因醫療技術之進步與病患病情需要，各種侵入性導管已大量被使用於治療及監測 。由於導管直接侵入身體組織至血流並長期留置於血管內，使造成重症病患之院內血流感染 機會增加。本研究探討加護中心內病患之原發性院內血流感染的發生情形，與其所使用侵入 性導管間的關連，希望能提供未來降低院內血流感染發生之參考方向。 自 85 年 1 月 1 日至 85 年 12 月底為止， 本研究收集某加護中心內所有 858 位住院病 患的逐日住院資料，如：侵入性導管種類、留置天數與疾病嚴重程度等資料，並以住院人日 數為計算院內血流感染率的分母。本研究以發生原發性院內血流感染之病患為研究之指標個 案，研究期間內， 該加護中心之原發性院內血流感染發生率為 7.35/1000 （ 65 人 /8842 人日）。 住入加護中心期間愈長，其原發性院內血流感染發生率也愈高（ p<0.005 ）。病 患嚴重程度的增加，也會促成院內血流感染事件的發生（ P=0.025 ）。 各導管留置時間愈 長，病患之原發性院內血流感染發生率愈高。以趨勢卡方檢定來看，中央靜脈導管留置超過 更換標準者，原發性院內血流感染發生率愈高（ p<0.005 ）。 以對數迴歸的模式分析，發 現病患嚴重程度的增加（ APACHE II 每增加 1 分），會促成原發性院內血流感染事件的發 生。導尿管、中央靜脈導管、或動脈導管的使用，都可能會促成院內血流感染事件的發生。 使用全靜脈營養術的 95 位病患有 13 人發生院內血流感染事件， 發生的百分比達 13.68% ，為使用者的 2.04 倍（ p=0.027 ）。 本研究結果與國外文獻報告相似，醫護人員應注意侵入性裝置與院內血流感染發生的關係， 並遵循必要的感染控制規範。未來的相關研究，若能進一步探討院內血流感染的後續影響， 相信更能提高醫護人員對院內血流感染事件的重視。

　　　　　Advanced monitoring techniques which require a long duration of insertion of catheters into patients have caused the increase of nosocomial bloodstream infections, especially in the intensive care setting. To provide information to prevent this catheter-related infection, this prospective follow-up study goal is to estimate the occurrence of the primary nosocomial bloodstream infection in severely ill patients, and to explore the possible relation with the use of invasive devices. From Jan. 1 to Dec. 31 1996, all 858 patients admitted into the ICU of a medical center were enrolled into this study. The severity of diseases, type and duration of each in vasive apparatus inserted into each patient were recorded. Cases of primary nosocomial bloodstream infection were identified, and the infection rate for each invasive apparatus was determined as the number of infected cases divided by the person-day experience of patients received the same apparatus. The rate of primary nosocomial bloostream infection in the ICU was 7.35/1000 (65 cases/8842 person-day). The rate increases with the duration of stay in the ICU (p<0.005). Patients who were more sick were prone to get the in fection (p=0.025). The risk of nosocomial infection increases as the duration of invasive catheters in situ increases. By a logistic regression analysis, the severity of diseases (APACHE II score), the insertion of urinary catheter, central venous line, or arterial line were all associated with an elevated risk. The findings of this study are similar to other reports. Health care providers should pay more attention to following the guidelines to control the nosocomial infection. Future study can focus on the adverse outcomes of the infected patients in order to estimate the cost of these nosocomial infections.