建立手術全期無菌實務臨床照護指引

Establishment of Clinical Guidelines for Perioperative Sterile Practice

10.6142/VGHN.202212_39(4).0001

桑潁潁(Yiing-Yiing Sang)；陳淑芬(Shu-Fen Chen)；彭慧美(Hui-Mei Peng)；戴宏達(Hung-Da Dai)；吳祚光(Tso-Kuang Wu)；羅佩芬(Pei-Fen Lo)；李小青(Hsiao-Ching Lee)；袁秋榮(Chiou-Rong Yuan)；卓素敏(Su-Min Juo)；傅玲(Fu-Ling Shaw)

手術全期護理 ； 無菌實務 ； 臨床照護指引 ； perioperative nursing ； sterile practice ； clinical guideline

榮總護理

39卷4期（2022 / 12 / 01）

330 - 346

繁體中文

手術部位感染是常見的醫療照護相關感染之一，為有效預防手術部位感染的發生，在手術全程中透過正確執行無菌實務防止微生物污染至關重要。本指引透過JBI實證照護架構分四階段進行：第一階段臨床照護指引工作小組的籌組及運作；第二階段進行2006年6月1日至2021年12月31日完整文獻搜尋及更新，依證據評析標準納入8篇臨床照護指引及11篇系統文獻回顧研究，為發展指引之依據；第三階段依專家焦點團體座談進行指引草案之效度檢定；第四階段以問卷調查20位專家及782位臨床手術全期護理人員實施指引的可行性，最後形成184項手術全期無菌實務之臨床照護指引。本指引含手術服裝與防護裝備37項、手術部位準備及消毒35項、建置無菌區域82項、無菌區域維持與監測24項、無菌實務教育訓練2項、無菌實務品質監測2項及無菌實務政策2項，其中建議等級Grade A 107項、Grade B 77項。本指引可作為手術全期護理無菌實務之應用，教育訓練與流程改善之依據，增強手術全期護理師無菌實務的專業知能，進而降低手術部位感染的發生率。

Surgical site infection is a common healthcare-associated complication. Therefore, the prevention of surgical site infection through sterile practice is critical in perioperative nursing. In this project, evidence-based guidelines for perioperative sterile practice were formulated using the Joanna Briggs Institute Model of Evidence-Based Healthcare. The clinical guidelines were developed in four phases: Phase I involved convening a team for the project; Phase II involved conducting a comprehensive systematic review of 8 sets of clinical guidelines and 11 systematic review studies published between January 1, 2006, and December, 31, 2021; Phase III involved conducting a focus group discussion with nursing personnel to understand their experiences in providing perioperative sterile practice during nursing care at their hospitals and to assess the validity of the drafted clinical guidelines; and Phase IV involved inviting 20 experts and 782 clinically relevant perioperative nursing personnel to conduct a clinical feasibility investigation. Finally, 184-item clinical guidelines covering four domains were developed for perioperative sterile practice: 37 items pertain to surgical attire and personal protective equipment, 35 items pertain to surgical site skin antisepsis, 82 items pertain to sterile field establishment, 24 items pertain to sterile field maintenance and monitoring, and 2 items pertain to education, quality, policy, and procedure separately. Overall, 107 Grade A items and 77 Grade B items were recommended. These guidelines can provide perioperative nursing administrators with practical recommendations that can be followed to ensure surgical patient safety and provide evidence-based information to perioperative nurses.

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