降低內科加護病房呼吸器相關肺炎感染率

To Reduce the Incidence of Ventilator-associated Pneumonia in Medical Intensive Care Unit

呼吸器相關肺炎在加護病房中，不僅加重病人疾病的嚴重度、延長住院天數、增加醫療成本，更可能造成致命性的院內感染。本專案旨在降低內科加護病房呼吸器相關肺炎感染率。現況問題有：護理人員對呼吸器相關肺炎感控知識不足、缺乏呼吸器相關肺炎感控護理標準、未執行感染病患分類管理、醫護人員未依規定洗手、噴霧器清潔方式錯誤、聽診器交互使用且未消毒、呼吸管路積水未清除、執行氣管內插管、口腔護理、灌食及抽痰技術不正確，導致呼吸器相關肺炎感染率高。經擬定護理人員執行『呼吸器相關肺炎感染管制護理標準』、改善洗手、噴霧器、聽診器與漱口水設備、進行工作流程與環境動線規劃、實施病患分區分類管理、舉辦『預防呼吸器相關肺炎感染控制』教育訓練、加強宣導並依標準技術定期稽核與呼吸器相關肺炎有關之護理技術等。專案措施實施後，呼吸器相關肺炎感染率由8.02‰降低至3.99‰；顯示本專案成效良好，期望藉此專案推動之經驗，增進臨床護理人員對呼吸器相關肺炎之認知，並提供日後感染管制執行之參考，減少院內感染的發生，提昇加護護理專業價值，維護病人安全。

Ventilator-associated pneumonia in medical intensive care unit not only increases the severity of a patient’s disease, it also increases the length of stay and costs. It also induces life-threatening nosocomial infection. This project was undertaken to reduce the incidence of ventilator-associated hospital acquired pneumonia in medical intensive care unit (MICU). Through literature review and practical observation, the special team had focused on several aspects for correction: 1. The infection control knowledge about the ventilator-associated pneumonia was insufficient. 2. Lack of standard nursing care procedure for preventing ventilator-associated pneumonia. 3. Medical staff did not follow the rules of washing hand strictly. 4. Shared use of un-sterilized stethoscopes. 5. Improper techniques of performing endotracheal tube intubation, oral cavity nursing care, NG feeding, and sputum suction, all of which may increase the incidence of ventilator-associated pneumonia. After setting up the nursing protocol for control of ventilator associated pneumonia, we improved the equipment for hand-washing, nebulizer, stethoscope, and mouthwash; revised the flowchart and the circulation for the patient; performed patient categorization and isolation; provided education training for the infection control of prevention of ventilator-associated pneumonia; and started periodical evaluation of nursing skill about preventing ventilator associated pneumonia. We hope this project can provide clinical experiences to reduce the risk of hospital-acquired infection and improve the intensive care nursing professional value and improve the quality of patient care and safety.