某醫學中心推行組合式照護對於預防導管相關血流感染之成效：2011-2015年

Abstract

目的： 主要探討推動組合式照護對於全院導管相關血流感染密度之效用以及血流感染微生物之相關性。以了解基礎感控措施可預防之成效及了解目前本院面臨之挑戰。 方法： 本研究為一回溯性研究，以2011年至2015年11月30日止，臺大醫院感染管制中心前瞻性主動監測臺大醫院醫療照護相關血流感染個案為研究對象。以2013年全院推行組合式照護為自變項，醫療照護導管相關血流感染密度為依變項，利用Student’s t-test檢定、Chi-square test檢定描述性資料分析及線性回歸（Linear regression）、卜瓦松回歸(Poisson regression)檢定推論性分析資料，p<0.05視為統計顯著差異。 結果： 2013年全院推行組合式照護對於降低全院導管相關血流感染密度達統計上顯著差異，RR：0.845(0.800-0.893)，p：<.0001。 主要觀察指標(Main outcome measures)：2013年全院推行組合式照護對於降低全院skin flora、Environment origin ( Acinetobacter spp.、Pseudomonas aeruginosa、Enterbacter spp.)導管相關血流感染密度達統計上顯著差異， RR：0.783 (0.721-0.851)，p：<.0001。 對照指標(Negative control outcome)：2013年全院推行組合式照護對於降低全院gut origin (Enterococcus. spp、Escherichia coli、Klebsiella pneumonia) 導管相關血流感染密度無達統計顯著差異，RR：0.930 (0.853-1.015)，p：0.1051。 結論：顯示2013年全院推行組合式照護，於全院導管相關血流感染密度及主要觀察指標有改善之成效，統計上達顯著差異。尤其加護病房成效明顯。故未來擬推動病人賦權計畫，於病房端由主要照顧者執行身體清潔及環境清潔等感管措施，以期改善一般病房導管相關血流感染率。

Purpose： It mainly discusses the effect of promoting bundle care on the density of catheter-related bloodstream infection in the whole hospital and the correlation of bloodstream infection with microorganisms. To understand the preventable effectiveness of basic infection control measures and to understand the current challenges facing the hospital. Method：A before-after prospective study was conducted in hospital wide in a medical center in northern Taiwan from January 2011 to November 2015, which include all CLABSI. Result： In 2013, the implementation of bundle care in the whole hospital had a statistically significant difference in reducing the density of catheter-related bloodstream infections in the whole hospital, RR: 0.845 (0.800-0.893), p: <.0001. Main outcome measures: The implementation of bundle care in the whole hospital in 2013 has a statistically significant difference in the reduction of skin flora and Environment origin (Acinetobacter spp., Pseudomonas aeruginosa, Enterbacter spp.) catheter-related bloodstream infection density. RR: 0.783 (0.721-0.851), p: <.0001. Negative control outcome: The implementation of bundle care in the whole hospital in 2013 has no statistically significant difference in reducing the gut origin (Enterococcus spp, Escherichia coli, Klebsiella pneumonia) catheter-related bloodstream infection density, RR: 0.930 (0.853) -1.015), p: 0.1051. Conclusion： It shows that in 2013, the hospital implemented bundle care, and the catheter-associated bloodstream infection density and the main observation indicators have been improved in the whole hospital, and there is a statistically significant difference. In particular, the intensive care unit has achieved remarkable results. Therefore, in the future, it is planned to promote the patient empowerment plan. At the ward side, the main caregivers will implement sensory measures such as body cleaning and environmental cleaning, in order to improve the rate of bloodstream infections related to catheters in general wards.