某區域教學醫院腫瘤科病房降低中心導管相關血流感染之經驗

The Reduction of Central Line-Associated Bloodstream Infections in Oncology Wards in a Regional Teaching Hospital

腫瘤病人需要中心導管注射化學治療藥物和營養輸液，病人本身就是導管相關血流感染的高風險族群。為了降低腫瘤科病房中心導管相關血流感染密度，於2011至2014年導入『中心導管相關血流感染之感染管制措施』，內容包括：一、植入式輸液導管（Port-A導管）之護理人員認證制度。二、Port-A導管角針置放之查檢表。三、擴大皮膚消毒範圍。四、擴大無菌面及穿著無菌隔離衣。五、以2% chlorhexidine進行皮膚消毒。六、加入『中心導管照護品質改善計畫』。腫瘤科病房中心導管相關血流感染密度由介入期前2010年3.34‰，下降至介入期結束2014年1.05‰（p<0.001），中心導管相關血流感染的細菌種類及表皮菌種，如凝固酶陰性葡萄球菌的數目（9株至1株）及百分比（13.8%至4.0%，p=0.183）也呈現逐年下降的趨勢。總而言之，利用中心導管相關血流感染之各項感染管制措施，能有效降低腫瘤科住院病房中心導管相關血流感染密度。

Cancer patients always need a central line for infusion of chemotherapy and nutritional fluid supplements. They are at high risk for central line-associated bloodstream infection (CLABSI). In order to reduce the incidence of CLABSI on the oncology ward, we implemented combined measures for infection control from 2011 to 2014. Care bundles included: (1) verification and instructions for Port-A-Cath needle insertion, (2) a Port-A-Cath identification check list, (3) instructions on hand hygiene, (4) maximization of sterile barrier precautions, (5) use of 2% chlorhexidine for sterilization, and (6) joint responsibility for central line care bundles. After implementation of central line care bundles, CLABSI incidence declined from 3.34 in 2010 to 1.05 in 2014(P < 0.001), Among CLABSI isolates, the number and percentage of coagulase-negative staphylococci declined from 9 to 1 and 13.8% to 4.0% (P = 0.183), respectively. Thus, implementation of combined measures for infection control can reduce CLABSI incidence in the oncology ward.