護理師照顧一位有新造口（ostomy）的病人，下列哪幾項護理師的行為對預防造口周圍皮膚破損與感染至關重要？（選所有適合的）

核心概念：造口（ostomy），無論是迴腸造口（ileostomy）或結腸造口（colostomy），都需要細心的照護以預防周圍皮膚（peristomal skin）的破損、刺激和感染。皮膚的完整性是維持造口功能和病人舒適度的基礎。 為何正確答案 A, C, D, E 對： A. 執行造口護理前後徹底洗手（wash hands），是預防任何感染（包括造口周圍皮膚感染和病人自身感染）的基本要求，遵循標準預防措施（Standard Precautions）。 C. 使用溫和的肥皂和清水輕柔清潔造口周圍皮膚，去除排泄物和殘留的黏膠，是維持皮膚清潔和健康的必要步驟。避免過度清潔或使用刺激性產品。 D. 確保造口用品（ostomy appliance，即造口袋和底盤）的貼合度至關重要。底盤（wafer/flange）應緊密貼合造口周圍皮膚，但又不能過緊而壓迫或限制造口血流。過大的開口會讓排泄物接觸皮膚，過小的開口則會限制造口。正確的貼合能保護皮膚。 E. 在清潔乾燥的造口周圍皮膚上塗抹一層薄薄的皮膚保護劑（barrier cream），能形成一層保護膜，隔絕排泄物對皮膚的刺激，預防皮膚破損和濕爛。 為何選項 B 錯：雖然在進行侵入性操作（如更換導管、處理開放性傷口）時，會使用無菌手套。但對於日常的造口護理，若病人皮膚完整無破損、無感染跡象，且護理師手部衛生良好，通常使用清潔的非無菌手套（clean non-sterile gloves）或甚至不戴手套（僅需徹底洗手）即可。使用無菌手套並非標準或必要措施，除非有特殊臨床指徵（如病人免疫功能低下或有感染風險）。 臨床思路（Safety / Infection Control / Skin Integrity）：此題考量的是造口照護的全面性，涵蓋感染預防、皮膚完整性保護以及操作者的基本衛生要求。

Core concept: An ostomy, whether an ileostomy or a colostomy, requires meticulous care to prevent breakdown, irritation, and infection of the peristomal skin. Skin integrity is the foundation for maintaining ostomy function and patient comfort. Why A, C, D, and E are correct: A. Thorough hand washing before and after ostomy care is fundamental for preventing any infection (including peristomal skin infection and patient self-infection) and adheres to Standard Precautions. C. Gently cleansing the peristomal skin with mild soap and water removes effluent and adhesive residue and is necessary for maintaining clean, healthy skin. Excessive cleansing or irritating products should be avoided. D. Ensuring proper fit of the ostomy appliance (pouch and wafer) is critical. The wafer/flange should fit snugly around the stoma without constricting it or limiting stomal blood flow. An opening that is too large allows effluent to contact the skin; one that is too small constricts the stoma. A proper fit protects the skin. E. Applying a thin layer of barrier cream to clean, dry peristomal skin creates a protective film that shields the skin from effluent irritation, preventing breakdown and maceration. Why B is incorrect: While sterile gloves are used for invasive procedures (such as catheter changes or open wound care), routine ostomy care for a client with intact skin, no infection, and good hand hygiene typically requires only clean (non-sterile) gloves or no gloves (with thorough hand washing). Sterile gloves are not a standard or required measure unless there are specific clinical indications (such as immunocompromise or infection risk). Clinical reasoning (Safety / Infection Control / Skin Integrity): This question addresses the comprehensive nature of ostomy care, covering infection prevention, skin integrity protection, and basic hygiene requirements for the practitioner.

造口照護的原則在美國和台灣是相同的，都強調手部衛生、皮膚清潔與保護、正確的造口袋更換與貼合。美國在造口治療師（WOCN - Wound, Ostomy, Continence Nurse）的專業認證和普及度上可能更為領先，提供高度專業化的照護。台灣的醫院也有專科護理師負責造口護理，但資源和培訓系統可能略有差異。