運用團隊資源管理改善加護病房中心導管相關血流感染率

Applying Team Resources Management to Improve Catheter-Related Bloodstream Infection in ICU

黃代泱(Dai-Yang Huang) ； 洪舒育(Shu-Yu Hung) ； 許雯琪(Wen-Chi Hsu) ； 陳俞君(Yu-Chun Chen) ； 林琪馨(Chi-Hsin Lin)

《台灣健康照顧研究學刊》 14期 (2013/03) Pp. 75-97

摘要

醫療照護感染以內科加護病房密度最高，其中血流感染最常發生，增加病人疾病嚴重程度導致死亡率上升。重症單位中心導管比例日增，也使感染率上升，但超過50％是可避免的，其中以人為及系統可以修正改善，最重要的方法是運用團隊資源管理。本專案主要目的為探討單位內中心導管相關血流感染率上升之導因，針對人為、政策及環境因素加以改善。於現況分析發現中心導管置入、照護及使用不完整率高，探討原因包含醫護人員置入及照護流程的不完整；政策缺乏在職教育和置入、照護及使用流程與稽核方式；環境設備缺乏無菌隔離設備與2% CHG。改善對策為制定標準流程、在職教育、執行組合式套裝行程、隔離設備與2% CHG備庫配置、運用查檢表及稽核，及運用TRM。本專案達中心導管置入、照護與使用流程完整率提升，進而使中心導管相關血流感染率獲得改善。

關鍵字

團隊資源管理 ； 加護病房 ； 血流感染

並列摘要

The highest rate of healthcare-associated infections in medical intensive care units was due to blood stream infection. The result may increase patients' severity and mortality consequently. The central catheter application was used very often in intensive care units (ICU). However, over 50% of infective cases were avoidable by applying team resource management as a remedy to rectify personnel and system factors.This project aimed to improve catheter-related bloodstream infections in ICU. Because the inadequate rates of nursing care and incompletion of central catheterization were high, the reasons for incompletion of central catheterization and care procedures were due to a lack of audit for central catheterization and nursing care, in-service education, and environmental facility such as germ-free isolation equipments, and 2% CHG. Solutions were listed as below; standardized procedures, in-service education, execution of CVC bundle, isolation equipments, 2% CHG stock configuration, check lists, audit, and application of TRM et al.,. The project had made some progress on central catheterization, nursing care, in result to improve central catheter-related bloodstream infection rate.

並列關鍵字

Team Resource Management ； Intensive Care Unit ； Bloodstream Infection