降低加護病房多重抗藥性菌株感染密度之專案

A Project to Reduce the Infection Density Rate of Multi-Drug Resistant Organisms in Intensive Care Units

背景：院內感染是醫療品質重要指標，唯有嚴格遵守隔離防護措施及環境清潔，方能控制多重抗藥性菌株（multidrug-resistant organisms, MDRO）之散播，防止院內感染。本單位於2016年3月至8月MDRO平均感染密度為7.12‰，造成病人及家屬抱怨、延長住院天數、甚至死亡。故引發筆者執行此降低MDRO感染密度專案之動機。
方法：經現況分析，確立的問題有工作人員未依照防護措施及接觸隔離標準流程、缺乏終期消毒標準流程、缺乏MDRO防護知識、醫療物品不齊全和缺乏稽核制度等；針對上述問題，擬定並執行的改善策略有修訂MDRO防護措施作業指導書及海報、舉辦工作坊、設計叮嚀小卡與工具箱、建立內部稽核制度。
結果與結論：經歷7個月實施此專案計畫，本單位的MDRO感染密度降至5.2‰，達到所設定的目標值；期能藉此專案之推廣，養成醫療工作人員嚴格遵守隔離防護措施之習慣，並提供臨床照護之參考。

Background: Hospital-acquired infection is an important indicator of medical quality. Only strict adherence to isolation protection measures and environmental cleanliness can control the spread of multidrug-resistant organisms (MDRO) and prevent nosocomial infections. The average infection density rate of MDRO in the unit under study from March to August 2016 was 7.12‰. Not only did the patients and their families complain, but infections also led to prolonged hospital stays, and even caused death. Therefore, we were prompted to implement this project to reduce the density of MDRO infection in intensive units.
Methods: A ccording to the analysis of the current situation, the identified problems were: the staff did not follow the standard procedures for precaution measures and contact isolation, lacked standard procedures for terminal disinfection, lacked precaution procedures for MDRO, medical supplies were incomplete, and no audit system was in place. In response to the above problems, the improvement intervention strategies formulated and implemented are: revision of MDRO precaution guidelines and posters, holding workshops, design of reminder cards and toolboxes, and establishment of an internal audit system.
Results and conclusions: After 7 months of implementation of this project, the MDRO infection density rate of the ward dropped by 5.2‰, reaching the set target value. This project can be promoted to our medical staffs, so that they strictly abide by the isolation precaution measures, and provide the standard of medical care for other staffs.