重症病人導管相關血流感染的預防與照護

Prevention and Nursing Care of Central Line-Associated Bloodstream Infections in Critically Ill Patients

中心靜脈導管與導管相關血流感染的發生息息相關。重症病人一旦發生血流感染，其後果堪慮，不僅會延長住院天數、增加住院費用，甚而影響疾病預後。因此，加護單位護理人員須審慎面對，以確保病人安全。本文目的為探討重症病人導管相關血流感染預防策略及照護措施之最新趨勢。根據美國疾病管制局（Centers for DiseaseControl, CDC）於2011年更新之照護指引內容及美國健康照護促進機構（the institute for healthcareimprovement, IHI）所提倡實證照護模組項目，其中包含洗手、最大消毒範圍、使用Chlorhexidine皮膚消毒、選擇注射部位、導管維護、注射部位護理及評估導管留置之必要性等項目，為預防中心靜脈導管相關血流感染重要且具成效的措施。同時，也建議機構可根據單位特性、可使用之資源及具實證之重要措施組成照護模組，並透過教育訓練等方式推展進行，同時利用稽核及監測來確保臨床照護人員確實遵循並持之以恆，方能有效預防中心靜脈導管相關血流感染，提升護理品質，也朝零容忍感染目標前進，達病人安全之里程碑。

Catheter-related bloodstream infections are associated with significantly increased morbidity, mortality, and expenditures. Such infections are a serious threat to patient safety in the intensive care unit. This review describes the latest protocols related to preventing and treating central venous catheter-associated bloodstream infections in critically ill patients. According to 2011 Center for Disease Control (CDC) guidelines and central line care bundles by the institute for healthcare improvement (IHI), prevention measures for catheter-related bloodstream infections include the following: hand hygiene, maximal barrier precautions insertion, chlorhexidine skin antisepsis, optimal catheter site selection, proper catheter maintenance, insertion site care, and daily review of line necessity, with prompt removal of unnecessary lines. These are important and effective infection prevention measures. Guidelines and care bundles also recommend organizing care modules based on unit characteristics; integrating resources and empirical measures; education and training to promote comprehensive implementation; and auditing and monitoring to ensure staff continue to follow procedures. Effectively preventing central venous catheter-related bloodstream infections can enhance care quality and move healthcare closer to achieving the goal of zero tolerance.