降低某血液腫瘤科病房中心靜脈導管相關Gram-Positive Cocci表皮菌之血流感染密度

Reducing the Infection Density of Central Venous Catheter related Gram-Positive Cocci Bloodstream Infections in the Hematology Ward

10.6880/TJON.201903/SP_19.12

洪燕萍(Yen-Ping Hung)；謝秀祝(Shiouh-Chu Shieh)；陳瑞儀(Jui-Yi Chen)

中心靜脈導管 ； 血流感染密度 ； 革蘭氏陽性表皮菌 ； central venous catheter ； density of bloodstream infections ； Gram-Positive Cocci

腫瘤護理雜誌

19卷增訂刊（2019 / 03 / 01）

137 - 150

繁體中文

對血液腫瘤病患而言，中心靜脈導管相關血流感染是致命的合併症，本單位中心靜脈導管相關Gram-Positive Cocci表皮菌之血流感染密度由2013年（千分之1.4）上升至2014年1∼6月（千分之2.29），經由現況分析發現原因為：1.缺乏皮膚清潔規範、2.病患及護理師對中心靜脈導管留置前及期間皮膚清潔認知不足、3.未全面提供適合每日皮膚清潔的2% Chlorhexidine消毒液。為降低中心靜脈導管相關GPC血流感染密度，目標為≤（千分之1.25），介入的措施有：1.訂定皮膚清潔規範、2.舉辦中心靜脈導管留置皮膚清潔教育訓練、3.製作皮膚清潔護理指導單張及海報、4.推廣每日使用抗菌消毒液。經由措施的介入，2014年11∼12月下降至（千分之0.46），2015∼2018年9月平均為（千分之0.38）∼（千分之0.39）。此專案藉由護理師主動提供中心靜脈導管留置皮膚清潔護理指導，提升病患皮膚清潔認知及執行，有效降低血流感染密度，建議可推廣參考。

For patients with hematologic malignancies, central venous catheter-related bloodstream infection (BSI) is a fatal complication. The BSI density at our unit rose from (1.4 per mille) in 2013 to (2.29 per mille) in January ~ June 2014. The risk factor analysis revealed that this deterioration may be caused by: (1) compliance failure to skin-cleansing guidelines, (2) unawareness of the importance of skin-cleansing before and during CVC insertion, and (3) inability of the unit to provide the 2% Chlorhexidine antiseptic solutions for daily skin-cleansing purposes. The goal for decrease of the density of central venous catheter associated Gram-positive cocci bloodstream infections was set at ≤ (1.25 per mille). We executed the following measures: (1) formulation of the skin-cleansing guidelines of our unit, (2) training courses to educate nursing staff on the skin-cleansing techniques around CVC sites, (3) health-education leaflets and posters focusing on nursing skills for skin-cleansing, (4) daily use of antimicrobial solutions. As a result, the BSI density at our unit dropped to (0.46 per mille) in November ~ December 2014 and continued to drop to (0.38 per mille)~(0.39 per mille) during 2015 and September 2018. By encouraging the nursing staff to provide professional instruction on proper skin-cleansing around the CVC sites and by raising the patient awareness of the importance of skin-cleansing and the actual implementation, we have successfully reduced the density of CVC associated Gram-positive cocci blood stream infections at our unit. We recommend this approach to other institutions.

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