運用組合式照護降低加護病房中心靜脈導管血流感染率

Applying Bundle Care to Reduce Bloodstream Infections Rate from Central Venous Catheters in the Intensive Care Unit

本專案目的藉由組合式照護降低中心靜脈導管血流感染率。現況分析發現南部某一區域醫院內科加護病房醫師放置中心靜脈導管前未正確洗手、皮膚消毒時間>2 分鐘；護理人員未落實評估中心靜脈導管傷口狀況、執行中心靜脈導管照護前未落實洗手技術，使中心靜脈導管血流感染率升高。介入方案為舉辦在職教育、制訂中心導管組合性感染管制措施、推行感染管制口號及制訂中心靜脈導管感染管制查核機制。2012 年08 月1 日至2013 年1 月31 日中心靜脈導管血流感染率，由11.6 ‰降為2.0 ‰已達專案目的，中心靜脈導管置入過程及照護過程正確率均達100.0%，醫護人員確實遵守組合式照護模式，降低中心靜脈導管血流感染的發生。

The purpose of this project was to use Bundle Care method to reduce bloodstream infection from central venous catheters. From an Intensive Care Unit (ICU) of a metropolitan hospital located in the south part of Taiwan, it was found that physicians did not follow protocol to wash their hands accurately before the insertion of central venous catheters and sterilization on skin was often less than 2 minutes. Furthermore, nurses did not evaluate wound conditions around central venous catheters. Staffs did not perfectly follow hand-washing guidelines before implementing care of central venous catheters. All these might cause the incidence of central venous catheter infection. An intervention of Bundle Care includes holding a continuing education, establishing a central composition infection control method, conducting slogans about infection control, and establishing an inspection mechanism for intravascular infection control During the executing period from August 1st, 2012 to January 31th, 2013, the incidence of central venous catheter infection reduced from 11.6‰ to 2.0‰. It has achieved the goal. Additionally, the accurate rates of central venous catheter inserting and management have reached 100%. It showed that following the bundle care intervention could decrease bloodstream infection from central venous catheters.