醫療院所落實感染管制是醫療品質提昇的重要指標。其中，血流感染是常見且重要的院 內感染，而主要為中心導管相關血流感染。雖然中心靜脈導管留置提供了醫療上的需求，卻 也相對提高了不必要的感染，如注射部位的感染與合併症，如靜脈炎、心內膜炎等。中心導 管相關血流感染確實可造成醫院醫療資源花費及住院日數延長。為減少病人發生醫療照護相 關感染，醫療人員與病患應致力參與及推動相關預防措施，採取執行組合式照護(bundle care) 措施以改善執行品質。根據目前的實證研究，中心導管相關血流感染(central-line associated bloodstream infection，CLABSI) 的組合式照護措施，應包括：選擇適當部位置入導管、手部 衛生(hand hygiene)、最大無菌面防護(maximal sterile barrier precautions)、使用含2% 氯弧 (chlorhexidine) 的酒精性消毒劑消毒皮膚、每日評估儘早拔除不需要之中心導管等五項重要 措施，若執行上述措施但中心導管相關血流感染率仍未下降時，則可考慮使用含氯弧的敷料 做傷口覆蓋或置放含有抗菌材質中心導管等。醫療院所推行中心導管相關血流感染組合式照 護，首先應進行所有中心導管醫療照護團隊人員之教育，包括：導管置放適應症及對推行組 合式照護之共識、無菌操作技術遵守及導管維護。此外醫療高層經營管理者必需對組合式照 護認知及提供適當資源支持，並有感染管制單位專業人員的監測及回饋，才能有效減少中心 導管相關血流感染，達到零感染容忍率的目標。實證醫學也顯示應用此組合式照護可以有效 降低中心導管相關血流感染。醫療人員應了解及持續落實相關感染管制措施，以確保病人安 全、提昇醫療品質。

Implementation of infection control is an important indicator of medical quality, while the central line associated bloodstream infection (CLABSI) is a common healthcare associated infection. Surveillance data from the intensive care units of United States estimated 15 million central catheter placement days and 80,000 CLABSI episodes annually. Patients with CLABSI had mortality rate of 12% to 25%. The Centers for Disease Control published CLABSI bundle care in 2011, included five elements of selecting the appropriate site for catheterization, hand hygiene, chlorhexidine disinfectant, maximal sterile barrier precautions, and remove unnecessary catheter earlier. All members should receive education include indications for catheter placement and consensus on the implementation of bundle care, compliance with aseptic techniques and daily catheter care. In addition, the leaders must provide appropriate resources to support performance, professionals monitoring and feedback in order to reduce the CLABSI. Evidence-based medicine shows that use of bundle care can effectively reduce the CLABSI. All staff should be aware of and continue to implement the infection control measures to ensure patient safety and improvement of quality. (J Intern Med Taiwan 2017; 28: 1-6)