降低加護病房呼吸器相關肺炎感染率

呼吸器相關肺炎是醫院使用呼吸器病人嚴重感染的問題之一，照護不完整易增加住加護病房天數及死亡率。本單位在2017年第一季呼吸器相關肺炎平均感染率驟增到7.8‰，因此，成立專案小組，希望透過專案提升呼吸器病人照護完整率、並降低呼吸相關肺炎感染率，本專案小組自2017年4月20日成立，分析照護正確率低的原因為未修訂口腔照護技術標準作業流程、鎮靜劑使用及呼吸器訓練認知不一致等三項問題。專案改善措施包括修正口腔標準照護技術、制定鎮靜藥物使用及呼吸器脫離流程。專案執行結果醫療團隊呼吸器病人照護完整率由66.4%提升至90.8%，呼吸器相關肺炎平均感染率更是由7.8‰降低到0‰，顯示本專案能有效改善呼吸器相關肺炎照護品質。

關鍵字

加護病房；呼吸器；肺炎

並列摘要

Ventilator-associated pneumonia is one of the serious infections of patients using ventilators in hospitals, and incomplete care may results in increase length of stay in intensive care units and mortality. The ventilator-associated pneumonia infection rate increased sharply to (7.8 per mille) degrees in the first quarter of 2017 in an ICU. In April 2017, the unit established a project team to improve ventilator patient care integrity and to reduce ventilator-associated pneumonia infection rate. Through the analyze the reasons for the low rate of care accuracy, problems identified were lack of update on standard of oral care procedure and technology, lack of standards in the use of tranquilizer and inconsistency in ventilator training. Improvements to the program include revising oral standard care techniques, developing standards on the use of sedatives, and ventilator weaning processes. Results: the complete rate of nursing care for ventilator patients increased from 66.4% to 90.8%, and the infection rate of ventilator-associated pneumonia was reduced from (7.8 per mille) to 0. These interventions effectively prevent the incidence of ventilator-associated pneumonia.

並列關鍵字

intensive care unit ； ventilator ； pneumonia

參考文獻

陳韻如、王思惠、方瑱珮、陳梨文（2014）．呼吸器相關性肺炎新定義及預防措施回顧．長庚科技學刊，21，13-24。https://doi.org/ 10.6192/CGUST.2014.12.21.2

鄭舒晴、楊慧芬、廖麗惠（2015）．某加護病房呼吸器相關肺炎組合式照護改善專案．澄清醫護管理雜誌，11（4），63-72。https://doi.org/10.30156/CCMJ

謝怡然、張藏能、施玉珊、哈多吉、李淑華（2014）．北部某醫學中心外科加護病房呼吸器相關肺炎組合式照護推動經驗．感控雜誌，24（3），122-132。https://doi.org/10.6526/ICJ.201406_24(3).0002

Leite, M. A., Osaku, E. F., Costa, C. R. L. d. M., Cândia, M. F., Toccolini, B., Covatti, C., Costa, N. L., Nogueira, S. T., Ogasawara, S. M., Albuquerque, C. E., Pilatti, C. M., Piana, P. A., Jorge, A. C., & Duarte, P. A. D. (2014). Delirium during weaning from mechanical ventilation. Critical Care Research and Practice, 1-6. https://doi.org/10.1155/2014/546349.

Charles, M. P., Easow, J. M., Joseph, N. M., Ravishankar, M., Kumar, S., & Umadevi, S. (2013). Incidence and risk factors of ventilator associated pneumonia in a tertiary care hospital. The Australasian Medical Journal,6(4), 178-182. https://doi.org/10.4066/AMJ.2013.1627

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