降低血液腫瘤科病人植入式中心導管相關血流感染密度

Reduce the Density of Bloodstream Infections Associated with Implantable Central Catheters in Hematology Oncology Patients

血液腫瘤科病房住院病人中心靜脈導管相關血流感染密度於2020年高達2.9‰，較2019年上升1.3‰。平均住院天數由6天增加至8天，3人接受手術移除導管，引發改善動機。經查證確認要因包括:護理師注射前未確實皮膚清潔、病人免疫力差、Port-A自我照護認知差、未確實身體清潔、導管接頭使用酒精棉枝有死角、處置多導管接頭反覆插拔，皆是造成血流感染的原因。專案目的為感染密度下降至2.2‰。為了降低血流感染，我們採用了標示提醒並定期稽核、使用含CHG（Chlorhexidine Gluconate）抗菌敷料、製作Port-A自我照顧教學影片及皮膚清潔護理指導海報、參與式衛教指導、使用酒精棉片、訂定血腫科輸液治療執行原則等對策。在實施對策後，血流感染密度由2.9‰降至2.1‰，有效降低感染率，提升病人安全及臨床照護品質。

In the Hematology-Oncology ward, the incidence density of central venous catheter-related bloodstream infections among hospitalized patients reached 2.9‰in 2020, showing a rise of 1.3‰compared to 2019. The average length of stay increased from 6 days to 8 days, with 3 patients undergoing catheter removal surgery, prompting a drive for improvement. Investigations confirmed various contributing factors, including inadequate skin cleaning before nurse injections, compromised patient immunity, poor self-care awareness regarding Port-A devices, insufficient body hygiene, dead angles in alcohol swab use at catheter junctions, and repeated insertion and withdrawal of multi-catheter junctions. These were identified as causes of bloodstream infections. The project aimed to reduce the infection density to 2.2‰. To achieve this, strategies were implemented including labeling reminders with regular audits, using CHG (Chlorhexidine Gluconate) antimicrobial dressings, creating instructional videos for Port-A self-care, skin cleansing posters, participatory health education, alcohol swab use, and establishing principles for fluid therapy in the hematology department. Following the implementation of these strategies, the bloodstream infection density decreased from 2.9‰to 2.1‰, effectively reducing the infection rate and enhancing patient safety and clinical care quality.