運用醫療品質突破方法降低Port-A導管相關血流感染

Use of a Medical Breakthrough Series Technique to Decrease Port-A-Related Bloodstream Infections

罹癌病人多需仰賴內植式輸液導管（Port-A）施打抗癌藥物，但也衍生導管有關血流感染，影響病人預後，增高死亡風險。爰此，為維護良好醫療品質及病人安全，由跨部門團隊合作，運用醫療品質系列手法（Breakthrough series model, BTS）及導入組合式照護包括：（1）引進2%Chlorhexidine gluconate alcohol執行皮膚消毒；（2）舉辦教育訓練及製作「人工血管衛教影音檔」結合行動工作車；（3）增訂實施全套防護措施等級；（4）落實手部衛生遵從性及正確性；（5）制定專科品質監控指標：參照TCPI的指標定義，擬訂「腫瘤科病房Port-A相關血流感染」密度監控；（6）增設port-A模型教具。經由上述策略實施後，得到下列成效：（1）Port-A相關血流感染密度由2.01‰至改善後1.50‰；另腫瘤科醫療照護相關血流感染密度由1.65‰至改善後1.24‰；（2）醫護團隊成員執行內植式輸液塞注射作業稽核正確率58.8%至改善後達100%；（3）腫瘤科平均住院天數由8.2天至改善後7.1天。藉由跨單位團隊合作，製作相關標準作業流程和落實手部衛生，正確執行內植式輸液塞導管注射及消毒技術，並全面施行組合式照護，證明可減少內植式輸液導管留置相關血流感染密度。

Cancer patients frequently rely on an implanted infusion catheter (Port-A) for injection of anti-cancer drugs; however, Port-A-related bloodstream infections affect patient outcomes and increase mortality. Thus, to maintain good quality of care and patient safety, we utilize cooperative interdepartmental teamwork and medical breakthrough series techniques (BTS) to formulate improvement strategies including: (1) introduction of 2% chlorhexidine gluconate for skin disinfection; (2) a training program and production of a Port-A health education video combined with action task vehicles; (3) introduction and execution of a maximal protection policy grade; (4) implementation of a hand hygiene compliance and accuracy audit; (5) development of specialist quality control indicators and clinical outcome indicators according to the Taiwan Clinical Practice Improvement (TCPI) indicators used to define oncology ward “Port-A-related bloodstream infections”; and (6) establishment of Port-A teaching model aids. The implementation of the above strategies resulted in a decrease in Port-A-related bloodstream infections from 2.01% to 1.50% (decreased 0.51%), decrease in oncology ward healthcare-associated bloodstream infections from 1.65% to 1.24% (decreased 0.41%), increase in the accuracy of the Port-A infusion procedure from 58.8% to 100% (increased 41.2%), and decrease in the average oncology ward hospital stay from 8.2 to 7.1 days (shortened by 1.1 days). Cooperative interdepartmental teamwork, establishment of standard Port-A infusion procedures, and implementation of hand hygiene audits and skin disinfection techniques can reduce Port-A-related bloodstream infections.