一位病人留置導尿管。哪項護理動作對減少感染風險最重要？

留置導尿管（Urinary Catheter）是醫療照護中常見的措施，但同時也是引發導尿管相關尿路感染（Catheter-Associated Urinary Tract Infection, CAUTI）的主要風險因子。 CAUTI 不僅會造成病人不適，還可能引發菌血症（Bacteremia）甚至敗血症（Sepsis），嚴重威脅病人生命。 預防 CAUTI 的關鍵在於維持導尿管系統的密閉性（Closed system），減少導尿管的留置時間，並採取適當的護理措施。其中，最重要的一環是防止尿液逆流（Reflux）回膀胱。, 選項 D 是正確的。將引流袋（Drainage bag）放置在低於膀胱的位置，是利用重力原理確保尿液能順暢地從膀胱引流至袋中，防止尿液在膀胱內積聚或逆流，這是預防 CAUTI 最重要的措施之一。 選項 C 是錯誤的。雖然定期清空引流袋很重要，但「滿了才清空」的標準可能不夠精確，有時引流袋約 2/3 滿時就應清空，以避免過重牽拉導管，或因袋體過重而影響引流。更重要的是，這不是防止感染的「最」重要措施。 選項 B 是錯誤的。頻繁地斷開導尿管與引流管的連接（Disconnect the tube frequently）會破壞整個系統的密閉性，引入外界細菌，大大增加感染風險，是絕對應避免的行為。 選項 A 是錯誤的。一般情況下，不建議對留置導尿管進行例行性沖洗（Irrigation），特別是使用自來水（Tap water）。自來水可能含有微生物，引入的風險高於潛在的益處。除非有特殊醫囑（如清除血塊），否則不應隨意沖洗。即使是醫囑沖洗，也需使用無菌生理食鹽水（Sterile normal saline）。 臨床思路：CAUTI 的預防遵循「無菌技術」和「維持引流通暢」的原則。當病人留置導尿管時，護理師的職責是持續監測引流情況，並採取措施防止尿液逆流及系統污染。

Indwelling urinary catheterization is a common procedure in medical care, but it is also the principal risk factor for catheter-associated urinary tract infection (CAUTI). CAUTI causes patient discomfort and can lead to bacteremia and even sepsis, posing a serious threat to life. The key to preventing CAUTI is maintaining a closed catheter system, minimizing the duration of catheterization, and instituting appropriate nursing measures. Among these, preventing reflux of urine into the bladder is the most important. Option D is correct. Keeping the drainage bag below the level of the bladder uses gravity to ensure smooth drainage of urine from the bladder into the bag and prevents urine from pooling in the bladder or refluxing back; this is one of the most important measures for preventing CAUTI. Option C is incorrect. Although emptying the drainage bag regularly is important, the standard of "emptying only when full" is not precise enough; the bag should typically be emptied when it is about two-thirds full to avoid heavy pulling on the catheter and to prevent the weight of the bag from impeding drainage. More importantly, this is not the most important measure for preventing infection. Option B is incorrect. Frequently disconnecting the catheter from the drainage tubing disrupts the closed system, introduces external bacteria, and substantially increases the risk of infection; this practice should be strictly avoided. Option A is incorrect. Routine irrigation of an indwelling catheter is generally not recommended, especially with tap water, which may contain microorganisms that pose a greater risk than potential benefit. Unless specifically ordered (for example to remove blood clots), irrigation should not be performed; even ordered irrigation requires sterile normal saline. Clinical reasoning: Prevention of CAUTI follows the principles of aseptic technique and maintenance of unobstructed drainage. When an indwelling catheter is in place, the nurse's responsibility is to continuously monitor drainage and to take measures that prevent urine reflux and system contamination.