降低剖腹產婦女術後傷口感染率

本院婦產科病房2012年剖腹產婦女之術後於傷口感染率高達千分之0.55，顯著高於台灣醫療品質指標千分之0.28之標準。經實際觀察剖腹產作業現況，發現剖腹產作業完整率僅61.4%，經訪談醫護人員，確立問題為：剖腹產照護規範不完整、標準不一致且缺乏實證基礎，護理人員未落實剖腹產照護，醫師未落實傷口照護原則。經由科會跨部門溝通，剖腹產作業納入組合式照護，舉辦剖腹產照護教育訓練課程，修訂剖腹產手術前後之衛教工具與剖腹產護理指導規範，執行剖腹產照護查核等解決方案，剖腹產傷口感染率由千分之0.55降至千分之0.16，剖腹產作業完整率達97.9%。後續持續落實解決方案，2013至2015年本院剖腹產術後傷口感染率維持在千分之0.19以下，顯示本專案的實施，確實改善剖腹產婦女傷口感染問題，有效為病人生命安全把關。

關鍵字

術後傷口感染；剖腹產；組合式照護；婦產科病房

並列摘要

The post-cesarean wound infection rate in the gynecology and obstetrics wards of our hospital was 0.55 in 2012, which was significantly higher than the 0.28 specified by the Taiwan Quality Indicator System. Furthermore, an on-site observation of cesarean sections (C-sections) revealed that the wound care procedure was only 61.4% completed in the majority of C-section cases. The lack of complete guidelines for C-sections, the inconsistent procedures and empirical basis of C-sections, as well as inadequate C-section wound care provided by the nurses and insufficient compliance with the guidelines on C-section wound care provided by the surgeons were identified as the causes of the issues through interviews with health care providers. After the integration of bundled care for C-sections, the holding of C-section care training, adjustment of the health education for patients for pre- and post- C-sections and of instructions for C-section care, and the implementation of C-section care audits through cross-departmental coordination, the post-cesarean wound infection rate in the gynecology and obstetrics wards declined from 0.55 to 0.16 and the completion rate of C-section procedures rose to 97.9%. These solutions were proven to be consistently effective, and the post-cesarean wound infection rate stayed below 0.19 between 2013 and 2015, indicating a substantial improvement in preventing wound infections in women undergoing C-section operations and ensuring their safety.