運用創新策略降低中心導管相關血流感染

Implementation of Innovative Strategies to Reduce Central Line Associated Bloodstream Infections

本專案旨在降低中心導管相關血流感染，動機係因本單位中心導管相關血流感染2017年第三季8.3‰，高於醫學中心同儕，經現況分析導因有：病人免疫功能低下、主要感染菌種為革蘭氏陰性菌、靜脈抗生素治療比率高、醫師未落實判定導管適應症、單位無逐案分析感染病人機制、置入物品置放零散。經專案小組與專家研商，擬訂創新策略為「車、車、車、車畚掉」，包含：PICC置入、CHG抗菌敷料、制定逐案分析制度、中心導管置入專用工作車、β-lactam抗生素延長輸注、修正中心導管拔掉步驟。經專案推動，中心導管相關血流感染2018年前三季5.0‰，均達到設定目標7.0‰；建議平行推廣以促進重症單位之照護品質。

This program aimed to reduce the incidence of central line-associated bloodstream Infections (CLABSI), as a higher CLABSI incidence of 8.3‰ was observed at the medical respiratory care center in the 3rd quarter of 2017, which was higher than peer medical centers. Underlying reasons to contribute to this trend include patients' immune-compromised status, Gram-negative bacteria as the main pathogen, high prevalence of intravenous antibiotic use, physicians' incomplete compliance to specify the indication to use central lines, lack of a mechanism to analyze the cases with infection, and the presence of scattered items at the care scene. After the discussion and analysis with a group of experts, we proposed innovative strategies including the implementation of peripherally inserted central catheters (PICC) placement, provision of antimicrobial wound dressing with chlorhexidine gluconate, development of case analysis system, deployment of a dedicated cart for central line placement, prolongation of infusion time β-lactams, and revision of process for the removal of the central line. After the implementation of these strategies, the CLABSI incidence was reduced to 5.0‰ in the first three quarters of 2018, which were all reached the target level below 7.0‰. Therefore, hoping for generalization, we recommend a spreading of these strategies to other critical care units to enhance the quality of care.