護理師準備為患者的中央靜脈導管（CVAD）更換無菌敷料。護理師應採取下列哪些行動以降低感染風險？（選所有適合的）
A nurse is preparing to perform a sterile dressing change on a client's central venous access device (CVAD). Which of the following actions should the nurse take to reduce the risk of infection? (Select all that apply.)
- AApply clean gloves to remove the old dressing✓ 正解戴乾淨手套以移除舊敷料
- BInstruct the client to turn their head away from the site✓ 正解指示客戶將頭轉離置管處
- CCleanse the site with 70% isopropyl alcohol using a circular motion以環形動作使用70%異丙醇清潔患處
- DUse chlorhexidine gluconate with a back-and-forth friction scrub✓ 正解使用葡萄糖酸氯己定進行往復式摩擦 scrub
- EWear a surgical mask during the procedure✓ 正解在操作期間佩戴外科口罩
中央靜脈導管照護是預防導管相關血流感染（CLABSI）的關鍵。核心原則包含無菌技術與化學消毒。A 是正確的：移除舊敷料只需使用乾淨手套，但移除後需換成無菌手套。B 是正確的：請病人轉頭或佩戴口罩可避免其口鼻細菌污染無菌區域。D 是正確的：目前的循證指南建議使用葡萄糖酸氯己定（Chlorhexidine），且應使用「往復式摩擦」而非舊式的圓周式擦拭，因為摩擦力能更有效地穿透皮膚皺褶進行殺菌。E 是正確的：護理師佩戴口罩是標準的 CVAD 換藥規範。C 是錯誤的：單純使用酒精效果不如氯己定，且「圓周式」已不再是 CVAD 照護的首選推薦動作。整體思路圍繞在「屏障保護」與「高效消毒」。
Central venous catheter care is key to preventing catheter-related bloodstream infections (CLABSI). Core principles include aseptic technique and chemical antisepsis. A is correct: removing the old dressing only requires clean gloves, but sterile gloves must be donned afterward. B is correct: asking the patient to turn the head or wear a mask helps avoid contamination of the sterile field by oral or nasal bacteria. D is correct: current evidence-based guidelines recommend the use of chlorhexidine gluconate with a back-and-forth friction technique rather than the older circular wiping method, because friction more effectively penetrates skin folds for disinfection. E is correct: the nurse wearing a mask is a standard practice for CVAD dressing changes. C is incorrect: alcohol alone is less effective than chlorhexidine, and "circular wiping" is no longer the first-line recommendation in CVAD care. The overall approach centers on "barrier protection" and "effective disinfection."
美國醫院對 CLABSI 的監測極為嚴格，因為這會直接影響保險給付（Non-reimbursable），因此 CVAD 換藥組（Kit）通常包含所有無菌配件與口罩。台灣醫院雖然也重視，但護理師在臨床忙碌時，有時會忽略請病人轉頭或佩戴口罩的步驟，且部分醫院仍沿用傳統優碘加酒精的消毒方式。