隨著醫療科技的進步，侵入性中心導管大量使用於臨床危急病患，增加醫?照護相關感染風險，造成住院天數延長、醫療資源耗用增加、死亡率提高。為瞭解應用中心導管組合式感染管制措施對中心導管相關血流密度、醫療資源耗用的影響，做為發展臨床導管整合式照護(Bundle care)之基礎及感染管制監控的參考，故進行本研究。研究的目的為暸解加護病房應用中心導管「組合式感染控制介入措施」後中心導管相關血流感染發生密度；分析加護病房病人中心導管相關血流感染源及危險因子；3.探討中心導管「組合式感染控制介入措施」應用於加護病房對住院天數、導管留置天數及住院費用等醫療資源耗用的影響；比較中心導管相關血流感染與未感染者在住院天數、加護病房留置天數、導管留置天數及住院費用的差異性。 本研究為一回顧性合併準實驗研究，對照組53例，收集時間為2009年7月29日至2010年7月28日，實驗組收案對象為2010年7月29日至2011年7月28日間於加護病房於置入中心導管前後進行中心導管組合式感染管制措施。研究排除對象為研究期間住加護病房不滿72小時、年齡小於二歲、收案前及出現現存血液感染者、收案期間未完成中心導管尖端細菌培養者。兩組收集年齡、疾病嚴重度、慢性疾病史、體溫、中心導管相關血流感染情形及發生密度等資料進行各變項分析。 研究結果發現實驗組導管相關血流感染密度由3.48?下降至0.58?、平均住院天數縮短約6.9天、住加護病房天數縮短約2.56天、平均住院費用降低約新台幣162021.36元以下、導管留置天數縮短4.9天，研究結果顯示CVCsBundle Care介入在住院天數、住加護病房天數及住院醫療費用之影響成效良好，可做為國內本土化Bundle Care前身，提供國內醫療院所對醫療照護相關感染防制政策運用之依據。 Central venous catheter (CVC) bundle care has been developed and applied in Intensive Care Units (ICUs) to improve the quality of care, especially on infection control, and to reduce the medical resources utilization. The purpose of this research is to investigate the improvement on Catheter-Related Bloodstream Infection (CRBSI), in addition to study the risk factors of CVCs, and medical resources utilization (e.g., length of hospital stay and costs) after CVC bundle care is applied. This is a retrospective study. The study population was patients who were applied with CVCs in the ICU of the medical center in Taichung. The 53 patients in the control group were in ICU with traditional CVC care between July 29, 2009 and July 28, 2010; while the 53 patients in the experimental group were with CVC bundle care between July 29, 2010 and July 28, 2011. Both groups are stratified and compared by demographic, treatments, and infectious variables. The results showed that patients in the experimental group were with less CRBSI (from 3.48? to 0.58?), less hospital stay (6.9 days less), less ICU stay (2.56 days less), less hospital cost (162021.36 NT dollars less), and less CVC days (4.9 days less). The results indicated a success of CVC bundle care in quality and cost control of care.
