運用創新策略降低中心導管相關血流感染

Implementation of Innovative Strategies to Reduce Central Line Associated Bloodstream Infections

呂淑如(Shu-Ju Lu) ； 張寶綾(Bao-Lin Chang) ； 陳瑞儀(Jui-Yi Chen) ； 蔡佩真(Pei-Chen Tsai) ； 楊淑惠(Shu-Hui Yang) ； 古世基(Shih-Chi Ku) ； 洪儀珍(I-Chen Hung) ； 黃筱芳(Hsiao-Fang Huang) ； 鄭之勛(Jih-Shuin Jerng) ； 高秀娥(Hsiu-O Kao)

《台灣醫學》 23卷6期 (2019/11) Pp. 758-768

https://doi.org/10.6320/FJM.201911_23(6).0010

摘要

本專案旨在降低中心導管相關血流感染，動機係因本單位中心導管相關血流感染2017年第三季（千分之8.3），高於醫學中心同儕，經現況分析導因有：病人免疫功能低下、主要感染菌種為革蘭氏陰性菌、靜脈抗生素治療比率高、醫師未落實判定導管適應症、單位無逐案分析感染病人機制、置入物品置放零散。經專案小組與專家研商，擬訂創新策略為「車、車、車、車畚掉」，包含：PICC置入、CHG抗菌敷料、制定逐案分析制度、中心導管置入專用工作車、β-lactam抗生素延長輸注、修正中心導管拔掉步驟。經專案推動，中心導管相關血流感染2018年前三季（千分之5.0），均達到設定目標（千分之7.0）；建議平行推廣以促進重症單位之照護品質。

關鍵字

中心導管 ； 導管相關血流感染 ； 感染控制

並列摘要

This program aimed to reduce the incidence of central line-associated bloodstream Infections (CLABSI), as a higher CLABSI incidence of (8.3 per mille) was observed at the medical respiratory care center in the 3rd quarter of 2017, which was higher than peer medical centers. Underlying reasons to contribute to this trend include patients' immune-compromised status, Gram-negative bacteria as the main pathogen, high prevalence of intravenous antibiotic use, physicians' incomplete compliance to specify the indication to use central lines, lack of a mechanism to analyze the cases with infection, and the presence of scattered items at the care scene. After the discussion and analysis with a group of experts, we proposed innovative strategies including the implementation of peripherally inserted central catheters (PICC) placement, provision of antimicrobial wound dressing with chlorhexidine gluconate, development of case analysis system, deployment of a dedicated cart for central line placement, prolongation of infusion time of β-lactams, and revision of process for the removal of the central line. After the implementation of these strategies, the CLABSI incidence was reduced to (5.0 per mille) in the first three quarters of 2018, which were all reached the target level below (7.0 per mille). Therefore, hoping for generalization, we recommend a spreading of these strategies to other critical care units to enhance the quality of care.

並列關鍵字

central line ； central line associated bloodstream infections ； infection control

參考文獻

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Ling ML, Apisarnthanarak A, Jaggi N, et al: APSIC guide for prevention of Central Line Associated Bloodstream Infections (CLABSI). Antimicrob Resist Infect Control 2016;5:16.

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Nolan ME, Yadav H, Cawcutt KA, et al: Complication rates among peripherally inserted central venous catheters and centrally inserted central catheters in the medical intensive care unit. J Crit Care 2016;31:238-42.