降低內科病房靜脈導管血流感染率之專案

Project to Reduce the Venous Catheter-Related blood Infection Rate in the Medical Ward

靜脈導管通常用於給藥、營養輸液、靜脈輸液及監測血液動力學，臨床導管置放後，細菌透過導管進入血管內造成血流感染，導致住院延長與死亡的風險。單位發現靜脈導管血流感染率偏高，發生靜脈炎、注射部位疼痛等不適症狀，造成病人發燒延遲出院、延長住院天數、降低照護品質。故成立專案小組改善，進行跨團隊討論，全面審查執行操作流程，嚴格遵守無菌原則，製作導管置放流程圖提示卡，統整導管置放及照護查檢表單，重新再教育導正行為及改變習慣，定期稽查執行成效，即時雙向回饋等改善措施。專案執行後，單位醫護人員執行靜脈導管置放及照護正確率由74％提升94％，靜脈導管血流感染率由0.88％下降0.43％，達成本專案目的，因此提出與醫護人員分享。

Intravenous catheters are commonly used for drug administration, nutritional infusion, intravenous infusion, and the monitoring of hemodynamics. After a clinical venous catheter is inserted in the patient, bacteria can easily enter the blood vessel through the catheter and cause a blood infection. Such infections often lead to prolonged hospitalization and a high risk of death. We found that the venous catheter-related blood infection rate was high in our medical ward. Patients often experienced uncomfortable symptoms, such as vasculitis and pain at the injection site. In addition, such infections can cause patients to have fever, delay discharge, increase the number of days in hospital, and reduce the quality of nursing care. Therefore, we gathered a project team to improve the current situation. After much discussion, a crossdepartmental team implemented improvement measures. These included a comprehensive review of the venous catheter placement procedure, strict adherence to the principle of sterility, use of a catheter placement flowchart reminder card, integration of a catheter placement checklist, reeducation of medical staff to reinforce behaviors and change habits leading to errors, regularly checking the effectiveness of the implementation, providing timely feedback on both sides, and other improvement measures. After the implementation of the project, the accuracy rate of venous catheter placement and care by the medical staff of the unit increased from 74% to 94%, and the venous catheter-related blood infection rate decreased from 0.88% to 0.43%. This project has reached its goal. Therefore, we proposed to share these improvement measures with the medical staff.