醫院常見多重抗藥菌叢護理照護重點

Multidrug-Resistant Bacteria in the Hospital: The Focus of Nursing Care

抗藥性菌種伴隨而來的高死亡率及高醫療成本支出已成為全球矚目的健康照護議題，台灣在2010年甚至出現無藥可治的超級細菌，引發媒體的大幅報導和民眾的恐慌！要避免這樣的多重抗藥性菌種的感染，最重要的即是照護團隊落實感染管制措施。從感染鏈的概念而言，現今的臨床照護實務因人口老化及慢性病、各種醫療措施的介入、免疫製劑、抗微生物制劑的使用、及人工植入物的增加…等，使得與醫療照護相關感染的易感受宿主人口日益增多。然而，最有效的感染管制措施如手部衛生，在醫療照護人員的執行率偏低，僅占30~70%之間，因環境及醫護人員手部交叉汙染而引起的感染群突發事件亦時有所聞。因此，本文依據臨床常見之多重抗藥菌種的特性及照護問題，綜整文獻與實務經驗之建議，以做為護理人員在臨床照護實務上的參考。

Antimicrobial resistance is a major global health threat associated with high mortality rates and high medical costs. In Taiwan, numerous news reports on threats from super-bacteria have caused intermittent public panics since 2010. Improving the adherence of medical team members to infection control precaution policies is the most effective and immediate way to prevent antimicrobial resistance. In line with the infection chain concept, the modern clinical practice faces increases in susceptible hosts in the form of various immune-compromised patients, aging populations, rising numbers of chronically ill patients, various medical interventions, and increased antimicrobial agent use. Such has significantly increased opportunities for hospital-acquired infections. Medical staffs have also widely failed to comply with infection control measures. The compliance rate for hand hygiene, for example, has been reported as only 30~70 %. Many reports have been published on hospital-acquired multidrug-resistant bacteria outbreaks traced to the hospital environment and medical staff cross-contamination. This article provides insight into the problem and facilitates clinical staff decision-making regarding the prevention and control of multidrug-resistant bacterial infections.