透過醫療團隊資源管理模式藉以改善呼吸器相關肺炎（VAP）收案的準確度之經驗分享──以南部某區域醫院為例

Successful Improvement of the Ventilator-associated Pneumonia Infection Rate through Teamwork

呼吸器相關肺炎（ventilator-associated pneumonia, VAP）是加護病房病人的死亡主因之一，同時也是重症病人最常見的醫療照護相關感染。2010 年南部某區域醫院為了改善呼吸器相關肺炎收案準確度，由加護醫學部、感染科、呼吸治療科及感染管制組共同組成團隊，修改現行的監測流程，分兩方面同時進行，一為感管師主動監測，二為臨床通報。團隊每月進行呼吸器相關肺炎案例討論以達共識。VAP感染密度由0.93‰修正為5.45‰。

Ventilator-associated pneumonia (VAP) is the most common and fatal nosocomial infection of intensive care units (ICU), and it therefore requires a surveillance program that allows detection and implementation of preventive strategies. We conducted this study in an 800-bed hospital that provides primary care in southern Taiwan. Surveillance of VAP incidence was performed via multidisciplinary team work; professionals involved included ICU chest physicians, infection specialists, the infection control unit, and respiratory therapists. We used the Centers for Disease Control and Prevention (CDC) National Nosocomial Infection Surveillance criteria as a surveillance protocol. After implementation of the multidisciplinary team VAP surveillance, VAP rates were found to be 0.93 cases/1000 ventilator days in the pre-intervention period, and 5.45 cases/1000 ventilator days in the post-intervention period. The real incidence of VAP in the adult ICU can only be revealed via multidisciplinary team work involving a CDC surveillance protocol.