以感染鍊的觀點談預防呼吸機相關性肺炎之護理

Preventive Interventions for Ventilator-Associated Pneumonia: Infection Chain View

呼吸機相關肺炎（ventilator-acquired pneumonia, VAP）是常見的院內感染容易導致死亡率上升、延長住院時間以及增加住院費用。以感染鍊的觀點而言，若能有效打破感染鍊：致病原、易感宿主和侵入途徑等三要素，便能有效預防VAP的發生。本文就以切斷感染鍊的角度，分別敘述以控制或去除感染源、提高易感宿主免疫力和控制或去除感染途徑等三方面預防VAP發生之照護措施，採用美國胸腔學會於2005年所提出實證分級為準則，統整近十年來文獻中常出現之學理依據或經研究方式證實之照護措施，以供臨床護理人員選擇使用，並透過二個臨床實際案例說明，期望能達成學理依據或研究結果能與臨床實務結合，運用於臨床實務之目標。

Ventilator-acquired pneumonia(VAP) is a common nosocomial infection which could increase the mortality rate, prolong hospitalization, and waste hospitalization costs. From the viewpoint of the infection chain we could effectively prevent VAP from occurring by successfully breaking the infection processes among infectious agent, susceptible host, and mode of transmission. This report aims to prevent VAP occurrence by controlling (or eliminating) the infectious agent, promoting the immunity of the susceptible host, and destroying the transmission mode. In this review, recommendations by the American Thoracic Society in 2005 based on an evidence-based grading system, a ten-year literature review of theory, and evidence-based care interventions are discussed. Through two cases studies, the authors expect to provide nurses with methods to support vulnerable patients and stop the authors expect to provide nurses with methods to support vulnerable patients and stop the probable spread of VAP infection. And awareness of the infection chain also provides all other nurses with the knowledge self-protection methods.