運用實證組合式照護於降低內科加護中心呼吸器相關肺炎之感染密度

Applying an Evidence-based Care Bundle to Reduce Infection Rate of Ventilator-associated Pneumonia in a Medical Intensive Care Center

鍾凱吉(Kai-Chi Chung) ； 曾雯萍(Wen-Ping Tzeng) ； 溫千慧(Chien-Hui Wen) ； 林佳慧(Chia-Huei Lin)

《源遠護理》 8卷3期 (2014/12) Pp. 57-66

https://doi.org/10.6530/YYN/2014.C.07

摘要

預防呼吸器相關肺炎（ventilator-associated pneumonia, VAP）的發生是提昇加護醫療品質相當重要的一環。本單位發現2011年第四季呼吸器相關肺炎平均感染密度攀升至千分之2.75，相較於其他醫學中心內科加護病房的感染密度高出3.4倍，故成立專案小組。經由實證文獻查證、實際觀察和討論，發現問題：缺乏預防VAP照護指引和查核、護理師對預防VAP之專業知識不足、未落實洗手五時機和感控原則、相關設備的使用和擺放有缺失等問題。經由舉辦在職教育、建立照護指引和查核表、制定設備擺放和標準以及後續加強查核等措施。經過12個月，本專案提昇護理師對預防VAP的認知正確率和執行率，VAP感染密度下降至0~千分之0.79。顯示本專案之照護措施能有效改善呼吸器相關肺炎的照護品質。

關鍵字

實證照護 ； 呼吸器相關肺炎 ； 院內感染 ； 加護照護 ； 組合式照護

並列摘要

Preventing ventilator-associated pneumonia (VAP) is an important quality improvement indicator in intensive care. According to report, VAP infection rate rose to 2.75 per mille in the fourth quarter of 2011 in theintensive care unit, which was 3.4 times higher than intensive care centers in other medical centers. This project team was established to reduce the VAP rate. Through literature review and an observational survey, possible causes identified were lack of standard of care, inadequate professional knowledge, inappropriate hand-washing and infection control strategy, and inappropriate supplies. The ICU established standard care guidelines and checklists for VAP, conducted education and training programs,, standardized equipment and locations, and an audit process. The project improved nurses' competency on care to prevent VAP and reduced the infection rate. In conclusion, the project effectively improved the quality of nursing care for VAP.

並列關鍵字

evidence-based practice ； ventilator-associated pneumonia ； nosocomial infection ； intensive care ； care bundle