品質指標運用於導管感染之成效

Quality Improvement Programs: Effectiveness on Catheter and Ventilator-Related Infections

簡素娥(Su-O Chien) ； 陳姿君(Tzu-Chun Chen) ； 黃情川(Chyng-Chuan Hwang) ； 黃瑞明(Ruay-Hing Huang) ； 簡聰健(Tsung-Chien Chien)

《感染控制雜誌》 14卷4期 (2004/08) Pp. 212-222

https://doi.org/10.6526/ICJ.200408_14(4).0002

摘要

院內感染為醫療照護重要品質指標之一，醫療品質又關係著醫療成本。加護中心之病患由於病情比較嚴重，通常接受多項侵入性醫療措施，而成為院內感染之高危險群。因此本報告統計分析過去二年來，加護中心住院病人各類導管使用率及裝置所引起之院內感染，並運用品質指標之資料分析及解讀以訂定相關感染管制措施及政策。依據醫策會1999年參考NNIS系統所訂定執行方式，每日至加護中心收集病人動態資料及侵入性裝置使用情形，凡符合NNIS系統之院內感染定義之個案予以收案。結果顯示過去二年來，在加護中心各類導管裝置的使用率如：導尿管、中心導管和呼吸器等裝置之使用率，從2000年之84.3%、39.3%和63.5%，到2001年之74.4%、34.9%和69.1%，實施兩年間導尿管及中心導管之使用率均有下降趨勢，唯呼吸器使用率未下降；但是在各類導管裝置所引起之院內感染發生密度，從2000年之3.50‰、4.40‰和10.9‰，到2001年之1.8‰、4.1‰和6.7‰，卽導管裝置引起之院內感染密度均逐年下降，特別是由導尿管所引起的泌尿道感染及使用呼吸器造成肺炎。有鑑於此可知，本院運用品質指標之資料解讀，成立品管圈並透過圈員腦力激盪提出要因分析、確立問題及擬定實施對策，可針對各類導管裝置之使用訂定標準操作程序，促使醫護人員確實遵循各項標準操作，使得導管裝置引起之感染發生密度降至合理範圍之成效。

關鍵字

泌尿道感染 ； 血流感染 ； 呼吸器相關肺炎 ； 品質改善 ； 台灣醫療品質指標計畫

並列摘要

Nosocomial infection is an indicator for the quality of health care. Good infection control measures are of cost-benefit. Most of the patients in the intensive care units (ICU), having underlying diseases and receiving invasive procedures, are prone to acquire nosocomial infections. We collected data of various catheter and ventilator usage and rates of nosocomial infections in our ICU in the year 2000 and 2001. We applied the methods of the Association of Medical Improvement, which was modified from the National Nosocomial Infection Surveillance (NISS) program of the US Centers for Disease Control and Prevention. The infection control practitioner visited ICU everyday to collect the patients' data, including patient transfer into or out of ICU, type of the foreign bodies, and the days of their usage; and enrolled the patients who fulfilled the definitions of nosocomial infections for further investigation. We used quality control (QC) circle activity and brainstorm exercise to analyze the weak points, and then set up an appropriate policy. The standard of procedures for the invasive procedures was strictly followed. The study revealed that the rates of the foreign body usage in our ICU were 84.3%, 39.3%, and 63.5% for indwelling urinary catheter, central venous catheter, and ventilators, respectively, in the year 2000; and were 74.4%, 34.9%, and 69.1%, for the respective foreign bodies in the year 2001. There were reduced frequencies in the usage of urinary catheter, and central venous catheter after the initiation of the quality improvement program. Further, the infection rates for the three procedures all decreased from 3.5‰, 4.4‰, and 10.9‰, respectively, in 2000, to 1.8‰, 4.1‰, and 6.7‰, respectively, in 2001. These data demonstrated that we successfully applied the QC methods to the nosocomial infection control.

並列關鍵字

urinary tract infection ； blood stream infection ； Ventilators associated pneumonia ； quality control ； Taiwan Quality Indicator Project