利用組合式護理降低加護病房中心靜脈導管相關血流感染密度

Using bundle care to decrease ICU bloodstream infection

呂麗戒(Li-Jung Lu) ； 楊怡君(Yi-Chun Yang) ； 李伊郡(Yi-Chun Li) ； 李碧月(Pi-Yueh Lee)

《安泰醫護雜誌》 23卷1期 (2017/06) Pp. 69-82

摘要

目的：本專案藉由推行組合照護模組概念降低加護病房血流感染率，提升單位照護品質及維護病人安全。方法；本單位2012年中心靜脈導管血流感染率為千分之4.19，影響發生之原因有病患年齡、插針部位、管路留置天數與環境及人員等原因，利用照護模組概念制定改善策略如落實洗手、增加無菌面積範圍、落實消毒溶液乾燥後執行治療、管路以OP site完全覆蓋減少暴露面積、有滲液或出血時馬上更換及每天監測管路傷口有無紅腫情形。結果:經由上述改善措施並落實執行後，單位中心靜脈導管血流感染率由千分之4.19。降低至千分之1.15。結論:使用組合式護理照護可以減少加護病房中心靜脈導管相關血流感染密度，同時也可以提升醫療照護品質及改善加護病房之病人安全。

關鍵字

血流感染率 ； 組合式護理 ； 加護病房

並列摘要

Purpose: The rate of central line-associated blood stream infection (CLABSI) of our hospital was still not optimal. The aim of this study was to determine whether implementation of the multifaceted systems interventions (Bundle Cares) would decrease the rate of CLABSI. Methods: After literature review, data analysis, and brainstorming from our colleagues, a quality improvement team had implemented eight interventions in our ICU. These interventions included : (1) strengthening the nursing care module concept (Bundle care) introduction; (2) strengthening pipeline care service education; (3) implementing wash techniques and concepts; (4) changing the sterile surface from the original hole towel from 50 x 50 cm to 300 x 180 cm hole towel in order to increase the sterile surface area and reduce the exposure area; (5) replacing the original butadiene solution by a 2% chlorhexidine solution; (6) covering the pipeline using the new dressing-- HCB Template in order to cover the exposed area completely; (7) changing the dressing immediately if there was any leakage or local bleeding; (8) implementing a checklist to ensure adherence to evidence-based guidelines for preventing the CLABSI. Results: Through improvement measures and implementing the 8 bundle care interventions, the rate of CLABSI was reduced from the original 4.19 per mille to 1.15 per mille. The rate of improvement was 72.55%. Conclusion: The study has demonstrated that implementation of bundle cares can reduce the CLABSI. This in turn helps improving the quality of nursing care and maintaining patients’ safety in ICU.

並列關鍵字

Bloodstream infections rate ； Bundle care ； Intensive care unit (ICU)