建立大量灼傷病患MDRAB照護標準化

Establishing MDRAB Care Guideline for Massive Burn-Injured Patients Establishing

近年來，美國醫療機構評鑑聯合會（Joint Commission on Accreditation of Helthcare Organization, JCAHO）將減少醫療相關感染之風險定為病人安全監控目標之一。本單位為北部某灼傷加護病房，於2015年6月八仙塵爆發生後，七月份病房感染率由2.91‰上升到22‰，感染率明顯上升，其中感染MDRAB有六人，因此成立專案小組，調查發現：團隊人員對MDRAB防護、認知不足及環管人員執行清潔不確實、缺乏定期環境清潔稽核、污衣桶及電腦硬體設備數量不足。經變更電腦使用原則、增加環管載運包布污衣次數、限定會客時間及人數、建立大量灼傷病人MDRAB照護標準化等改善措施，至今灼傷病人MDRAB感染率無新增情形；團隊人員執行MDRAB防護正確率由72.5％提升至96.1％、環管人員執行MDRAB防護正確率由75.6％提升至98.1％、團隊人員對MDRAB認知正確率由76.8％提升至95.5％。

In recent years, one of the purposes of Joint commission on accreditation of healthcare organization (JCAHO) is to decrease the risk of healthcare-associated infections. After flammable powder apparently exploded in midair at a recreational water park in Taiwan in June 2015, the rate of infections increased from 2.91% to 22% in July. The infection rate increased significantly. We found that the increasing of infection rate was related to 1) lack of awareness of protective isolation, 2) some cleaning staffs not able to clean appropriately, 3) the lack of regular environmental cleaning audits, and 4) lack of dirty laundry trolley and computer hardware equipment. To decrease the infection rate, we 1) changed the principle of using computer 2) increased frequency of exchange dirty laundry, 3) limited visitors and visiting hours, and 4) established MDRAB care guideline for massive burn-injured patients. After these interventions, we achieved the improvement of decreasing infection rate. The accuracy of team workers to perform MDRAB prevention improved from 72.5% to 96.1%; the cleaning staff performing prevention of MDRAB improved from 75.6% to 98.1%; and the cognitive of MDRAB also improved from 76.8% to 95.5% .