應用組合式照護預防中心導管相關血流感染

Reducing Central Line-Associated Bloodstream Infections by Implementing the Care Bundle

簡麗蓉(Li-Jung Chien) ； 張淑玲(Shu-Ling Chang) ； 曾淑慧(Shu-Hui Tseng)

《榮總護理》 33卷3期 (2016/09) Pp. 222-228

https://doi.org/10.6142/VGHN.33.3.222

摘要

醫療照護相關感染是反映醫療品質及病人安全的一個重要指標，近年來不僅世界衛生組織極力呼籲，許多國家也都將醫療照護相關感染的預防與管制納入衛生政策的重要施政事項。為預防侵入性導管相關感染的發生，國外已經有許多國家的專業團體或政府部門推動運用組合式照護的手法，組合3至5種具有實證基礎的介入措施，並確保這些措施能共同且確實的執行，來提升病人預後改善的成效；其中最早的成功案例是中心導管組合式照護措施。我國參考美國的推動模式，並以先驅研究建立本土經驗，於2013-2014年執行全國「中心導管照護品質提升計畫」，導入包含手部衛生、最大無菌面防護、使用酒精性2% chlorhexidine消毒皮膚、避免由股骨部位置入之中心導管策組合式置入措施，以及包含每日評估是否拔除導管、手部衛生、導管置入部位更換無菌敷料、輸液套的更換、消毒注射帽5項中心導管組合式照護措施。連續2年參加計畫的133個加護病房中心導管相關血流感染密度下降幅度達34.8%，全國區域級以上醫院加護病房的中心導管相關血流感染密度，也自2013年全國計畫啟動後開始翻轉，計畫初步執行成效符合減少醫療資源耗用及維護病人安全的目標。

關鍵字

中心導管 ； 中心導管相關血流感染 ； 組合式照護

並列摘要

Health care-associated infection (HAI) is a critical indicator of the quality and safety of patient care. Not only has the World Health Organization strongly appealed to society to confront the challenges posed by HAIs, but many countries have also considered the prevention and control of HAIs a top priority of health policy in recent years. To prevent device-associated infections, professional organizations or government health departments in many countries have used the bundle approach, which includes a small set of evidence-based interventions, generally three to five, and have ensured that each of them were performed collectively and reliably to improve patient outcomes. The central line bundle was the first bundle proven to be successful in a large scale project. By learning from the successful strategy implemented in the United States and the experience from an indigenous pilot study, a national action plan for improving the quality of central line care was conducted in Taiwan during 2013-2014. This project implemented multifaceted strategies to improve the compliance of the central line insertion bundle, the characteristics of which were optimal catheter site selection, hand hygiene, chlorhexidine skin antisepsis, and maximal sterile barrier precautions; those of the maintenance bundle were the daily review of line necessity, hand hygiene, dressing change, replacement of administration sets, and scrubbing the hub. A total of 133 ICUs that participated in the program for 2 years achieved a 34.8% reduction in central line-associated bloodstream infection (CLABSI). In addition, the trend of CLABSI incidence in ICUs at medical centers and regional hospitals declined after the launch of the national action plan, demonstrating that the preliminary outcome fulfilled the goal of reducing medical costs and protecting patient safety.

並列關鍵字

central line ； central line-associated bloodstream infection ； care bundle

參考文獻

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