運用“品管圈”以降低加護病房呼吸道院內感染率

Using Quality Control Circle Methods to Lower the Nosocomial Infection Rate in Intensive Care Unit

賴明雪(Ming-Sheue Lay) ； 陳美玲(Meei-Ling Chern) ； 楊佩玲(Pey-Ling Yang) ； 彭佳琪(Jia-Chyi Perng) ； 紀政儀(Jenq-Yi Jih) ； 劉韋侖(Wei-Luen Liou) ； 張雅玟(Yea-Wen Jahg) ； 蔡玲馨(Ling-Shin Tsay)

《感染控制雜誌》 15卷1期 (2005/02) Pp. 16-26

https://doi.org/10.6526/ICJ.200502_15(1).0002

摘要

院內感染為醫療照護重要品質指標之一，此文為內外科加護病房工作人員運用品管圈(quality control circle；QCC)手法，用於降低加護病房呼吸道院內感染率之實例。本加護病房90年度平均院內感染率為11.3%，其中又以呼吸道感染高居第一位，佔60.4%。品管圈於91年9月由單位內護理人員及負責單位之感控師組成，將降低加護病房呼吸道院內感染率為品管主題。經由圈員以腦力激盪的方式、問卷調查及現場觀察法選出：洗手及使用酒精性乾洗手液未確實、抽痰用具擺設易染污、未依據無菌原則組裝呼吸器管路及浸泡消毒液過程、護理人員對潮濕瓶及蓄水瓶使用認知不足四項為主要的改善重點，再與負責單位之感控師共同討論出對策：教導正確洗手及酒精性乾洗手液使用方法、正確抽痰擺設位置、教導以無菌方式三人更換管路、教導正確操作潮溼瓶加水及倒除蓄水瓶之方法，加上全體加護病房工作人員配合執行，使每月呼吸道感染率降為4.7%（目標值）以下，若當月未達目標值，則再做檢討改進，擬訂新的對策。由此次經驗，促使單位內感控知識的提昇及團隊的合作精神，共同達到改進的目標。

關鍵字

品管圈 ； 呼吸道感染 ； 院內感染

並列摘要

Nosocomial infection rate is an important measurement of the quality of the medical care. This report is on how we utilized the Quality Control Circle (QCC) methods to lower the nosocomial infection rate in our ICU. The nosocomial infection rate in ICU was 11.3% in 2001, and the respiratory tract infection comprised 60.4% of it (i.e. 6.8%). We organized a Quality Control Group from our staff nurses and the Infection Control Department members. We targeted the hand-washing; installation of the ventilator tubings; disinfecting procedures the ventilator tubing system after its use; and handling of the moisturizing tank and water reservoir of ventilator system as the four major problems to be improved. We reviewed the problems and designed the methods to correct the errors. The result of the enforcement of the new procedures in our ICU is that the rate of nosocomial pneumonia was reduced to below 4.7% by 2003. The QCC method is strongly recommended to reduce the nosocomial infection rate.

並列關鍵字

quality control circle ； respiratory tract infection ； nosocomial infection