降低急診室血液培養汙染率

Abstract

血液培養採檢為急診室常見的護理技術,然而血液培養汙染容易間接造成病人傷害,鑑於單位血液培養污染率高達 7.77%,遠超出設定之閾值 <3%,需立即改善 為專案成立動機,為降低血液培養汙染率,專案小組人員分析發現護理人員執行血液培養採檢技術錯誤率高、認知測驗答對率低、採血工具不符需求且未稽核,經安 排在職教育課程、引進 3M 低敏護手乳(Cavilon)提高洗手遵從性、針對特定族群增加皮膚清潔次數、導入讀秒機制概念、稽核和回饋機制,成功降低血液培養污染 率至 2.3%、血液培養採檢錯誤率降至 3%、血液培養認知測驗答對率提升至 100%達專案目的,經由本專案推行針對特定族群較年長者和長照機構住民,增加皮膚清 潔次數與運用讀秒機制,落實等待消毒液乾燥,推行成效良好,建議可平行展開至其他科室,提升病人照護品質。  Blood culture sampling is a common nursing technique in emergency rooms. However, blood culture contamination is likely to indirectly cause patient harm. Given that the unit blood culture contamination rate is as high as 7.77%, which far exceeds the set threshold of <3%, it needs to be immediately improved as the motivation for project establishment. To reduce the contamination rate of blood cultures, the task force analysis found that the nursing staff had a high error rate in performing blood culture sampling, a low rate of correct answers to cognitive tests, and blood sampling tools that did not meet the requirements and were not audited. After arranging an on-the-job education course, providing 3M hyposensi-tive hand cream (Cavilon), increasing the frequency of skin cleansing for specific ethnic groups, introducing the concept of the countdown mechanism, and devel-oping an audit and feedback mechanism, we successfully reduced the blood culture contamination rate to 2.3%, the blood culture sampling error rate to 3%, and increased the blood culture cognitive test answer rate to 100% of the project purpose, This project was aimed at older people and residents of long-term care institution. We aimed to increase the frequency of skin cleaning and used a count- down mechanism to wait for the disinfectant to dry. According to our findings, the improvement effect was good. Currently, the plan is being implemented in other parallel wards.