運用『 問題解決流程』改善新生兒加護中心經皮式中央靜脈導管感染率

A Problem Solving Process to Decrease the Nosocomial Infections in Percutaneous Central Venous Catheter in a Neonatal Intensive Care Unit

黃美麗(Mei-li Huang) ； 賴芳足(Fang-Tzwu Lay) ； 楊祖光(Tzuu-Guang Young) ； 周詩卿(Shih-Ching Chou) ； 陳秀熹(Hsiu-Hsi Chen)

《院內感染控制雜誌》 12卷5期 (2002/10) Pp. 257-267

摘要

某醫學中心新生兒加護中心民國87年以前因置放經皮式中央靜脈導管（percutaneous central venous oatheter ; PCVC）引起院內感染平均感染人次為0至2人次，感染發生密度為1.9‰，於民國88年起感染發生密度明顯增加，1月為5.1‰、2月突然增加至11.2‰，3月持續增加為18.7‰，為瞭解新生兒加護中心PCVC感染發生密度逐漸增高之原因，故於民國88年4月由新生兒加護中心與感染管制小組籌組跨部門之品質改善小組，並運用『 問題解決流程』 改善手法進行專案改善。經由現況分析發現影響PCVC感染率增加之主要相關因素為人為因素及制度因素，包括未嚴格執行洗手技術、未制訂PCVC標準操作流程等11項原因。故品質改善小組依照各項原因擬定改善對策包括重新修定PCVC注射照顧流程；訂定PCVC注射照顧審核單；制定洗手技術標準及審核單等五項改善借施。因許多研究文獻證實加強洗手可以有效預防及減少院內感染，故本專案於擬定改善方案時，特別加強醫護人員執行洗手之策略，並實施洗手考核不合格之罰則制度以提升洗手及格率。改善對策實施後PCVC感染發生密度有明顯地下降，民國88年7-12月為0.7‰，民國89年平均為0.95‰。因本改善專案之推動對改善新生兒院內感染有明顯效果，故於民國89年1月起除將本改善方法運用於其他單位之外，也將洗手考核制度推動至全院所有加護病房。

關鍵字

問題解決流程 ； 院內感染 ； 洗手 ； 經皮式中央靜脈導管 ； 新生兒加護中心

並列摘要

In a neonatal intensive care unit (NICU) at a medical center in central Taiwan, the infection density for percutaneous central venous catheter (PCVC) was around l.9‰ prior to 1999. In 1999, it increased gradually from 5.1‰ in January, 11.2‰ in February, and to 18.7‰ in March. The infection control committee at the hospital organized interdepartmental Quality Improvement Team (QIT) and investigated the cause of the increasing rate of the infection employing the “Problem Solving Process” designed by the QIT. On analysis, 3 major items, including the new personnel, inadequate training in the hand-washing technique, and the lack of a standard of operation for the PCVC, were identified as the causes of the increase in the infection rate.
Thus, the SOP was provided for the PCVC, the training of new personnel enforced, and the proper hand-washing procedures stressed. Only 67% of the hand-washing by the staff was rated as qualified in following the appropriate method, despite vigorous emphasis. Therefore, a fine was incurred to those who did not follow the correct hand-washing technique. After the change, the infection density of the PCVC dropped to O.7‰ from July-Dec 1999, and the average rate was O.95‰ in 2000. These strategies were applied to all ICUs at the Medical Center since then.

並列關鍵字

problem solving process ； nosocomial infection ； percutaneous central venous catheter (PCVC)