應用Chlorhexidine Bathing介入措施降低內科加護病房病人院內感染率成效探討

Effectiveness of Chlorhexidine Bathing to Reduce Hospital Acquired Infections in Medical Intensive Care Unit Patients

10.6540/NTJN.2017.1.003

吳家榛(Chia-Chen Wu)

院內感染 ； 病人洗澡 ； 4% Chlorhexidined ； hospital acquired infections ； patient bathing ； 4% CHG

新臺北護理期刊

19卷1期（2017 / 03 / 01）

23 - 33

繁體中文

隨著醫療進步，侵入性導管大量使用於臨床危急病人，但由於微生物體經常會經由病人皮膚，沿著導管或破損皮膚進入而發生感染，增加醫療照護相關感染風險，造成住院天數延長且增加發生抗藥性機會，因此，如何有效控制及降低感染非常重要。故主要探討於重症病人洗澡用水中加入Chlorhexidine使用，是否能有效降低院內感染密度及抗藥性細菌移生，進而做為發展臨床照護參考。本研究主要於16床的內科加護病房進行收案，對照組收案時間為2014年01月01日至06月30日，每2日維持以沐浴露和溫水洗澡。實驗組收案時間為2014年07月01日至12月31日，每2日以4% Chlorhexidine加入沐浴露及溫水中洗澡。符合收案標準有效個案對照組198人，實驗組203人。經分析介入使用4% Chlorhexidine加入沐浴露及溫水洗澡後，整體院內感染密度千分之7.738降為千分之2.565（p=0.0001），其中導尿管相關泌尿感染密度千分之3.893降低為千分之0.500（p=0.0125），中心導管相關血流感染密度千分之5.405降為千分之3.487（p=0.4787），呼吸器相關相關肺炎感染密度千分之0.889降為千分之0.000（p=0.7319），而因泛抗藥性菌株需隔離的個案數亦由13件降為5件（p=0.0256），結果僅在降低整體院內感染密度、導尿管相關泌尿感染密度及因泛抗藥性菌株需隔離個案數方面，達顯著差異。由於以4% Chlorhexidine加入沐浴露及溫水介入加護病房病人日常洗澡活動後，發現對部分院內感染有下降趨勢，未來應可持續此策略，密切觀察成效，以落實降低院內感染，減少醫療成本。

Hospital acquired infections increase the duration of hospitalization and mortality rates as well as the burden on health care personnel and expenses. Therefore, how to control and reduce the infection is very important. This study aims to understand whether the chlorhexidine gluconate (CHG) bathing can reduce the hospital acquired infections and multiple drug resistant pathogens, with the purpose of hoping to develop clinical nursing care guidelines. We used a before and after study design to evaluate the efficacy of bathing with traditional bathing way (water and liquid soap) compared with 4% CHG in the water and soap . The study collected data on patients admitted to the 16 bed MICU. During the baseline period (from January 2014 to June 2014), all patients admitted to the MICU were bathed with traditional bathing way every two days and we had collected 198 patients. From July 2014 to December 2014, we used 4% CHG in the water and liquid soap to bathing every two days and had collected 203 patients. Baseline and intervention period patients' characteristics were similar. We found that every two days bathing with 4% CHG was associated with a statistically significant decrease in the rate of the hospital acquired infections (from 7.738 per mille to 2.565 per mille, cases per 1,000 patient days; p=0.0001) and in the rate of the catheter related urinary tract infections (from 3.893 per mille to 0.500 per mille, cases per 1,000 urinary tract days; p=0.0125). In addition, the patients of colonization with multiple drug resistant pathogens were significantly lower in the chlorhexidine group (p=0.0256). The results should be closely observed in the future, so as to reduce nosocomial infections and health care costs.

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