運用品管手法改善疥瘡院內感染

THE APPLICATION OF QUALITY CONTROL METHOD TO IMPROVE NOSOCOMIAL INFECTIONS OF SCABIES

疥瘡（Scabies） 是一種具高度傳染性的皮膚疾病，傳染途徑主要以近距離接觸傳染為主。在病患集中之安義院、長期照護機構、護理之家、醫院等，均容易造成群突發事件；爆發群突發的原因，多半與診斷之延誤及未適時採取接觸隔離措施有關。本院於2003年9 月發現RCW （Respiratory Care Ward） 5 位看誰護人員及9位病人皆有皮膚紅疹情形，經皮膚科多次診斷後才確認為疥瘡。造成此次院內感染發生的主要原因為工作人員知識不足、隔離措施與洗手技術不夠落實及診斷延遲，致失去最佳治療時機所造成。故與單位商討後組成品管圈，運用QCC 手法提出對策進行改善，於2003 年10 月得以控制。本院運用品管手法，成立品管圈透過圈員腦力激盪確立問題、提出相關要因並擬定實施對策，針對疥瘡訂定標準照護流程與皮膚評估表、舉辦相關在職教育，要求單位落實執行各項對策，得以控制此一疥瘡院內感染事件。

Scabies is a kind of highly infectious dermatosis, usually spread by close contact. Patients are mostly found in long-term care facilities, nursing homes, and hospitals, where outbreak events are easily induced.The causes of the outbreak usually have a history of close contact. In September of 2003, a number of RCW caregivers and medical staff were found to have a skin rash, which was confirmed to be a case of scabies after several visits to a dermatologist. The major cause of this nosocomial infection includes the staff's lack of sufficient related knowledge, poor seclusion policy and hand-washing technique, and delayed diagnosis, which would usually miss the best timing of treatment. So a quality control circle was set up to determine a better strategy, and consequently, the entire nosocomial infections situation was brought under control by October 2003. In the application of quality methods, we built up a quality control circle by brainstorming and cooperation of all the circle members on problem confirmation, policy framing, constitution of standard caring procedure and skin assessment list, organization of relation on-jobtraining, and enhancing the practice and realization of the decided strategy. With all these efforts,this outbreak of scabies nosocomia1 infections was finally brought under control, offering at the same time real experience as an example that all other departments in the hospitaI could refer to.