導入周邊置入中心靜脈導管（PICC）於組合式照護2.0：優化中心導管血流感染防治

Enhancing CLABSI Prevention: Integrating PICC into Care Bundle 2.0

中心靜脈導管相關血流感染為加護病房中重要且可預防之院內感染之一，與住院天數延長、醫療成本增加及死亡率上升密切相關。過去以手部衛生、最大無菌防護及適當皮膚消毒為核心之組合式照護措施（Care Bundle 1.0）已被證實可有效降低感染發生率。然而，在重症比例高及導管留置時間延長之臨床情境中，感染率常於下降後進入瓶頸期，顯示僅依賴傳統措施可能不足以持續改善。
近年感染管制策略逐漸演進為Care Bundle 2.0，除延續既有措施外，更強調置入後照護品質、持續性監測及組織文化建構，並將導管選擇與使用時機納入整體管理架構。在此概念下，導管管理由單一程序執行轉向整體風險評估與暴露時間控制。
周邊置入中心靜脈導管於感染穩定期可作為策略性轉換工具，透過縮短傳統中心靜脈導管之留置時間，降低生物膜形成及持續菌血症風險。本文綜整相關文獻，探討CLABSI防治由Care Bundle 1.0演進至2.0之趨勢，並分析PICC於臨床應用中的角色，以提供高複雜度醫療環境中持續降低感染率之可行方向。

Central line–associated bloodstream infection (CLABSI) remains a major healthcare-associated infection in intensive care units and is associated with increased mortality, prolonged hospitalization, and higher medical costs. Traditional prevention strategies, represented by Care Bundle 1.0, have demonstrated substantial effectiveness in reducing infection rates using standardized aseptic insertion techniques. However, in high-acuity settings, CLABSI incidences often reach a plateau despite high compliance, suggesting the presence of residual risks not addressed by insertion-focused measures alone.
Care Bundle 2.0 has emerged as an advanced framework that expands beyond procedural compliance to include the maintenance of quality, continuous monitoring, and organizational culture. In addition, catheter exposure time and device selection have been increasingly recognized as critical determinants of infection risk. The prolonged use of conventional central venous catheters (CVCs) is strongly associated with biofilm formation and persistent bloodstream infections.
Peripherally inserted central catheters (PICCs) may be strategic alternatives for clinically stable patients who require long-term intravenous therapy. Timely transition from CVC to PICC can reduce high-risk catheter exposure and improve infection control outcomes.
This review summarizes the evolution of CLABSI prevention strategies and highlights the role of device optimization within the Care Bundle 2.0 framework, emphasizing the shift from checklist-based compliance to dynamic risk management.