改 變 護 理 人 員 在 導 尿 管 相 關 泌 尿 道 感 染 的 照 護 行 為, 而 使 導 尿 管 相 關 泌 尿 道 感 染 發 生 率 降 低, 故 建 議 長 照 機 構 未 來 可 利 用 多 媒 體 影 音 光 碟 教 學 作 為 在 職 教 育 的 策 略 關 鍵 詞 : 光 碟 教 學 長 照 機 構 護 理 人 員 導 尿 管 相 關 泌 尿 道 感 染 知 識 2005 2010 catheter-associated urinary tract infection, CAUTIWillson et al., 2009 75.3% 2008 30 Willson et al., 2009 CAUTI 10 2 CFU/ml 2009 Fekete, 2008 CAUTI Nicolle, 101 1 2 * 80708 100 07 3121101 2616 8 卷 1 期 中 華 民 國 101 年 3 月

62 Knowledge of CAUTI 2001 CAUTI CAUTI CAUTI Willson et al., 2009 CAUTI CAUTI 2009 2009 Willson et al., 2009 CAUTI CAUTI 2008 55% CAUTI CAUTI CAUTI ㈠ 6 CAUTI CAUTI Parker et al., 2009; Willson et al., 2009 CAUTI Elpern et al., 2009; Meddings, Rogers, Macy, & Saint, 2010; Willson et al., 2009 2007 2009 Willson et al., 2009 2009 Gray, 2004; Willson et al., 2009 Gray, 2004; Willson et al., 2009 ㈡ 2009 Lin, Yang, Lu, & Kao, 2008; Singson, Murphy, & Merrill, 2011 Singson et al., 2011; Willson et al., 2009 27 45% Zimakoff, Pontoppidan, Larsen, Poulsen, & Stickler, 1995 75% 74% Singson et al., 2011 2008 38% Drekonja, Kuskowski, & Johnson, 2010 CAUTI 2009 2009 Willson et al., 2009 2009 = 62 = 89 CAUTI 8 卷 1 期 中 華 民 國 101 年 3 月

63 2005 Huckstadt & Hayes, 2005 MacDonald, Stodel, & Casimiro, 2008; Petrucci et al., 1991 CAUTI 99 4 6 24 1 IRB98-3133B ㈠ 24 ㈡ ㈢ 75 65 10 72 37 27 10 35 35 Fekete, 2008 2009 Gray, 2004; Willson et al., 2009 CAUTI 30 CAUTI 30 ㈠ ㈡ 2009 Fekete, 2008; Willson et al., 2009 1 0 CAUTI CAUTI 0 18 8 卷 1 期 中 華 民 國 101 年 3 月

64 Knowledge of CAUTI 4 3 21 3 content validity index, CVI CVI 1.0 KR-20.85 20.38 35.74 p >.01 SPSS 14.0 tancova 28.4033.68 Z = 0.11, p >.05; Z = 1.27, p >.05Z = 1.86, p >.05 Z = 1.84, p >.05t ANCOVA F = 0.97, p =.33 N = 72 n % n = 37 n = 35 χ 2 / t p 1 2.7 4 11.4 36 97.3 31 88.6 8.36.015* 30 81.1 22 62.8 7 18.9 13 37.2 36 97.3 33 94.3 1 2.7 2 5.7 10.40 a.340 6 16.2 14 40.0 31 83.8 19 60.0.00 a 1.000 23 62.1 21 60.0 14 37.9 14 40.0.33 a.566 26 70.3 24 72.7 11 29.7 11 31.4 M ± SD 22 52 28.40 ± 3.73 33.68 ± 8.14-4.30 b.000* M ± SD 2 135 20.38 ±15.40 35.74 ± 34.19-2.98 b.004* a χ2 b t *p <.05. 8 卷 1 期 中 華 民 國 101 年 3 月

65 N = 72 M ± SD n = 37 n = 35 t p 23 37 28.00 ± 2.11 28.39 ± 2.09-1.34.182 33.43 ± 2.01 28.95 ± 2.42 14.76.000* *p <.01. ANCOVA ISS df MS F p 450.63 2 225.31 84.48.000* 449.84 1 449.84 168.67.000* 0.79 1 0.79 0.30.588 184.03 69 2.67 634.65 71 439.38 2 219.69 77.63.000* 437.24 1 437.24 154.50.000* 2.14 1 2.14 0.76.388 195.28 69 2.83 634.65 71 439.43 2 219.71 77.66.000* 437.24 1 437.24 154.54.000* 2.19 1 2.19 0.77.382 195.23 69 2.83 634.65 71 443.69 2 221.85 80.16.000* 437.24 1 437.24 157.99.000* a 6.45 1 6.45 2.33.131 190.96 69 634.65 71 a *p <.01. F = 1.61, p =.21 F = 3.48, p =.07 F = 3.82, p =.06 ANCOVA 2009 MacDonald et al., 2008; Petrucci et al., 1991 2009 2007 95%2008 57% 8 卷 1 期 中 華 民 國 101 年 3 月

