降低加護病房內中心靜脈導管感染之研究

Reducing Infection of Central Venous Catheters in Intensive Care Unit

林文雄(Wen-Shiung Lin)

指導教授 ： 蔡行瀚

臺北醫學大學/公共衛生暨營養學院/傷害防治學研究所/碩士(2011年)

https://doi.org/10.6831/TMU.2011.00139

摘要

美國每年「植入中心靜脈導管」數量超過500萬支。相關研究發現有3%到8%發生血流感染，這同時也佔加護病房院內血流感染原因的第一位。
根據台北市立聯合醫院感染控制資料，2008年本院（仁愛院區）加護病房內中心靜脈導管感染，高於同儕醫院（區域醫院）；以本院內科加護病房為例，中心靜脈導管感染率是6.07‰，而同儕醫院是2.94‰，甚至高於醫學中心的5.77‰；本研究之主要目的是要探討是否有相關的感染因子，及如何降低加護病房內中心靜脈導管感染，以保護病人生命安全及節省健保預算。
本研究之方法是從2009年1月1日到12月31日，我們在加護病房，對植入中心靜脈導管前的步驟做了介入措施，包括：(1) 操作前先用hibiscrub 溶液洗手。 (2) 操作時戴手術用帽子、口罩、手套，穿手術衣。 (3) 操作時擴大無菌區。 (4) 會診感染科醫師。 (5) 中心靜脈導管植入超過七天則更換。 (6) 當懷疑中心靜脈導管有感染時，予以拔除及送tip culture。
經過這些介入措施後，加護病房中心靜脈導管感染率，從2008年的4.56‰ (per 1000 catheter-days)降到2009年的2.07‰，這樣的感染率在2009年已經低於同儕醫院。
根據研究指出，在美國每位中心靜脈導管感染的病人，需多花費美金3萬元的醫療支出，這包括多1星期的加護病房及2-3星期的住院治療，同時也增加了0-35%的死亡率。在本研究中，我們加護病房，中心靜脈導管感染的病人數，由2008年的23人降為2009年的9人，如果換算成台灣的醫療支出，本院在2009年減少14位中心靜脈導管感染的病人數，初步估計可能減少病人死亡及最少可減少115萬元台幣的醫療支出。
本研究結果顯示，上述介入措施是有效的，特別是在植入中心靜脈導管時，無菌操作技術最為重要，我們應該要繼續實行，未來做更有效的修正，期能控制、降低加護病房內中心靜脈導管的感染。

關鍵字

中心靜脈導管 ； 感染 ； 加護病房

並列摘要

In the USA, physicians insert more than 5 million central venous catheters every year. Catheter-related bloodstream infections have been
reported to occur 3 to 8% of inserted catheters and the first cause of
nosocomial bloodstream in intensive care units.
The infection control data from Taipei City Hospital Ren-Ai
Branch, in our medical intensive care unit, our central venous catheter (CVC) infection rate was 6.07‰, however other hospital it was 2.94‰, and medical center it was 5.77‰. The purposes of this study is to reduce the infection of CVCs and to find the related factors, caused higher infection rate of CVCs than other hospital in 2008, this study try to promote the patient’s safety and save the health expenses.
The period of this study was from 1 Jan 2009 to 31 Dec 2009. We had different procedures (intervention) for the insertion of CVCs in our intensive care unit, including: (1) Wash hands with hibiscrub solution. (2) Use of a mask, cap, sterile gloves and gown. (3) Enlarge sterile drape. (4) Consult with infection physician. (5) Removal or re-insertion, if the CVC was inserted more than 7 days. (6) Send tip culture and remove the CVC, if the infectious complication was highly suspected.
After intervention, we lowered the infection rate of CVCs in our intensive care unit, from 4.56 infections per 1000 catheter-days in 2008 to 2.07 infections per 1000 catheter-days in 2009, had relatively lower
infection rate of CVCs than it was in other hospital in 2009.
Additional financial costs may be as high as US$30,000 per
survivor (the CVC infected patient), including one extra week in the ICU and 2-3 additional weeks in the hospital, in addition, the attributable
mortality rates range from 0-35% in the USA. In this study, we reduced the CVC infected patient, from 23 patients (in 2008) to 9 patients (in
2009) in our intensive care unit, this intervention reduced 14 CVC
infected patients, we may save patient’s life and reduce at least NT$
1,150,000 in cost.
Based on this study, this intervention showed effectively, with these
aseptic procedures for CVC insertion, the intervention should follow up and keep observing the outcome in the future to reduce infection of CVCs in intensive care unit.

並列關鍵字

Central venous catheter ； Infection ； Intensive care unit.

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