運用組合式照護降低血液透析雙腔導管照護感染率

Nursing Project of Using a Bundle Care Intervention for Prevention of Double Lumen Catheter Related Infection among Hemodialysis Patients

吳佩珍(Pei-Chen Wu) ； 吳麗敏(Li-Min Wu) ； 黃茹卿(Rr-Cing Huang) ； 林佩兒(Pei-Er Lin)

《新臺北護理期刊》 22卷1期 (2020/03) Pp. 47-61

https://doi.org/10.6540/NTJN.202003_22(1).0005

摘要

血液透析雙腔導管對透析病人而言，如同第二生命線，因此，落實感染管制是非常重要。本單位雙腔導管感染率有逐漸升高情形，於2015年12月之平均感染率高達（千分之11），統計因感染而重新置換導管有5位病人，其中1位更因菌血症導致死亡。故本單位成立專案小組，經查核，發現護理師未進行傷口評估就執行導管消毒、醫師未落實無菌防護措施、護理師洗手認知不足、護理師執行照護時消毒溶液停留未達2分鐘、洗手台感應不良、乾洗手液不足為主要原因。專案小組於2016年3月至2016年7月，運用雙腔導管組合式照護，修訂雙腔導管置入流程及照護查檢表、規劃感控在職教育課程、增設腳踏式洗手檯、乾洗手液、雙腔導管用物工作車等方案，雙腔導管照護正確率由83.3%提升至99.2%，而雙腔導管感染率自（千分之11）降低至（千分之5.5），以提升導管照護品質。

關鍵字

組合式照護 ； 血液透析雙腔導管 ； 感染率

並列摘要

Double lumen catheter are like the second lifeline for dialysis patients, so it is important to implement infection control. The infection rate of double lumen catheter in this unit has gradually increased. The average infection rate reached (11 per mille) from December 2015. There were 5 patients receiving double lumen catheter replacement because of the infection, and one patient died from sepsis. The internal investigation team concluded the reasons that caused Double lumen catheter infection were that nurses performed catheter disinfection without a wound assessment; doctors did not implement sterile protective measures; nurses lacked awareness of hand washing; the disinfectant stayed for less than 2 minutes while the nurse was performing the care; hand washing sensor station did not function well; and there were lack of dry hand sanitizers. From March 2016 to July 2016, the project team applied bundle care to revise the double lumen catheter placement procedure and care checklist, planned the inductive in-service education curriculum, and added pedal-mounted sinks, dry hand sanitizer and double lumen catheter work vehicle. The correct rate of double lumen catheter increased from 83.3% to 99.2%, and the infection rate of the double lumen catheter was reduced from (11 per mille) to (5.5 per mille) to improve the quality of catheter care.

並列關鍵字

bundle care ； hemodialysis double lumen ； infection rate

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