血液透析室疥瘡群聚感染改善專案

Improvement Project for Cluster Infection of Scabies in Hemodialysis Room

疥瘡會加重腎衰竭病患之皮膚搔癢症狀，造成皮膚完整性損傷亦或因搔抓而誤拔透析導管。血液透析病床每4小時會輪換一批病患，一旦有病患感染疥瘡，很容易爆發群聚感染。本單位於2007年12月份發生疥瘡群聚感染事件（感染率為11.1％）；分析主要問題為護理人員對疥瘡認知不足、未訂定有效篩檢疥瘡評估表及感染防治之作業標準。本專案之目的在提升護理人員對疥瘡評估的敏感度與照護知識、降低血液透析病患疥瘡感染率。專案策略包括制定疥瘡評估表、在職教育訓練、建立疥瘡處理流程圖及運用衛教單張、交班本等作為與家屬、機構之聯繫方式（以確保治療之持續性）。執行後，本單位病患及工作人員之疥瘡感染率降低至零（且持續近二年）。本專案實施結果不僅提高血液透析室工作人員對疥瘡防治的認知及警覺性，更能及早治療並預防感染擴散，確實可達到預防血液透析病患疥瘡感染率，確保病患與工作人員的安全。

Scabies infection can exacerbate the sensation of itchiness among patients with renal failure. Patients may break their skin or even pull the dialysis catheter out accidentally when scratching. As the patient's turnover in a general dialysis ward averaged four hours per batch, a single patient infected with scabies can lead to cluster infection outbreak. In December 2007, a cluster of scabies infection occurred in our hemodialysis unit (the infection rate was 11.1%). The main cause of outbreak was a lack of cognition about scabies, and the absence of a standard operation procedure to effectively prevent their infection. The objective of this project aimed to increase the alertness of nursing staff to scabies and reduce the infection rate among hemodialysis patients. Project strategies included establishing a scabies assessment check list, in-service training programs, a flow chart based on the management of scabies infection, and the utilization of healthcare education leaflets and shift-handover logs for between family-institution intercommunication (hence providing a continuity of treatment). After the implementation of this project, the scabies infection rate dropped to zero for both patients and nursing staff in our hemodialysis unit (a record that has endured for nearly two years). The outcome of this project not only allowed increased alertness of hemodialysis staff on scabies prevention but also enabled early treatment to further preventing the spreading of the infection. As a result, the scabies infection rate among hemodialysis patients was successfully reduced, ensuring the safety of patients and staff alike.