某加護病房呼吸器相關肺炎組合式照護改善專案

Improving Ventilator-Associated Pneumonia Bundle Care in An ICU

目的：本單位自2012年開始執行呼吸器相關肺炎（VAP）組合式照護（Bundle Care），其成效不佳，照護正確率僅68.7％，施行後呼吸器相關肺炎（VAP）感染率高達6.16‰，根據文獻指出組合式照護（Bundle Care）正確執行可有效降低呼吸器相關肺炎（ventilator associated pneumonia，VAP）的感染率。方法：單位於2012年7月初期開始實施組合式照護（Bundle Care），執行時因無共同標準作業流程，組合式照護（Bundle Care）項目不明確，經現況分析發現導致組合式照護（Bundle Care）正確率低的原因為：護理人員認知不足、欠缺標準規範及稽核制度、漱口水的成份未統一及缺乏測量抬高床頭工具。經專案改善措施包括：舉辦教育訓練及回覆示教、制定組合式照護（Bundle Care）標準規範、記錄單及稽核辦法，統一使 0.2％Chlorhexidine漱口水，運用顏色標示床頭抬高之刻度。結果：本專案透過制定標準規範後，組合式照護（Bundle Care）正確率由68.7％提升至91％。呼吸器相關肺炎（VAP）感染率則由6.16‰降至1.71‰，顯示本專案有效提升加護病房照護品質。結論：藉由透過有效的護理照護措施，不僅可降低住院病人院內感染的風險，減少住院天數，讓病人遠離疾病的迫害，確保病人安全，充分發揮加護病房護理人員的專業能力及照護品質。

Purposes: Our intensive care unit began implementing ventilator-associated pneumonia bundle care in 2012 but the results were poor and care correctness was only 68.7%. After the application of bundle care, the ventilator-associated pneumonia infection rate increased by 6.16%. However, some references pointed out that bundle care could effectively lower the ventilator associated-pneumonia infection rate if executed correctly. Methods: We started to implement bundle care in July 2012 but we had no common standard operational procedures and were unclear about some items of the bundle care method. The causes of the low correct rate for bundle care were: lack of recognition by the nurses, lack of standard operational procedures and audit system, lack of unified ingredients in the mouthwash and the lack of instruments to measure the correct elevation of the head of the bed. The improvement measures introduced included educational training and repetition of what was demonstrated earlier, drafted standard bundle care specifications, record sheets, audit approach, unified use of 0.2% Chlorhexidine mouthwash, and the use of color-coded labels for calibration measurements of the elevation of the head of the bed. Results: The improvements realised through setting out standard specifications increased the correct rate for bundle care from 68.7% to 91%. The ventilator-acquired pneumonia infection rate decreased from 6.16% to 1.71%, showing that this improvement plan was able to improve the quality of care in our intensive care unit. Conclusions: With effective nursing measures, nosocomial infection risks can be lowered and days of hospitalization reduced, protecting patients from disease and ensuring patient safety. In addition, the measures introduced have fully unleashed the professional competence and quality of care provided by the nurses in our intensive care unit.