運用跨領域團隊組合式照護改善內科加護病房中心導管相關血流感染率

The Effect of Bundle Care on Central Line Associated Bloodstream Infection in a Medical Intensive Care Unit

背景：中心導管是時常用於重症照護的醫療處置，然而，中心導管相關血流感染同時也是加護病房常見的感染。本內科加護病房於2011年1-5月中心導管相關血流感染率上升至平均千分之4.7，引發專案小組改善動機，運用跨團隊方式建立符合需求的中心導管組合式照護（bundle care），並藉由執行組合式照護來改善中心導管相關血流感染率。目的：本專案旨在降低內科加護病房中心導管相關血流感染率至千分之3.0以下。解決方案：自2011年6月1日至2012年5月31日，經文獻查證、現況調查後，設立確實執行bundle care的改善策略包括：（一）提供擦手用無菌小毛巾。（二）在插入導管時鋪設最大無菌覆蓋面（從頭到腳）。（三）繪製2% CHG（chlorhexidine gluconate）使用圖示卡。（四）制訂中心導管置入流程及照護查檢表。（五）執行中心導管置入流程及照護品管監測計畫。（六）規劃並舉辦組合式照護相關教育訓練。結果：中心導管相關血流感染率由千分之4.7降至千分之2.4。結論：期望藉此跨團隊共同建立合適的組合式照護來降低中心導管相關血流感染率，提升重症照護品質的經驗，朝零容忍感染率目標前進。

Background & Problems: While the central line catheter is a common device used in intensive medical care, it is a frequent source of nosocomial infection. The central line associated bloodstream infection (CLABSI) rate at our medical ICU had increased steadily, with an average rate between January and May 2011 of 4.7 per mille. We used a cross-team approach to implement bundle care as a strategy to reduce the CLABSI rate. Purpose: We designed a project to reduce the CLABSI rate below 3.0 per mille in our ICU. Resolution: This project was conducted between June 2011 and May 2012. Our strategy included providing a sterile towel, implementing maximal barrier precautions (head to toe), designing an illustration explaining how to use 2% CHG, establishing a procedures and care checklist, implementing quality assurance for procedures and care, and providing education on bundle care. Results: The CLABSI rate reduced to 2.4 per mille after project implementation. This result was below the target of 3.0 per mille. Conclusions: We want to share this experience to help other hospitals and units improve critical care quality and to continue working to achieve a zero-tolerance infection rate.