應用Chlorhexidine Bathing介入措施降低內科加護病房病人院內感染率成效探討

Effectiveness of Chlorhexidine Bathing to Reduce Hospital Acquired Infections in Medical Intensive Care Unit Patients

隨著醫療進步，侵入性導管大量使用於臨床危急病人，但由於微生物體經常會經由病人皮膚，沿著導管或破損皮膚進入而發生感染，增加醫療照護相關感染風險，造成住院天數延長且增加發生抗藥性機會，因此，如何有效控制及降低感染非常重要。故主要探討於重症病人洗澡用水中加入Chlorhexidine使用，是否能有效降低院內感染密度及抗藥性細菌移生，進而做為發展臨床照護參考。本研究主要於16床的內科加護病房進行收案，對照組收案時間為2014年01月01日至06月30日，每2日維持以沐浴露和溫水洗澡。實驗組收案時間為2014年07月01日至12月31日，每2日以4% Chlorhexidine加入沐浴露及溫水中洗澡。符合收案標準有效個案對照組198人，實驗組203人。經分析介入使用4% Chlorhexidine加入沐浴露及溫水洗澡後，整體院內感染密度7.738‰降為2.565‰（p=0.0001），其中導尿管相關泌尿感染密度3.893‰降低為0.500‰（p=0.0125），中心導管相關血流感染密度5.405‰降為3.487‰（p=0.4787），呼吸器相關相關肺炎感染密度0.889‰降為0.000‰（p=0.7319），而因泛抗藥性菌株需隔離的個案數亦由13件降為5件（p=0.0256），結果僅在降低整體院內感染密度、導尿管相關泌尿感染密度及因泛抗藥性菌株需隔離個案數方面，達顯著差異。由於以4% Chlorhexidine加入沐浴露及溫水介入加護病房病人日常洗澡活動後，發現對部分院內感染有下降趨勢，未來應可持續此策略，密切觀察成效，以落實降低院內感染，減少醫療成本。

Hospital acquired infections increase the duration of hospitalization and mortality rates as well as the burden onhealth care personnel and expenses. Therefore, how to control and reduce the infection is very important. This studyaims to understand whether the chlorhexidine gluconate (CHG) bathing can reduce the hospital acquired infections andmultiple drug resistant pathogens, with the purpose of hoping to develop clinical nursing care guidelines.We used a before and after study design to evaluate the efficacy of bathing with traditional bathing way (waterand liquid soap) compared with 4% CHG in the water and soap . The study collected data on patients admitted to the16 bed MICU. During the baseline period (from January 2014 toJune 2014), all patients admitted to the MICU werebathed with traditional bathing way every two days and we had collected 198 patients. From July 2014 to December2014, we used 4% CHG in the water and liquid soap to bathing every two days and had collected 203 patients. Baselineand intervention period patients’ characteristics were similar. We found that every two days bathing with 4% CHG wasassociated with a statistically significant decrease in the rate of the hospital acquired infections (from 7.738 ‰ to 2.565‰, cases per 1,000 patient days; p=0.0001) and in the rate of the catheter related urinary tract infections (from 3.893 ‰to 0.500‰,cases per 1,000 urinary tract days ; p=0.0125). In addition, the patients of colonization with multiple drugresistant pathogens were significantly lower in the chlorhexidine group (p=0.0256). The results should be closelyobserved in the future, so as to reduce nosocomial infections and health care costs.