降低加護病房中心靜脈導管相關血流感染率

Reducing Central Venous Catheter Associated Bloodstream Infection Rates in Intensive Care Unit

劉姿吟(Tzu-Yin Liu) ； 李育珮(Yu-Pei Li) ； 陳惇杰(Tun-Chieh Chen) ； 徐琬茵(Wan-Yin Hsu)

《安泰醫護雜誌》 23卷2期 (2017/12) Pp. 15-30

摘要

2013年度加護病房中心靜脈導管相關血流感染率千分之4.41高於同儕值，且發生此導管引起血流感染併發全身性感染死亡個案，故引發改善動機，期望降低中心靜脈導管相關血流感染率，經調查後發現醫師置入中心靜脈導管流程不正確、護理師執行導管傷口照護技術及給藥方式不正確、無菌洞巾面積範圍不足、備物不齊全、缺乏中心靜脈導管傷口照護及給藥標準作業、缺乏教育訓練課程為主要原因，故擬定改善對策：（一）制定中心靜脈導管傷口及導管照護指導書（二）規劃醫護教育訓練課程（三）採購2% CHG消毒溶液（四）設計CVC相關用物（五）修訂及制定查核表（六）設計導管置入流程圖海報（七）拍攝教學影片。經由實施對策後中心靜脈導管相關血流感染率降為千分之0。

關鍵字

中心靜脈導管 ； 血流感染 ； 加護病房

並列摘要

The annual rates of central venous catheter (CVC) associated bloodstream infection were 4.41 ‰ in our intensive care unit in 2013 which were higher than comparator. Among the catheter associated bloodstream infection cases, one developed sepsis and eventual expired. So we conducted a quality improving project to reduce the catheter associated bloodstream infection rates. After surveillance, we found several faults that including inappropriate insertion process by physicians, incorrect technologies of wound care and medication administration by nurses, inadequate sterile coverage and equipments, lack of catheter wound care and administration standard operating processes and lack of education and training. We proposed the improving projects that including drafting standard operating processes for CVC wound care, holding education and training courses for physicians and nurses, using 2% chlorhexidine for skin preparation, providing CVC related equipments, drafting checklists for CVC, designing poster for CVC insertion, taping video for CVC insertion and catheter wound care. After introducing the project, CVC associated bloodstream infection rate down to 0 ‰ and achieve the goal of zero tolerance.

並列關鍵字

Central Venous Catheter ； Bloodstream Infection ； Intensive Care Unit