신경계 장기 입원환자의 도뇨와 요로감염 실태

Abstract

This study is the survey study and the purpose of this research is to analyze the type of urethral catheterization used by long term patient with nervous system problem and the state of urinary tract infection. The subject of the study were 86 patients who hospitalized in a long term and used urinary catheterization which are located at the 12 hospitals of D metropolitan city and K province. The time period of gathering data was from 15 May, 2005 to 15 June, 2005. To the used as tools for the research, Korea infection management guideline (2004) and Ryu Soo Bang(2002). The data were analysis with SPSS WIN 12.0 program, frequency, percentage, average, standard deviation, t-test and χ2-test. The result of this study are as follows: The state of urinary catheterization use for the patients showed that 63 patients (73.3%) used indwelling urinary catheterization for average 10.3 months, 21 patients (24.4%) used extra-corporeal urinary catheterization for average 16.48 months and 2 patients (2.3%) used intermittent urinary catheterization for average 8.24 months. The case of indwelling urinary catheterization and intermittent urinary catheterization showed 100% of infection rate and the case of extra-corporeal urinary catheterization showed 52.6% of infection rate. The case of indwelling urinary catheterization and intermittent urinarycatheterization was managed with Benzalkonium and Chlorhexidine, and the case of extra-corporeal urinary catheterization was managed with soap water and lavatory tissue by practitioner. In case of indwelling urinary catheterization, patients felt comfortable (61.9%), on the other hand, some patients were worried about urinary tact infection (33.3%). And, the case of intermittent urinary catheterization was reluctant to use it due to botheration (50%). In case of extra-corporeal urinary catheterization, patients thought it’s easy to manage and economical (33.3%), but they worried about skin damage (42.9%). For the frequency of bacterial species which cause the urinary tact infection, the patients were infected by E-coli with 24patients(45.3%) which were the biggest number, Klebsiella with 8patients(15.1%), Pseudomonas with 6patients(11.1%), Staphylococcus with 6patients(11.3%), Proteus with 5patients(9.4%) and Candida 4patients(7.6%). The urinary tact infection of object was mainly by the mixed infection pattern. For the difference of general variables between the infectious group and noninfectious group, there was a significant difference in the period of hospitalization (t=2.930, p=0.004), age (t=1.90, p=0.013), academic background (p=0.000), financial state (p=0.005), consciousness status (p=0.027) and existence of virus outflow (p=0.028) In conclusion, long-term indwelling urinary catheterization is still the most common method used for the long-term patient with Nervous System Problem and after removing and replacing the indwelling urinary catheterization with a different method of urinary catheterization, extra-corporeal urinary catheterization is much more frequently used than the intermittent urinary catheterization. extra-corporeal urinary catheterization, helps reduce the rate of urinary tract infection, so it is necessary to promote the use of extra-corporeal urinary catheterization after conducting further in-depth research on the method of extra-corporeal urinary catheterization.

본 연구는 서술적 조사연구로, 신경계 장기 환자의 도뇨 사용과 요로감염실태를 조사하기 위해 시도되었다. 자료수집은 2005년 5월15일부터 6월15일 까지였으며, 대상자는 D광역시, K지역 종합병원 신경과, 신경외과에 장기재원중이면서 도뇨를 사용 중인 86명을 대상으로 실시하였다. 본 연구에서는 도뇨 사용 실태와 요로감염을 조사하기 위해 감염관리지침(2004)과 류수방 (2002)의 조사기록지를 기초로 하여 본 연구자가 수정 보완하여 사용하였다. 수집된 자료는 SPSS WIN 12.0 프로그램을 이용하여 빈도, 백분율, 평균, 표준편차, t-test, χ2-test를 이용하여 분석하였다. 연구결과는 다음과 같다. 대상자들의 도뇨사용 실태는 유치도뇨 63명(73.3%) 평균 사용개월 수는 10.3개월, 체외도뇨 21명(24.4%) 16.48개월, 간헐도뇨 2명(2.3%) 8.24개월로 나타났다. 요로감염 실태는 유치도뇨와 간헐도뇨의 경우 100%감염률을 체외도뇨의 경우 52.6% 감염률을 나타냈다. 유치도뇨와 간헐도뇨의 경우 의료인에 의해 Benzalkonium(제파논), Chlorhexidine으로 소독하고, 체외도뇨의 경우 비눗물과 화장지로 관리하는 것으로 나타났다. 유치도뇨의 경우 대상자들이 편하게 느끼는(61.9%) 반면 요로감염(33.3%)을 우려하였고, 간헐도뇨의 경우 귀찮아서 잘 사용하기를 꺼리는 것(50%)으로 나타났다. 체외도뇨의 경우 관리도 편하고 경제적(33.3%)인 반면 피부손상(42.9%)을 우려하였다. 요로감염의 원인 균종의 빈도는 E-coli에 의한 감염24명(45.3%)으로 가장 많았고, Klebsiella 8명(15.1%), Pseudomonas 6명(11.1%), Staphylococcus 6명(11.3%), Proteus 5명 (9.4%), Candida 4명(7.6%)의 감염빈도로 나타났으며, 대상자의 요로감염은 혼합감염 형태가 주를 이루었다. 감염군과 비감염군간의 일반적 변수의 차이에서 재원기간(t=2.930, p=0.004), 나이(t=1.90, p=0.013), 학력(p=0.000), 경제상태(p=0.005), 의식상태(p=0.027), 균 배출 유무(p=0.028)에서는 유의한 차이가 있었다. 결론적으로 신경계 장기 입원환자들의 도뇨사용 실태는 아직 장기적 유치도뇨를 가장 많이 사용하고 있으며, 유치도뇨 제거 후 간헐도뇨보다는 체외도뇨의 빈도가 훨씬 높았다. 비침습적인 방법인 체외도뇨를 사용하는 경우 요로감염률 저하를 볼 수 있었으므로 향후 체외도뇨법에 대한 연구를 거쳐 활성화가 필요하리라 사료된다.