預防感染為重症患者重要課題。呼吸器相關性肺炎，泌尿道感染與導管相關血流感染 為重症患者三大感染原因。呼吸器相關性肺炎是造成重症患者死亡的主因之一，它會延長 呼吸器使用時間、加護病房使用天數，死亡率可高達30~50%，預防呼吸器相關性肺炎的產 生乃當務之急，它不但能減少醫療花費，也能降低死亡率。預防呼吸器相關性肺炎的措施 包含勤洗手；提高護理人力對病人比例；預防呼吸道嗆入（頭部抬高30 至45 度、抽吸聲 門下分泌物、維持氣管內管氣囊壓力在20 至35 cmH2O）；減少口腔或消化道的細菌（使用 chlorhexidine 去除口腔細菌、於消化道使用抗生素）；另外，每日中斷鎮定劑使用、早期拔除 氣管內管、早日脫離呼吸器都是減少呼吸器相關性肺炎的措施。使用組合式照護，綜合多種 有效的方式一起預防感染，會有效降低呼吸器相關性肺炎產生的機會。沒有研究顯示哪一種 組合式照護是預防呼吸器相關性肺炎最好的組合式治療，然而，早期拔管是最有效降低呼吸 器相關性肺炎的方法。醫療院所依據個別狀況選擇3 至5 項實証做為組合式照護項目時，應 優先考慮納入使用脫離呼吸器流程，降低呼吸器使用天數，做為建立預防呼吸器相關性肺炎 的組合式照護的首要策略。

Prevention of infection is important issue for critical care. Ventilator-associated pneumonia (VAP), urinary tract and bloodstream infection are the three most common infection in the critically ill patients. VAP is one of the most common causes of mortality, and it increases duration of mechanical ventilation, stay of intensive care unit (ICU) and mortality rate up to 30-50%. Prevention of VAP is critical issue, it can reduce medical cost and mortality rate. The strategies of VAP prevention include hand hygiene, nurse staffing, prevention of aspiration (elevation of the head of the bed, drainage of subglottic secretions, endotracheal cuff pressure maintaining 20 to 35 cmH2O), selective oral or digestive decontamination, daily interruption of sedation, early weaning from ventilator and removal of endotracheal tube. To perform bundling multiple interventions has an additive benefit, but there is no consensus on the ideal set of interventions to be included in VAP prevention bundles. Ventilator weaning protocols have striking success in decreasing length of patients’ ventilator usage and ICU days, resulting in decreasing incidence of VAP. This strategy is the most important when considering a VAP prevention bundle care. (J Intern Med Taiwan 2017; 28: 18-23)