# 病人尿液培養出KPC(Klebsiella pneumoniae carbapenemase) — CRE菌株後入院。護理師應執行哪些感染預防控制措施？請選擇所有適用項目。

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=373257&lang=zh-tw  
> language: zh-TW  
> subject: Safety and Infection Prevention and Control  
> category: SIPC

## 題目

病人尿液培養出KPC(Klebsiella pneumoniae carbapenemase) — CRE菌株後入院。護理師應執行哪些感染預防控制措施？請選擇所有適用項目。

1

病人一旦無症狀即解除隔離，即使培養仍為陽性。

2

將病人列入接觸隔離，每次入室著隔離衣與手套。

3

專門為該病人指定照護器材(聽診器、血壓計、體溫計)並加上專用標示。

4

若可行採用chlorhexidine沐浴流程，且每次接觸前後嚴格手部衛生(即使戴手套)。

5

通報感染管制團隊，並依機構流程篩檢同房病人與近期接觸者。

## 解析

CRE/KPC須採接觸隔離：每次入室隔離衣+手套、專用器材、肥皂水或酒精消毒手部、MDRO組合中的chlorhexidine沐浴、通知感染管制並追蹤接觸者。選項4錯誤 — CRE可於症狀消失後仍長期定植與排放數月；解除隔離須依CDC/機構流程多次監測培養陰性，僅以無症狀為準不充分。

## 深入解析

CRE為CDC「緊急威脅」病原 — 死亡率高且治療選擇有限(常僅colistin、tigecycline或新型ceftazidime-avibactam)。長期定植為常態 — 「病人好了所以解除隔離」為院內水平傳播之主要原因。

## 臨床情境

**因尿路感染入院**；培養為**產KPC之Klebsiella pneumoniae** — CRE菌株。醫院將CRE列為高優先多重抗藥菌(MDRO)。

## 重要概念

- **CRE(對碳青黴烯類抗生素具抗藥性之腸內菌)** — 含KPC、NDM、OXA-48、VIM酵素生產者之碳青黴烯抗藥革蘭氏陰性菌；CDC緊急威脅。
- **KPC(Klebsiella pneumoniae carbapenemase)** — 美國最常見之CRE酵素；水解碳青黴烯；經接觸醫療環境傳播。
- **接觸隔離組合** — 入室時隔離衣+手套、專用器材、手部衛生、chlorhexidine沐浴、強調環境清潔。

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