運用組合式照護降低加護病房中心靜脈導管血流感染率

本院2015年1～9月加護病房血流感染率平均為4.32％，10月為8.12％，11月為9.32％，12月更攀升為10.49％，高於同等級區域醫院的中心導管血流感染率2.23％，經查血流感染率高之主要原因為：未確實執行手部衛生、缺乏組合式照護稽核制度、缺乏最大無菌面防護、插管用物放置位置凌亂、缺乏相關教育訓練。經落實查核手部衛生、建立稽核制度、製作最大無菌面洞巾、插管用物置放標準化、舉辦在職教育等措施後，使中心靜脈導管血流感染率由10.49％降低至2.46％；醫師中心靜脈導管置入過程正確率由66.5％提升至100％；護理人員中心靜脈導管照護正確率由64.9％提升至97.5％，均達目標值，期望此經驗能提供臨床照護參考。

The average bloodstream infection rate in our intensive care units from January to September 2015 was 4.32%, 8.12% in October, 9.32% in November and 10.49% in December. It was higher than the mean 2.23% in other regional hospitals. The reasons were: lack of hand hygiene, lack of appropriate audition on bundle care procedure, lack of appropriate sterile surface, the catheter kit not in order, lack of education and training. After establishing an audit tool to inspect hand hygiene, making the bigger sterile fenestrated drape, standardized intubation supplies, and held inservice education, the central venous catheter bloodstream infection rate was decreased from 10.49% to 2.46%; the accurate rate of placing the central venous catheter was increased from 66.5% to 100%; the accurate rate of nursing care on central venous catheter was increased from 64.9% to 97.5%, reaching the goals. Hope this project can provide information on caring for the patients with central venous catheter.