護理師準備為病人進行中央靜脈導管（CVC）無菌換藥。下列哪項措施對於維持感染控制最為優先？
A nurse is preparing to perform a sterile dressing change on a client's central venous catheter. Which action is the priority to maintain infection control?
- AEnsure the client wears a mask during the dressing change確保病人在換藥期間佩戴口罩
- BApply a sterile transparent dressing貼上無菌透明敷料
- CPerform hand hygiene before and after the procedure✓ 正解在操作前後執行手部衛生
- DClean the site with chlorhexidine using friction使用氯己定進行摩擦清潔
無菌技術的核心首要原則永遠是手部衛生。在進行任何涉及侵入性裝置（如 CVC）的操作前，徹底的手部清潔是切斷院內交叉感染最基礎且最有效的手段。雖然清潔皮膚（D）、戴口罩（A）和無菌敷料（B）都是預防導管相關血流感染（CRBSI）的環節，但若手部帶菌，後續的步驟皆會直接污染導管接口。此題強調『最優先』，根據世界衛生組織（WHO）與 CDC 的感染控制指引，手部衛生是所有醫療行為的基石。護理師在執行此程序時，必須嚴格遵守標準防護措施，確保自身手部微生物菌叢不會經由操作傳播給脆弱的病人。
The foremost principle of aseptic technique is always hand hygiene. Before any procedure involving an invasive device (such as a central venous catheter, CVC), thorough hand cleansing is the most basic and effective way to break the chain of nosocomial cross-infection. Although skin antisepsis (D), masking (A), and sterile dressing (B) are all part of preventing catheter-related bloodstream infection (CRBSI), if the hands are contaminated, all subsequent steps will contaminate the catheter hub. This question stresses 'highest priority': according to the infection control guidelines of the WHO and CDC, hand hygiene is the cornerstone of all medical care. When performing this procedure, the nurse must strictly adhere to standard precautions to ensure that microorganisms on the hands are not transmitted via the procedure to a vulnerable patient.
美國醫院針對 CVC 換藥通常要求護理師與病人皆需佩戴口罩（Masking Protocol），並有嚴格的 Bundle care 查核表；台灣醫院臨床實務中，對於病人佩戴口罩的要求依各院感染控制標準略有差異，部分醫院側重於換藥技術本身的無菌操作與使用氯己定消毒，對於病人的呼吸道防護要求較彈性。