運用管制圖分析某醫院11年間醫療照護相關的金黃色葡萄球菌血流感染

Application of Process Control Chart to Analyze the Incidence of Healthcare-associated Staphylococcus aureus Bacteremia

張育菁(Yu-Ching Chang) ； 林慧姬(Hui-Chi Lin) ； 黃筱芳(Hsiao-Fang Huang) ； 盛望徽(Wang-Huei Sheng) ； 王振泰(Jann-Tay Wang) ； 陳宜君(Yee-Chun Chen)

《感染控制雜誌》 30卷1期 (2020/02) Pp. 33-42

https://doi.org/10.6526/ICJ.202002_30(1).0004

摘要

當罹患醫療照護相關的金黃色葡萄球菌的血流感染（Healthcare-associated Staphylococcus aureus bacteraemia, HA-SAB）時，可能會造成死亡率及醫療花費的上升、延長住院天數、增加入住加護病房的機率、及導管置放時間較長等，然而，金黃色葡萄球菌或其他皮膚菌叢造成的血流感染，通常可以經由良好的感染管制措施來預防。本研究為回溯性研究，運用多種的感染管制措施，包括「預防導管相關血流感染的組合式照護措施」、「中心導管照護品質提升計畫」「降低加護病房血流感染競賽」等，並配合運用統計管制圖（Statistical process control chart, SPCC），長期觀察11年的資料，自2008年1月至2018年12月共計發生1,272例HA-SAB個案，以SPCC的u chart統計軟體進行繪圖，發現在2008～2011年推動相關感染管制措施之初期，皆超出SPCC Chart的Central line且依據SPCC判斷原則為非隨機變異而呈現紅點，而在推動後期2011～2018年間則大部分皆低於SPCC Chart的Central line且依據SPCC判斷原則為非隨機變異而呈現紅點，顯示HA-SAB個案較少。推動感染管制措施確實可以降低HA-SAB，而SPCC Chart的運用在視覺上容易判斷其變化型態，也十分適用於感染管制的監測。

關鍵字

醫療照護相關血流感染 ； 金黃色葡萄球菌 ； 統計管制圖

並列摘要

Staphylococcus aureus is a causative agent of bloodstream infections (BSIs), and healthcare-associated S. aureus bacteremia (HA-SAB) is associated with high morbidity and mortality. Root cause analysis focusing on healthcare workers revealed inadequate knowledge and suboptimal infection prevention and control (IPC) practice as factors that prevented central-line (CL)-associated bloodstream infection (CLABSI). In this retrospective study, we gathered evidence and promoted CLABSI bundle, Center of Excellent in a national action plan, to reduce CLABSI in Taiwan that was funded by Taiwan CDC to reduce bloodstream infection at intensive care units. The incidence of HA-SAB before and after interventions were compared using the U chart. The step-wide implementation and promotion of CLABSI bundle since 2009 resulted in a decrease in SPC outside the upper control limit and the standard deviations. A total of 1272 episodes of HA-SAB were identified during the 11-year study period. A multidisciplinary team involving all stakeholders, the adapt-to-adopt evidence-based practice and its integration into the workflow, annual promotion, and continuous education were important for the implementation and sustenance of the program during the 11-year period to demonstrate the long-term hospital-wide impact.

並列關鍵字

Healthcare-associated bloodstream infection ； Staphylococcus aureus ； Statistical process control char