66 Knowledge of CAUTI 82% Lin 2008 CAUTI CAUTI CAUTI CAUTI IRB 98-3133B CMRP- G6A0191 2008 19 4 331 336 [Lee, C. M., Chen, Y. L., & Yang, C. L. (2008). Nosocomial infection in one long term care facility-a nursing home. Journal of Internal Medicine of Taiwan, 19(4), 331 336.] 2009 19 4 205 213 [Chu, C. L., Chen, M. C., Chang, C. H., Lin, M., & Wang, F. D. (2009). Evaluation of infection control strategy in indwelling urinary catheter in a medical center. Infection Control Journal, 19(4), 205 213.] 2005 45 6 49 55 [Yao, C. Y., & Chao, J. Y. (2005). E-learning in a hospital clinical nursing staff of the advanced application training. Bulletin of Research on Elementary Education, 45(6), 49 55.] 2010 27 4 328-336 [Chi, M. M., Chen, Y. C., Chou, S. S., & Chen, Y. Y. (2010). Risk factors of urinary tract infection in an intensive care unit. VGH Nursing, 27(4), 328 336.] 2009 8 卷 1 期 中 華 民 國 101 年 3 月

67 26 4 336 345 [Chang, M. Y., Wang, F. Y., Wang, S. H., Wang, K. J., & Chang, J. W. (2001). The effectiveness of a urinary catheter care bundle on patients with indwelling catheters in intensive care units. VGH Nursing, 26(4), 336 345.] 2008 [Tsao, J. Y. (2008). A study of the needs of nursing continuous education in long term care institute and its related factors in Pingtung county (Unpublished master s thesis). Meiho University, Pingtung City, Taiwan, ROC.] 2005 1 2 65 78 [Chen, T. T., Hwang, L. C., Tjung, J. J., & Chang, C. M. (2005). Hospitalized urinary tract infections in residents of a nursing home. Taiwan Geriatrics & Gerontology, 1(2), 65 78.] 2009 13 2 191 201 [Cheng, U. T. (2009). Prevention and nursing care of catheter-associated urinary tract infections. Formosan Journal of Medicine, 13(2), 191 201.] 2007 17 1 1 10 [Chu, T. H., Chang, S. C., Chen, M. C., & Hwang, K. P. (2007). A plan to control the urinary tract infection in emergency intensive care unit of a medical center in southern Taiwan. Infection Control Journal, 17(1), 1 10.] Drekonja, D. M., Kuskowski, M. A., & Johnson, J. R. (2010). Foley catheter practices and knowledge among Minnesota physicians. American Journal of Inflection Control, 38(9), 694 700. doi:10.1016/j.ajic.2010.03.011 Elpern, E. H., Killeen, K., Ketchem, A., Wiley, A., Patel, G., & Lateef, O. (2009). Reducing use of indwelling urinary catheters and associated urinary tract infections. American Journal of Critical Care, 18(6), 535 541. doi:10.4037/ ajcc2009938 Fekete, T. (2008). Urinary tract associated with indwelling bladder catheters. Retrieved from http://www.utdol.com/online/ content/topic.do?topickey=uti_infe/2922&selectedtitle=3 Gray, M. (2004). What nursing interventions reduce the risk of symptomatic urinary tract infection in the patient with an indwelling catheter? Journal of Wound, Ostomy, & Continence Nursing, 31(1), 3 13. Huckstadt, A., & Hayes, K. (2005). Evaluation of interactive online courses for advanced practice nurses. Journal of the American Academy of Nurse Practitioners, 17(3), 85 89. Lin, C. F., Yang, C. Y., Lu, M. S., & Kao, C. C. (2008). Effectiveness of a nosocomial infection control training in improving knowledge in patient-hired attendants and outsourced workers in Taiwan. The Journal of Nursing Research, 16(3), 187 194. doi:10.1097/01.jnr.0000 387305.96622.5b MacDonald, C. J., Stodel, E. J., & Casimiro, L. (2008). An online interpersonal learning resource for physicians, pharmacists, nurse practitioners, and nurses in long-term care: Benefits, barriers, and lessons learned. Informatics for Health & Social Care, 33(1), 21 38. doi:10.1080/146392 30801886824 Meddings, J., Rogers, M. A., Macy, M., & Saint, S. (2010). Systematic review and meta-analysis: Reminder systems to reduce catheter-associated urinary tract infections and urinary catheter use in hospitalized patients. Clinical Infectious Diseases, 51(5), 550 560. doi:10.1086/655133 Nicolle, L. E. (2001). Epidemiology of urinary tract infection. Infections in Medicine, 18(3), 153 162. Parker, D., Callan, L., Harwood, J., Thompson, D., Webb, M., Wilde, M., & Willson, M. (2009). Catheter-associated urinary tract infections: Fact sheet. Journal of Wound, Ostomy and Continence Nursing, 36(2), 156 159. Petrucci, K., Petrucci, P., Canfield, K., McCormick, K. A., Kjerulff, K., & Parks, P. (1991). Evaluation of UNIS: Urological nursing information systems. In American Medical Informatics Association (Ed.), Proceedings of the Annual Symposium on Computer Application in Medical Care (pp. 43 47). Washington, DC: American Medical Informatics Association. Singson, K., Murphy, S., & Merrill, C. K. (2011). Nurses knowledge and compliance to catheter associated urinary tract infection prevention bundle: A baseline survey. 8 卷 1 期 中 華 民 國 101 年 3 月

