護理之家感染密度改善專案

目的：2015年1月至2016年6月平均感染密度千分之2.1，以呼吸道感染佔53%居首，專案目的在降低護理之家感染密度至千分之1.89以下。方法：在每位照服員照護對象選擇1~2位住民稽核，感管人員稽核41位員工，分析感染密度高原因有肺炎感染密度高、手部衛生遵從率低等相關因素。實施對策：1.擬定抗藥性菌種、肺炎相關照護指引。2.醫護人員外文版在職教育訓練及衛教光碟。3.增購拍痰設備、乾洗手液及洗手乳設備。4.建立床頭搖高標示，並訂定搖高床頭比率及住民下床比率稽核制度。結果：感染密度由2015年1月至2016年6月千分之2.1降至2017年7至12月千分之1.27，目標達成率大於100%，進步率的40%。住民平均住院天數由15.8天降低至13.1天、下床率由66%上升至88%、床頭搖高比率由31%上升至85%。結論：未來將錄製常見疾病及照護注意事項外文版，提供外籍新進員工職前訓練，以提升機構照護品質。

關鍵字

護理之家；感染密度；手部衛生

並列摘要

Objective: From 2015 to June 2016, the average density of infection is 2.1 per mille and the most of the infected is the respiratory tract (53%) . The goal of this project is to reduce the density of infection to be under 1.89%. Methods: To audit one or two patients whom each nurse takes care of, and infection control specialists audit 41 employees. Further, we analyzed the reasons of high infection density are related to the high Pneumonia infection density and low hand hygiene compliance. Improvements: 1. Develop the care guides which are related to drug resistant organism and Pneumonia. 2. English edition compact disk of in-service training and patient instruction for medical workers. 3. Purchase more chest percussion devices, and hand sanitizer. 4. Setting the height indicators on the head side of a hospital bed. Audit for the rates to raise the head side and get off the beds. Results: The infection density is reduced from 2.1 per mille to 1.27 per mille. The achievement rate is more than 100%, and improvement rate is 40%. The average length of stay is reduced from 15.8 days to 13.1 days. The rate of resignation is reduced from 14% to 8%. The rate of the recovery for ambulation is increased from 66% to 88%. The rate of semi or high-Fowler 's position IS increased from 31% to 85%. Conclusion: To improve the quality of care in the nursing homes, we'll make an English edition compact disk of common diseases and nursing instruction for the foreign new employee' in-service training.