手術室醫護人員手部滅菌方式之探討

Evaluation of Antiseptic Formulation for Hands of Surgical Staff in Operating Room

王定偉(DIEN-WEI WANG)

指導教授 ： 藍守仁

亞洲大學/健康學院/健康產業管理學系健康管理組/碩士(2011年)

摘要

不需水、不用刷子的乾刷手，對許多經過傳統醫學教育的醫護同仁產生衝擊，國外的文獻顯示與傳統外科刷手比較，乾刷手有較佳之滅菌效力和較低的皮膚刺激性。
本論文為一前瞻性（Prospective）研究，以交叉（Cross over）的方法比較乾刷手與傳統外科刷手的滅菌效力和對皮膚敏感度的認知。自2010年元月24日至5月14日，共18位合格的手術室醫護同仁參與實驗。合格的受測者必需符合：一、排除條件：不可使用全身抗生素及局部保養品。二、包含條件：三次基礎手部菌落採樣，必須有二次每手總菌落數大於103 ∕ CFU。研究設計是依據美國食品及藥物管理局的Tentative Final Monograph For Health-care Antiseptic Drug Products（TFM）規範及評估外科刷手的標準測試方法（ASTM E1115-02）。
針對乾刷手及傳統外科刷手兩種方式比較，在個別12次的刷手動作前後的三個時間點，作手部菌落數採樣。其滅菌效力以菌落數的對數值差（log10 Reduction）表示。三個時間點分別代表滅菌效力的立即效果，持續效果及累積效果。針對皮膚的敏感度，則分別以問卷及評量表的方式比較。統計方法為配對t檢定及威氏符號等級檢定（Wilcoxon signed ranks test），p值小於0.05為有統計差異。分析結果發現兩種手部清潔方式的滅菌效力在立即效果及累積效果並無差異，但持續效果則乾刷手優於傳統外科刷手。但兩種方式的滅菌效力均符合TFM的要求。皮膚敏感性則以乾刷手的濕潤感優於傳統刷手，且有統計差異；其它指標無統計差異。
乾刷手的滅菌效力優於傳統刷手，且醫護人員自覺皮膚變的較濕潤，故接受程度較高。故乾刷手是可以廣泛使用在手術前手部消毒的新方式。

關鍵字

外科刷手 ； 乾刷手

並列摘要

There are two options for preoperative treatment of hands. Surgical hand scrub, which is the cleaning of hands with antimicrobial soap, brush, and water; and surgical hand rub, which is the application of an alcohol-based hand rub into dry hand without water.
AvagardTM (CHG/Ethanol/emollient) surgical hand rub marketed in Taiwan three years ago. Waterless, brushless surgical hand rub challenged the traditional hand-hygiene formulation. This clinical study was based on the modified Tentative Final Monograph for Health-Care Antiseptic Products (TFM) and the Standard Test Method for Evaluation of Surgical Hand Scrub Formulation (ASTM E1115-02) to illuminate the activity of AvagardTM hand rub and HibitaneTM (4% CHG) hand scrub by logarithm reduction (LR). From Jan 24, 2010 to May 14, 2010, total 18 qualified surgical staff enrolled this clinical trial. Bacterial samples were got with glove-juice technique at 1 minute and 3 hour, the 1st hand antiseptic, and 1 minute, the 12th hand antiseptic. The skin irritation was check with score, grade and assessment. The LR and moisture content of assessment of the surgical hand rub proved to be significantly better (p < 0.05) than traditional hand scrub. Antimicrobial activities of the two preparations were all fitted the recommendation of TFM. The combination of 1% CHG. / 61% ethanol /emollient had significantly greater microbial reduction and moisture skin than HibitaneTM.

並列關鍵字

surgical hand rub ； surgical hand scrub ； antiseptic

參考文獻

3. AORN J. (1999). AORN : Recommended Practices Committee. Recommended Practices for surgical hand scrubs, 69:842-50.

4. AORN J. (2001). AORN : Recommended Practices Committee.

Comparison of different regiments for surgical hand preparation, 73:412-432.

6.Bissett, L. (2002). Can alcohol hand rubs increase compliance with hand hygiene? Br. J. Nurs, 11:1074-1077.

7.Boyce, J. M., & Pittet, D. (2002). Guideline for hand hygiene in health-care settings. Recommendations of the healthcare infection control practices advisory committee and the HICPAC/SHEA/APIC/IDSA hand hygiene task force. Morb. Mortal. Wkly. Rep, 51:1-45.