以實證觀點探討加護照護中心之中心靜脈導管血流感染

A Study on CLABSI in Intensive Care Units through Evidence - Based Approach

加護照護中心(Intensive care unit, ICU)是院內感染發生率最高的醫療單位，其中與中心導管相關的血流感染(Central line-associated bloodstream infection, CLABSI)易造成病人住院時間延長，增加醫療資源消耗。本文以文獻回顧之方式，搜尋PudMed、Medline、CINAHL及Cochrane Library在2000年1月至2010年6月之隨機控制試驗研究共十篇，研究對象皆為成人內外科ICU，探討CLABSI與穿刺部位、消毒溶液、導管材質、導管接頭及護理照護的關係。若以CLABSI作為考量，建議的穿刺部位為鎖骨下靜脈、消毒溶液以Chlorhexidine-based為主，Alcohol PI-based次之。期望本文能提供護理人員在臨床上的新知及實證手法之參考指標，並有助於護理臨床實務及未來研究之應用。

The highest infection rate in a hospital usually occurs in the intensive care unit. A central line-associated bloodstream infection (CLABSI) is often likely to result in longer hospitalization and additional consumption of medical resources. This paper reviewed 10 relevant literatures of randomized controlled experimental studies from PudMed, Medline, CINAHL and Cochrane Library between on January 2000 and on June 2010. The subjects of these studies were adults hospitalized in internal medicine and surgery intensive care centers. The relationships between CLABSI and punctured spots, sterilizing solutions, tube materials, tube connectors, and nursing care were reviewed. If CLABSI is taken into consideration, the subclavian vein is recommended as the best puncture spot. As for sterilizing solutions, chlorhexidine-based solution should be the priority choice, followed by alcohol PI-based solution. We hope this article will provide nursing staff with new clinical insight and empirical references for nursing clinical practices as well as for application in future studies.