Chlorhexidine Gluconate擦澡降低加護病房抗藥性菌株移生個案數之專案

Project to Reduce Cases of Drug-Resistant Strain Colonization in the Intensive Care Unit Using a Chlorhexidine Gluconate Bath

背景：抗藥性菌株會引發菌血症、休克及死亡之嚴重後果，也會增加住院天數及醫療消費，影響甚鉅，因此降低抗藥性菌株的散播是非常重要的議題。期望透過專案的進行，降低急診加護病房抗藥性菌株移生個案數，增加重症照護品質。目的：透過專案的進行，降低急診加護病房抗藥性菌株移生個案數，增加重症照護品質。解決方案：專案執行過程中，運用chlorhexidine gluconate（CHG）擦澡標準流程的建立、製作CHG擦澡技術評核表、規劃教育訓練課程、擬定床簾更換頻率、水槽清潔原則、定期稽核等方式，進行專案的分析與改善。結果：2018年10－12月萬古黴素抗藥性腸球菌（Vancomycin-resistant Enterococci）月平均移生個案數由6.08位降低至4.33位，多重抗藥性鮑氏不動桿菌（multidrug-resistant Acinetobacter baumannii）月平均移生個案數由4.08位降至1.33位；後續2019年1－7月間追蹤其成效，分別為4位及0.86位，多重抗藥性鮑氏不動桿菌移生個案數的下降達目標值。結論：本專案的結果支持，透過CHG擦澡的執行，能有效降低抗藥性菌株移生個案數，也降低感染密度，建議CHG擦澡可運用於臨床，提升重症照護品質。

Background: Drug-resistant strains of bacteria are associated with severe consequences such as bacteremia, shock, and death, and increase hospital stay durations and medical health expenses. Therefore, reducing the spread of drug-resistant strains is a priority concern. Purpose: This project was developed to reduce the number of colonization cases of drug-resistant strains and subsequently increase the quality of care provided in our intensive care unit. Resolutions: In this project, a chlorhexidine gluconate (CHG) bath standard protocol and CHG bath skill checklist were established, education and training courses were planned, a regular bed curtain replacement schedule and sink cleaning protocols were implemented, and regular audits were conducted. Results: Immediately following project implementation (October - December 2018), the average monthly cases of Vancomycin-resistant enterococci colonization decreased from 6.08 to 4.33, and the average monthly cases of multi-drug resistant Acinebacter baumannii colonization decreased from 4.08 to 1.33. Furthermore, between January and July 2019, the average monthly cases of colonization for the abovementioned bacteria numbered 4 and 0.86, respectively, which met the level of reduction targeted in this project. Conclusion: The results of this project indicate that implementing CHG bed baths is effective in reducing the incidence of drug resistant strain colonization and rate of related infections in patients. CHG bed baths should be applied clinically to improve the quality of intensive care.