護理師正在為留置導尿管的病人制定護理計畫。下列哪些措施能有效預防導尿管相關尿路感染 (CAUTI)？（選所有適合的）
The nurse is planning care for a client with an indwelling urinary catheter. Which interventions should the nurse include to prevent catheter-associated urinary tract infections (CAUTI)? (Select all that apply.)
- APerform catheter care using povidone-iodine solution daily每日使用聚維酮碘溶液進行導尿管護理
- BKeep the drainage bag below the level of the bladder✓ 正解保持引流袋低於膀胱水平
- CEnsure the drainage system remains closed and free of kinks✓ 正解確保引流系統保持封閉且無扭曲
- DEmpty the drainage bag when it is half full using a clean container✓ 正解當引流袋裝至一半時，使用清潔容器排空
- EApply antibiotic ointment to the urethral meatus daily每日在尿道口塗抹抗生素藥膏
預防 CAUTI 的核心在於維持導尿系統的無菌完整性與重力引流。首先，引流袋必須始終低於膀胱水平（選項 B），以防止尿液逆流導致感染。其次，維持密閉系統（選項 C）是預防細菌侵入的最強防線，且必須確保管路無扭曲以維持引流通暢。第三，及時排空尿袋（約 1/2 到 2/3 滿時，選項 D）可防止尿液過重拉扯導尿管造成尿道黏膜受損，且排空時應使用病人專屬的清潔容器。至於選項 A 與 E 是常見誤區：目前的實證護理（EBP）指出，頻繁使用優碘或抗生素藥膏清洗尿道口反而會破壞正常菌叢或刺激黏膜，只需每日以溫水和肥皂清潔即可。維持足夠的液體攝取以達到「內沖洗」效果也是關鍵。
Preventing catheter-associated urinary tract infections (CAUTI) requires maintaining the integrity of the closed drainage system and ensuring gravity-dependent flow. The drainage bag must always remain below the level of the bladder to prevent reflux of contaminated urine, and the tubing must be kept free of kinks to ensure unobstructed drainage. Additionally, emptying the bag when it is half to two-thirds full prevents excessive weight from pulling on the catheter, which could damage the urethral mucosa.
美國非常強調 CAUTI 的零容忍政策，因為這屬於「永不事件」(Never Events)，保險可能不予給付。台灣醫院對於尿道口清潔雖也遵循 EBP，但在臨床實際操作中，仍有部分單位習慣使用稀釋優碘，需注意與最新考試指引的落差。