降低外傷科加護病房多重抗藥性鮑氏不動桿菌交互感染之專案

Improvement of Cross Infection by Multidrug Resistant Acinetobacter Baumannii in Trauma ICU

10.6974/TCNJ.201108.0064

黃惠卿(Hui-Ching Huang)；翁芝棋(Chih-Chi Weng)；黃美玲(Mei-Ling Huang)；謝麗琴(Li-Chin Hsieh)

多重抗藥性 ； 鮑氏不動桿菌 ； 外傷科加護病房 ； 交互感染 ； acinetobacter baumannii ； cross infection ； multidrug resistant ； trauma ICU

志為護理-慈濟護理雜誌

10卷4期（2011 / 08 / 01）

64 - 75

繁體中文

加護病房病人疾病嚴重度高，抗生素用藥多，引起抗藥性問題日趨嚴重，而易引起多重抗藥性之感染，嚴重者甚至死亡。美國評鑑聯合會(JCAHO)在99-100年醫療品質及病人安全工作目標中指出，醫療照護相關感染事件應視爲警訊事件處理，並進行環境因素與管理流程等系統面改善。本單位於2009年8月至10月共檢驗出二例鮑氏不動桿菌個案，及二例多重抗藥性鮑氏不動桿菌個案，故成立專案小組，經現況分析發現護理人員對多重抗藥性鮑氏不動桿菌照護認知不足、無病室環境設備清潔消毒原則、病室環境管理不當。經改善方案：舉辦在職教育課程、製作病室環境設備清潔消毒原則、規劃病室環境物品擺放，經上述改善方案實施後，無新增交互感染個案數，也提升病患照護品質。

Due to the high disease severity of the patients in ICU, heavy antibiotic abuse is prevalent, and the result is the growing issues of multidrug resistance, which in turn lead to multidrug resistant infection, even death in severe cases. Joint Commission on Accreditation of Healthcare Organization points out in 2010-2011 Taiwan Patient Safety Goals that healthcare-related infection should be considered a sentinel event and improve from the aspects of the syste such as environmental factors and management process. Our unit examined two cases of Acinetobacter baumannii and two case of multidrug resistant Acinetobacter baumannii between August 2009 and October 2009, so a task force was assembled. After analyzing the situation, the result indicated the insufficient recognition of nursing staffs regarding care for multidrug resistant Acinetobacter baumannii patiets, the absence of standard procedures for cleaning and sterilization of ward and equipments, and improper management of the ward. An improvement plan was formulated: hold in-service training, establish standard procedures on cleaning and sterilization of ward and equipments, and revise plans for placement of materials in wards. After implementing the improvement plan, there were no new reports on cases of cross-infections, and the quality of patient care was enhanced.

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