血液透析水質異常之改善專案

Improving the Rate of Abnormal Colony Count in Hemodialysis Water

10.3966/172674042018031701002

葉淑敏(Shu-Nin Yeh)；林育如(Yu-Ju Lin)；翁敏惠(Min-Hui Weng)

血液透析用水 ； 管路消毒 ； 逆滲透 ； 菌落數 ； Hemodialysis water ； Pipeline disinfection ； RO (Reverse Osmosis) ； bacteria count

臺灣腎臟護理學會雜誌

17卷1期（2018 / 03 / 01）

19 - 31

繁體中文

血液透析水質的品質管理對透析單位而言，攸關病人生命安全，管理監測不當可能導致病人引發感染、敗血症甚至死亡。本單位於2012年第一季透析水質細菌培養菌落數≧50 cfu/mL異常率為 12.5％，第二季更攀升至19.0％，調查原因為：同仁未落實採檢技術且對透析水質品管知識不清楚、未修訂採樣標準作業以及缺乏相關教育訓練、未建立稽核制度及異常追蹤管理。本專案經過臨床調查、現況分析及文獻查證後，擬定措施：修訂透析水質採檢技術標準作業及制定透析水質品質管理記錄與稽核表，舉辦教育訓練並建立稽核制度。對策實施後水質檢測異常率由 19.0％降至0.9％，達到目標值。本專案提升單位同仁對血液透析治療與透析用水的品質與安全，確實建立一個安心的醫療環境。

For dialysis units, the management of hemodialysis water quality is a crucial issue as it relates to patients' lives and safety; poor management and monitoring may result in patient infections, septicemia, and/or death. Our dialysis unit underwent a dialysis water quality assessment in the first quarter of 2012 and determined that the bacterial colony count in the collected water samples (≥50 cfu/mL) exhibited an abnormal rate of 12.5%. In the second quarter of the same year, the assessment was conducted again and yielded a further increased abnormal rate of 19.0%. The causes of such high abnormal rates were examined, and the following results were obtained: The department staff did not follow the sampling and inspection procedures and possessed inadequate knowledge about dialysis water quality control; failed to revise the standard sampling procedure and lacked related education and training; lacked review or management systems for tracking abnormal cases. By performing a clinical investigation, current situation analysis, and literature review, this study revised the standard operating procedure for dialysis water sampling and inspection, created a form for recording and reviewing dialysis water quality management, held education and training sessions, and established a review system for staff performance. After implementing the aforementioned measures, this study decreased the colony count abnormal rate from 19.0% to 0.9%, meeting the target value. This study successfully improved the department staff's effort in conducting hemodialysis treatment and their knowledge of dialysis water quality and safety, thereby ensuring a safe hospital environment.

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