內科加護病房病患Acinetobacter Baumannii菌種感染之改善方案

An Improvement Project of Controlling Acinetobacter Baumannii Infection in a Medical Intensive Care Unit

依據研究報告指出加護病房的病患因抵抗力低、多重侵入性管路留置及抗生素使用，容易造成臨床發生A. Baumannii菌種感染。本院內科加護病房於2004年3～4月發生A. Baumannii菌種感染率突然由3.5‰升高為8‰，同時感染病患因菌種變異為多重抗藥性菌種。因此，於2004年5月1日～2004年6月9成立專案改善小組，進行有關A. Baumannii菌種資料收集及原因分析，結果包括醫療人員對A. Baumannii菌種感染認知、無菌技術操作、洗手技術、共用之醫療物品消毒及清潔等方面。確立問題後，制定A. Baumannii菌種照護標準、流程及監控執行，針對加護病房的所有醫療人員進行相關訓練。經專案改善後醫療人員認知達從70.38% 提升為90%，遵守無菌及洗手技術正確性33.33%提升為100%，醫療物品消毒及清潔正確性各0%提升為100%，進而改善 A. Baumannii菌種的發生率降低至2.5‰。藉由A. Baumannii菌種照護措施介入後，對加護病房的感染管制是非常重要的，將此專案結果應用於其他加護病房之A. Baumannii菌種病患之照護，以預防此細菌之發生。

The intensive care unit (ICU) patients are at high risk of developing Acinetobacter Baumannii infection (A. B. infection) due to impaired immunity, long length of stay, and multiple invasive procedures. During March to April of 2004, the A. B. infection rate with the emergence of multi-drug resistance due to bacterial mutations rose from 3.5‰ to 8‰ in the medical ICU. Therefore, the A. B. infection improvement program was executed between May 1, 2004 and June 9, 2004 in the unit. The program evaluated the recognition of A.B. infection among healthcare workers and observed the behaviors of performing aseptic technique, methods of hand washing, and sterilization and cleaning g procedure of medical instruments. After evaluation, the intervention was executed, including establishment of clinical standards and monitoring system for A.B. infection. The education training for A.B. infection was also provided. After the intervention, the healthcare workers’ recognition of A.B. infection increased from 70.4% to 90%. The workers’ behaviors of performing aseptic technique and hand washing increased from 33.33% to 100%. In addition, sterilization and cleaning performance of medical instruments increased from 0% to 100%. Finally, the A. B. infection dropped from 8‰ to 2.5‰. The results showed that the intervention program was effective in preventing A. B. infection in ICU.