運用多元策略降低加護病房萬古黴素抗藥性腸球菌移生率

Multidisciplinary Strategies to Reduce the Colonization Rate of Vancomycin-resistant Enterococci (VRE) in Intensive Care Unit

本專案旨為降低加護病房萬古黴素抗藥性腸球茵（vancomycin-resistant enterococcus, VRE）移生率，重症病人因免疫力低且密集使用抗生素，易致抗藥性菌株發生，造成伺機性感染。本單位為急診加護病房，自2019-2020年VRE移生率8.9%，經現況分析發現，清潔人員漂白水泡製方式不正確、終期消毒流程未標準化、微生物無法用肉眼所及和易感宿主。2021年6月1日開始，為期2個月時間，藉由多元策略重新製作漂白水泡製工具、終期消毒流程標準化、運用紫消燈加強消毒及跨團隊檢視病人用藥機制，改善策略實施後，2021/8/1-2022/2/28，VRE移生率由9.1 %降為2.3%，VRE月平均移生個案數由4.3人次降為1.0人次，希望此專案成果可作為其他高感染風險單位臨床照護參考，以控制抗藥性茵株傳播與伺機感染之發生，維護病人安全。

This project aimed to reduce the colonization rate of vancomycin-resistant enterococcus (VRE) in the intensive care unit (ICU). Critically ill patients are highly susceptible to opportunistic infections due to their immunosuppression and frequent use of antibiotics, which contribute to the development of resistant bacterial strains. From 2019 to 2020, the VRE colonization rate in our emergency ICU was 8.9%. A situational analysis identified several issues, including improper preparation of bleach solutions by cleaning staff, lack of standardized terminal disinfection procedures, and the inability to detect of microorganisms with the naked eye, leaving patients vulnerable to infection. Starting on June 1, 2021, a two-month intervention was implemented, incorporating multiple strategies: redesigning bleach preparation tools, standardizing terminal disinfection procedures, utilizing ultraviolet-C (UVC) light to enhance disinfection, and conducting interdisciplinary reviews of patient medication regimens. Following these interventions, from August 1, 2021, to February 28, 2022, the VRE colonization rate decreased from 9.1% to 2.3%, and the average monthly number of VRE colonization cases was reduced from 4.3 to 1.0. We hope that the findings of this project can serve as a reference for clinical care in other units with high-risk infection, aiding in the control of resistant strains and opportunistic infections, and ultimately ensuring patient safety.