建立資訊化系統輔助推展組合式照護降低加護單位中心導管相關血流感染密度

Establishment of an Information System to Introduce a Bundle Care Model to Reduce the Rate of Bloodstream Infections

東部某醫學中心加護單位2012年資料顯示，中心導管相關血流感染密度平均為6.6‰，明顯高於台灣臨床成效指標系統（Taiwan Clinical Performance Indicator, TCPI）醫學中心之平均指標之上，於2013年2月至2014年12月推動中心導管組合式照護改善計畫，藉由流程改善以及資訊化系統建置，提升中心導管置入之品質，儘早移除不必要之管路，2014年加護單位中心導管相關血流感染密度由執行前6.6‰下降至3.2‰，中心導管留置率也從2012年68.6%下降至52.0%，兩者均有統計學上差異（p < 0.05）。改善計畫結果顯示，系統性推動組合式照護模式的確可以明顯降低中心導管相關血流感染，而運用資訊系統內化組合式照護精神於臨床照護中，不但能強化臨床照護人員導管相關感染防護認知、簡化推動過程的繁瑣文書作業，行政上減少紙張列印、書寫、存放的物品、人力、時間、空間成本耗費，臨床實務上更能節省醫療成本，提升病人安全及照護品質。

According to the 2012 data obtained from the intensive care unit (ICU) of an eastern medical center, the average central line-associated bloodstream infection (CLABSI) rate was 6.63‰. This rate was significantly higher than the average rate of the medical center as reported in the Taiwan Clinical Performance Indicator. By improving procedures and setting up an information system, a bundle care improvement plan was implemented from February 2013 to December 2014 to improve the quality of catheter insertion and removal of unnecessary catheters as early as possible. In 2014, the CLABSI rate in the ICU dropped from 6.63‰ (before implementation of the improvement plan) to 3.21‰. The catheter indwelling rate increased from 68.55% to 52.03%. Both displayed statistically significant changes (p < 0.05). The results showed that implementation of the bundle care could systematically lower the rate of CLABSI. The care staffs became more aware of CRBSI prevention after incorporation of the information system and principles of bundle care in clinical care. The complicated administrative procedure associated with the improvement plan was also simplified along with the reduction in paper waste by printing, document writing, stock supplies, manpower, time, and space. Finally, the medical expense for clinical operations was curbed, while patient safety and care quality were greatly improved.