以時間序列分析某醫學中心加護病房導管相關血流感染之趨勢

Abstract

目的 描述臺大醫院成人加護病房2002~2010年，發生導管相關血流感染的時間趨勢變化。並利用時間序列分析法探討重要感染管制措施介入施行，是否會影響導管相關血流感染的發生率。同時分析不同階段品質管理改善方案及感染管制介入措施，對成人加護病房導管相關血流感染密度之影響。 方法 本研究為回溯性研究，以2002年至2010年臺大醫院感染控制中心前瞻性主動監測加護病房醫療相關血流感染個案為樣本。以四個階段推動之感染管制措施、每月時間、季節、SARS事件、中心導管使用率、延遲效應及自我相關時間因素等為自變項，以每月中心導管相關血流感染發生人次與每月中心導管使用人日數為依變項，利用布瓦松迴歸進行多變項分析及自我相關模式分析，p< 0.05視為統計顯著差異。 結果 2004年4月推動「手部衛生運動」及2005年7月推行「感染控制學習護照」雖未立即讓導管相關血流感染密度隨時間往下降，但感染密度上升的趨勢是緩慢的。2006年8月執行「置放中心導管評核」當時的感染密度下降至2.59‰，而且在2006年8月至2008年5月感染密度皆低於預測值的95%下限。2009年12月推動「血流感染複合式感染管制措施」，時感染密度高達5.32‰，但從2010年1月份起感染密度開始逐月遞減，到2010年12月感染密度已下降至3.56‰。 結論 由我們的研究顯示「手部衛生運動」及「感染控制學習護照」，對於降低導管相關血流感染密度並不顯著。但是對於降低導管相關血流感染密度而言，「置放中心導管評核（CVC評核貼紙）」及「血流感染複合式感染管制措施」是兩個有意義的變項。總結，對於降低導管相關血流感染密度，「血流感染複合式感染管制措施」是一項重要且有效的措施。

Purpose The purpose of this thesis is to describe the time trend of catheter-associated bloodstream infection (CA-BSI) in adult intensive care units (ICUs) at National Taiwan University Hospital (NTUH) from 2002 to 2010. Time series analysis was used to investigate the possible effects of various important infection control and quality improvement programs that conducted at different time stages on the incidence rate of CA-BSI. Method This is a retrospective study. The study population was patients developing CA-BSI while staying in adult ICUs at NTUH from 2002 to 2010. Patients with CA-BSI at NTUH were identified through active surveillance by infection control center during this period. Four important infection control programs, calendar time (month), season, epidemics, the central catheter utiliztion, the time delay effect and autocorrelation factors of severe acute respiratory syndrome, were treated as the independent variables. Monthly incidence of CA-BSI was treated as dependent variable. Poisson regression multivariate analysis and the models of autocorrelation were used to evaluate the potential effects of independent variables on dependent variable. A p value less than 0.05 were considered as statistically significantly. Result Four important infection control programs, hand hygiene campaign, Infection Control Learning Passport, CVC-care check list, and bloodstream infection bundle care, were implemented since April 2004, during July 2005 to March 2008, since August 2006, and since December 2009, respectively. Implementation of hand hygiene campaign and Infection Control Learning Passport did not decrease, but only slowed down the trend of increase the CA-BSI incidence. The CA-BSI incidence decreased to 2.59 per 1000 catheter-days (‰) in August 2006. And it was less than the lower limit of 95% confident interval of predicted value, during August 2006 to May 2008. However, it increased again (up to 5.32‰ in December 2009) thereafter. After implementation of BSI bundle care, the incidence decrease with time significantly (down to 3.56 ‰ in December 2010). Conclusion Our study showed that implementation of hand hygiene campaign and Infection Control Learning Passport were not sufficient to decrease the CA-BSI incidence. CA-BSI bundle care and CVC-care check list were the two significant variable associated with the decrease of CA-BSI. We conclude that promotion of CA-BSI bundle care is an important event and effective intervention to control CA-BSI.