預防手術部位感染：應用組合式照護措施的本土挑戰與執行策略

Prevention of Surgical Site Infections: Local Challenges and Strategies of Implementation

根據台灣院內感染監視系統 （Taiwan Nosocomial Infections SurveillanceSystem, TNIS） 分析，醫學中心及區域醫院加護病房醫療照護相關感染，手術部位感染排名第四位。國外研究證實，執行手術部位感染組合式照護可以有效地降低手術部位感染；世界衛生組織 （World Health Organization, WHO） 於 2009年提出「安全手術，拯救生命 （Safe Surgery, Save Lives）」活動，呼籲各國將提升手術安全列為醫療品質重點項目；WHO 與美國疾病管制中心 （Centers forDisease Control and Prevention, CDC） 更相繼提出具有實證基礎的手術部位感染照護措施。2016 年財團法人醫院評鑑暨醫療品質策進會承辦台灣疾病管制署「推動組合式照護措施降低手術部位感染先驅研究計畫」，參考國外實證研究及預防手術部位感染相關指引，將適當使用預防性抗生素、血糖控制、維持正常體溫、皮膚準備及傷口照護等組合式措施，於術前、術中、術後的手術全期確實執行。雖然過去在醫院端，落實執行感染管制措施與預防性抗生素的給予已經獲致成效，但是血糖控制、維持正常體溫等管理措施仍有很大的進步空間；手術部位感染的收案與感染率呈現，需要更加強。本篇報告列出預防手術部位感染的問題，期望藉由改善收案方式、加強生理數據管理與確實執行組合式照護措施，能有效的降低手術部位感染，提升醫療品質與手術病人的安全。"

According to the report of the Taiwan Nosocomial Infections SurveillanceSystem (TNIS), surgical site infections (SSIs) rank fourth among hospital-acquiredinfections in intensive care units of medical centers and regional hospitals. Theliterature has confirmed that the implementation of SSI care bundles can effectivelyreduce SSIs. In 2009, the World Health Organization (WHO) proposed 'Safesurgery, Save Lives' and called for increasing surgery safety as a priority formedical care quality. The WHO and the United States Centers for Disease Controland Prevention also launched evidence-based recommendations of measures for SSIprevention.Beginning in 2016, the Taiwan Centers for Disease Control requested for theJoint Commission of Taiwan in 2017 to execute the “Project of Promoting Bundle Care to Reduce the Prevalence of Surgical Site Infections.” Employing guidelinesand evidence from the literature, the measures include the proper use of prophylacticantibiotics, glycemic control, the maintenance of normal body temperature,skin preparation, and wound care in the SSI care bundle. This bundle has beenimplementing during entire preoperative periods. During the past few years inTaiwan hospitals, the execution of infection prevention and control and prophylacticantibiotics for patients who had been treated with surgery has gained success;however, the glycemic control and maintenance of normal body temperature requireimprovement. The methods for SSI cases and SSI rates also need to be developed toallow for more accurate reporting. This report, via improvement of the SSI reportingsystem, monitoring of physiologic parameters, and implementing care bundles,expects the achievement of SSI reductions and increased surgery safety for patientsin the future.