68 Knowledge of CAUTI American Journal of Infection Control, 39(5), E170. doi:10.1016/j.ajic.2011.04.285 Willson, M., Wilde, M., Lu, M. W., Thompson, D., Parker, D., Harwood, J., & Gray, M. (2009). Nursing interventions to reduce the risk of catheter-associated urinary tract infection. Part 2: Staff education, monitoring, and care techniques. Journal of Wound, Ostomy, & Continence Nursing, 36(2), 137 154. doi:10.1097/01.won.0000 347655.56851.04 Zimakoff, J. D., Pontoppidan, B., Larsen, S. O., Poulsen, K. B., & Stickler, D. J. (1995). The management of urinary catheters: Compliance of practice in Danish hospitals, nursing homes and home care to national guidelines. Journal of Urology and Nephrology, 29(3), 299 309. 8 卷 1 期 中 華 民 國 101 年 3 月

69 Improving Catheter-Associated Urinary Tract Infection Knowledge in Long-Term Care Facility Nurses: The Efficacy of CD-ROM-based Instruction Mei-Hsuen Chen 1 Shu-Yuan Lin 2 * 1 RN, MSN, Head Nurse, Department of Nursing, Chiayi Chang Gung Memorial Hospital; 2 RN, PhD, Assistant Professor, School of Nursing, Kaohsiung Medical University. Abstract Background: Urinary tract infection (UTI) is one of the most prevalent infections in long-term care facilities. Catheter-associated urinary tract infection (CAUTI) is the major cause of UTI in these facilities. Nurses knowledge of CAUTI in many free-standing long-term care facilities is inadequate due to resource limitations. Purpose: This study assessed the effect on CAUTI knowledge of multimedia CD-ROM instruction by comparing the CAUTI knowledge of nurses who received such instruction and those who did not. Methods: Researchers used a quasi-experimental pretest - posttest control group design; This study was conducted from April to June 2010; Data were collected from 72 nurses working in 24 assisted-living facilities and one hospitalaffiliated nursing home in Kaohsiung. Group assignment was based on nursing home administrator choice. The experimental group received one month of multimedia CD-ROM instruction, and the control group received no CD-ROM instruction. Both groups completed a CAUTI knowledge questionnaire prior to and after the intervention. Results: There was no significant pre-test difference in CAUTI knowledge between the two groups (p =.18). Post-test improvement in CAUTI knowledge in the experimental group nurses was significantly larger than in the control group (p <.01). Using pre-test CAUTI knowledge, marriage, age and work experience as covariates, experimental group nurses had significantly better CAUTI knowledge compared to control group nurses at post-test (p <.01). Conclusions: Multimedia CD-ROM instruction can increase CAUTI knowledge in nurses, which may lead to improved nurse CAUTI care behavior and decreased CAUTI incidence. We suggest promoting multimedia CD-ROM teaching as a continuing education strategy in long-term care facilities. Key Words: compact-disc teaching, long-term care facilities, nurses, catheter-associated urinary tract infection (CAUTI), knowledge. Accepted for publication: January 2, 2012 *Address correspondence to: Shu-Yuan Lin, No. 100, Shi-Chuan 1st Rd., San Min District, Kaohsiung City 80708, Taiwan, ROC. Tel: +886 (7) 312-1101 ext. 2616; E-mail: m845008@kmu.edu.tw 8 卷 1 期 中 華 民 國 101 年 3 月