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題名：血液腫瘤病患人工血管照護品質改善專案
書刊名：護理雜誌
作者：陳怡蓉／顏慶雲
作者(外文)：Chen, Yi-zung／Yan, Ching-yun
出版日期：2011
卷期：58:3(附冊)
頁次：頁64-72
主題關鍵詞：照護品質；血液腫瘤；人工血管；血流感染；Nursing care quality；Hematology-oncology；Port-A；Bloodstream infections
原始連結：連回原系統網址new window
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背景 : 血液腫瘤病患裝置人工血管以利化學治療，卻易血流感染影響預後。護理因其獨特地位得成為醫療團隊領導角色，藉由高品質護理、執行需要的改變，以預防人工血管血流感染並改善病人照護成效。 2008年 7月至 2009年 6月，本單位發生 12件人工血管血流感染案例，感染率 3.18‰。經現況分析發現主要原因為： ⑴護理人員人工血管照護知能不足； ⑵人工血管護理技術標準及敷料更改； ⑶病患及家屬人工血管自我照護不足。因而成立專案小組進行改善。 目的 : 本專案旨在提昇護理人員執行人工血管照護品質，以降低病患血流感染率。 解決方案 : 於 2009年 8月 15日至 2009年 12月 20日執行改善策略，包含： ⑴修訂人工血管護理技術標準； ⑵更換敷料型號； ⑶執行不定期技術稽核； ⑷舉辦人工血管護理教育訓練； ⑸統一病患及家屬對人工血管的自我照護指導標準。 結果 : 血液腫瘤病患人工血管血流感染率由 3.18‰降至 0.99‰，下降率 68.87%。 結論 : 本專案有效降低人工血管血流感染率、提升病患安全及臨床照護品質，可作為同儕單位照護血液腫瘤病患之參酌。
Background: Hospitalized hematology-oncology patients undergoing chemotherapy face a significant risk of port-A related bloodstream infections. Nurses are uniquely positioned to help adjust clinical practices necessary to prevent port-A related bloodstream infections and improve patient outcomes. Between July 1st, 2008 and June 30th, 2009, twelve patients in our ward were stricken with port-A related bloodstream infections (an infection rate of 3.18‰). Data analysis indicated inadequate nursing competency in all aspects of port-A care. Nurses did not have adequate knowledge of port-A modified standard care protocols and did not provide dressings suited to hematology-oncology patient needs. Also, both patients and caregivers lacked adequate skin care knowledge. Our team developed a project to address and minimize port-A related bloodstream infection issues in our hospital. Objects: The authors designed this project to enhance integration of both the central line insertion care and maintenance practice bundles in order to reduce port-A related bloodstream infection incidence. Resolution: The plan was implemented from August 15, 2009 to December 20, 2009. It included establishing a standardization port-A care protocol, implementing a more appropriate dressing type, performing an irregular audit of port-A care techniques, holding educational training, and establishing skin care instructions for patients and their families. Results: Hematology-oncology patient port-A related bloodstream infections fell from 3.18‰ pre-implementation to 0.99‰ post-implementation. The effective rate of improvement was 68.87%. Conclusion: Standardization of Port-A care under this project achieved infection reduction results that achieved our anticipated goals. This project furthermore enhanced the delivery and quality of patient nursing services. This experience can serve as a reference to medical organizations involved in hematology-oncology patient care.
Other
1.疾病管制局全球資訊網Centers for Disease Control, R.O.C. (Taiwan)(2009)。侵入性醫療裝置相關感染監測定義Monitoring and defining intrusional medical equipment-related infections。  延伸查詢new window
2.疾病管制局全球資訊網Centers for Disease Control, R.O.C. (Taiwan)(2008)。8傳染病統計暨監視年報Annual statistical report: Infectious diseases and surveillance。  延伸查詢new window
3.吳淑萍、黃樹樺、黃高彬、盧柏樑、蔡季君、李怡慧等Wu, S. P., Hwang, S. H., Hwang, K. P., Lu, P. L., Tsai, J. J., Lee, Y. W., et al(2002)。成人院內念珠菌血流感染流行病學特徵之分析An analysis of nosocomial candidemia among hospitalized adult patients。  延伸查詢new window
4.金聖芳、郭玉芷、林玉蓮Jin, S. F., Kuo, Y. C., & Lin, Y. L.(2007)。降低暫時性血液透析導管引發之血流感染率Decreasing the bloodstream infection rate for temporary catheter-related hemodialysis。  延伸查詢new window
5.陳秀惠、陳采琳、陳麗琴Chen, S. H., Chen, T. L., & Chen, L. C.(2008)。降低血液透析病人人工血管阻塞率之改善方案Strategies to decrease the obstruction rate of arteriovenous graft in hemodialysis patients。  延伸查詢new window
6.賴伊貞、王拔群、黃政華Lai, I. C., Wang, P. C., & Huang, C. H.(2000)。中心靜脈導管使用及其相關感染之調查Risk factors for central venous catheter-related infection--a prospective analysis。  延伸查詢new window
7.賴美珠、許國忠、許啟森、林金絲Lai, M. Z., Xu, G. Z., Xu, Q. S., & Lin, J. S.(2002)。血流感染及血液培養之臨床意義The clinical significance of bloodstream infections and blood culturing。  延伸查詢new window
8.Adams, D., & Elliott, T. S. J.(2007)。Skin antiseptics used prior to intravascular catheter insertion。  new window
9.Casey, A. L., & Elliott, T. S. J.(2007)。Infection risks associated with needleless intravenous access devices。  new window
10.Kelly, L. J.(2008)。The care of vascular access devices in community care。  new window
11.Orto, V., & Greene, L.(2006)。Beyond the ICU: Nursing’s role in decreasing central venous CR-BSIs [Electronic version]。  new window
12.Poole, C. V., Carlton, D., Bimbo, L., & Allen, M.(2004)。Treatment of catheter-related bacteraemia with an antibiotic lock protocol: Effect of bacterial pathogen。  new window
13.Scale, K.(2008)。Intravenous therapy: A guide to good practice。  new window
14.Sheng, W. H., Chie, W. C., Chen, Y. C., Hung, C. C., Wang, J. T., & Chang, S. C.(2005)。Impact of nosocomial infections on medical costs, hospital stay, and outcome in hospitalized patients。  new window
15.Smith, M.(2007)。A care bundle for management of central venous catheters。  new window
期刊論文
1.張雪梅、王麗華(20050800)。中心靜脈導管相關的血流感染。感染控制雜誌，15(4)，236-241。  延伸查詢new window
2.O'Grady, N. P.、Alexander, M.、Dellinger, E. P.、Gerberding, J. L.、Heard, S. O.、Maki, D. G.(2002)。Guidelines for the prevention of intravascular catheter--related infections。Morbidity and Mortality Weekly Report，51(10)，1-29。  new window
 
 
 
 
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