降低加護病房中心靜脈導管相關血流感染率

背景與問題：中心靜脈導管相關血流感染為醫療照護品質重要指標之一，本單位於2011年第一季中心靜脈導管相關血流感染率為千分之10.9，遠高於單位閾值2倍。目的：降低中心靜脈導管相關血流感染率。解決方案：針對中心靜脈導管相關血流感染率高的問題，經由專案小組共同擬定解決方案：包括修訂中心靜脈導管照護作業、建立中心靜脈導管置放流程查核制度、規劃相關教育訓練課程等。結果：中心靜脈導管相關血流感染率由千分之10.9降低為千分之2.2，醫師置放中心靜脈導管流程正確率由61.1%提升至93.5%、護理師中心靜脈導管照護正確率由72%提升至97%、醫師及護理師洗手之正確率分別提升至94.6%、100%。結論：經專案推動措施後，使單位中心靜脈導管相關血流感染率下降，且病人平均住院天數由3.56縮短為3.25天，死亡率12.1%下降為10.6%，確實有效降低單位中心靜脈導管相關之血流感染率，以促進醫療品質，提升病人安全。

關鍵字

加護病房；中心靜脈導管；血流感染；成效指標

並列摘要

Central venous catheter-related bloodstream infection is an important indicator of health care quality. The central venous catheter-related bloodstream infection rate of the studied unit was 10.9% in the first quarter of 2011, two times higher than the threshold. The project to reduce infection rate included amendments to the catheter site care policy and procedures, establishing a central venous catheter placement audit, and conducting related education and training. Results showed that the central venous catheter-related bloodstream infection reduced from 10.9 per mille to 2.2 per mille, average hospital stay reduced from 3.56 to 3.25 days, and the mortality rate reduced from 12.1% to 10.6%. This project effectively reduced the center venous catheter related bloodstream infection rate and improved the quality and safety care.

並列關鍵字

intensive care unit ； central venous catheter ； bloodstream infection ； outcome indicator

參考文獻

Kim, J. S., Holtom, P., & Vigen, C. (2011). Reduction of catheter-related bloodstream infections through the use of a central venous line bundle: Epidemiologic and economic consequences. American Journal of Infection Control, 39(8), 640-646. doi:10.1016/j.ajic.2010.11.005

McLaws, M. L., & Burrell, A. R. (2012). Zero risk for central line-associated bloodstream infection: Are we there yet? Critical Care Medicine, 40(2), 388-393. doi:10.1097/CCM.0b013e318232e4f3

Shah, H., Bosch, W., Thompson, K. M., & Hellinger, W. C. (2013). Intravascular catheter-related bloodstream infection. Neurohospitalist, 3(3), 144-151. doi:10.1177/1941874413476043

江錦玲、謝美玲、王琬詳（2011）．中心靜脈導管照護及其相關感染之探討．長庚護理，22（2），184-190。