燒傷病人的感染預防與管制

Infection Prevention and Control for Burns

造成燒傷病人死亡的第一大原因就是感染。感染的部位可能是血流感染、肺炎、傷口感染和泌尿道感染。其中吸入性嗆傷的病人較常發生肺炎。本文簡介燒傷感染的流行病學、感染的定義、燒傷傷口感染的原理及致病菌、燒傷感染抗生素使用的原則及統整燒傷感染管制和作法。造成感染的微生物有可能是來自內源性或外源性的細菌、病毒或是黴菌。化膿性鏈球菌（Streptococcus pyogenes）是以往最常被培養出來的細菌，而最近已被金黃色葡萄球菌（Staphylococcus aureus）取代。依據八仙塵暴事件之菌種分析，水生性的細菌如：羅爾斯通氏菌屬（Ralstonia spp.）、鮑氏不動桿菌（Acinetobacter baumannii）、金黃桿菌屬（Chryseobacterium spp.）和綠膿桿菌（Pseudomonas aeruginosa）應該在燒燙發生14天內被列入感染源的考量當中。經驗性抗生治療要依據該燒傷中心的抗生素抗藥性菌譜，延長藥物注射的時間可以改善藥物濃度分布，進而增加治療感染機會。最有效預防燒傷病人的到外源性細菌感染的方式是醫療照顧人員正確的洗手，在不可避免直接的體液接觸狀況下，必須穿帶口罩、防水的隔離衣及手套。於燒傷病房中實施組合式的醫療照顧（Care bundle）以降低院內感染率。

Infection is the main cause of death in patients with burns. Infection sites may include bloodstream infections, pneumonia, wound infections, and urinary tract infection s. Patients with inhalational choking injuries often develop pneumonia. This article briefly introduces the epidemiology of burn infection, definition of infection, principle and pathogenic bacteria of burn wound infection, principle of antibiotic use for burn infection, and integrated control and practice of burn infection. The microorganisms causing the infection may be endogenous or exogenous bacteria, viruses, or molds. Streptococcus pyogenes was the most commonly cultured bacterium in the past but has recently been replaced by Staphylococcus aureus. Several types of mold can cause burns and scald infections. According to the analysis of the species of the Eight Immortals dust storm event, aquatic bacteria such as Ralstonia spp., Acinetobacter baumannii, Chryseobacterium spp., and Pseudomonas aeruginosa should be considered a source of infection within 14 days of burn onset. Empirical antibiotic treatment should be based on the antibiotic resistance patterns of burn centers. Prolonging the duration of drug infusion can improve the distribution of drug concentrations, thereby increasing the chance of treating infection. The most effective way to prevent patients with burns from exogenous bacterial infection is to for the medical staff to wash their hands correctly. In case of unavoidable direct contact with body fluids, masks, waterproof gowns, and gloves must be worn. Implementing a combined care bundle in the burn ward can reduce the rate of health-care associated infection.