降低血液透析逆滲透水處理系統與透析液菌落數之專案

A Project for Reducing Reverse Osmosis Water Conditioning Systems and Bacteria Count in Hemodialysate

余秀芬(Hsiu-Fen Yu) ； 張麗娟(Li-Chuan Chang)

《臺灣腎臟護理學會雜誌》 15卷1期 (2016/03) Pp. 11-25

https://doi.org/10.3966/172674042016031501002

摘要

透析醫療品質的首要重心是透析液，本單位於2010年4月至12月透析液菌落數偏高，確保病人安全故成立專案小組，旨在降低逆滲透（reverse osmosis, RO）水處理系統與透析液菌落數、提升透析護理品質。經分析發現問題有：透析機消毒時間不足、RO水處理系統採水時取樣口污染、透析機RO水入口處未執行無菌技術採水、人員對透析液品質知識不足、透析機老舊。改善方法為：（一）修訂透析室採水標準技術；（二）修訂水質異常處理作業規範、制訂設備管理作業規範、制訂RO設備消毒作業規範；（三）更換老舊血液透析機；（四）建立稽核機制；（五）舉辦在職教育等方法，結果菌落數異常件數3.92件／月降至0件／月，顯示病人安全得到保障也提昇了透析品質。

關鍵字

病人安全 ； 透析液 ； 菌落數

並列摘要

Dialysate is regarded as the key in the healthcare quality of dialysis. The elevated dialysate bacteria count of this unit between April and December of 2010 led to the establishment of an ad hoc group assigned to reducing the bacteria count in the reverse osmosis (RO) water conditioning systems and dialysate, as well as enhancing the quality of nursing care during dialysis. Some of the problems discovered through the analysis included inadequate sterilization of dialysis machines, sampling port pollution of RO water conditioning systems, failure to use aseptic water intake techniques for the RO water inlets of dialysis machines, insufficient knowledge about dialysate quality, and worn dialysis machines. Suggested improvements included: (1) revising the standard technique for water intake in dialysis units; (2) revising the standard operating procedures for handling abnormal water quality, equipment management, and RO apparatus disinfection; (3) replacement of worn hemodialysis machines; (4) establishing auditing mechanisms, and (5) hosting of inservice education. The number of cases of abnormal bacteria count subsequently dropped from 3.92 to 0 cases per month. Patient safety was therefore assured while dialysis quality was improved as well.

並列關鍵字

patient safety ； dialysate ； bacteria count

參考文獻

徐宗福（2007）‧根本原因分析在醫療照護的應用‧護理雜誌，54（6），77-83。doi: 10.6224/JN.54.6.77

Borges, C. R. M., Lascowski, K. M. S., Filho, N. R., & Pelayo, J. S. (2007). Microbiological quality of water and dialysate in a haemodialysis unit in Ponta Grossa-PR Brazil. Journal of Applied Microbiology, 103(5), 1791-1797. doi: 10.1111/j.1365-2672.2007.03431.x

Hoenich, N. A., Levin, R., & Ronco, C. (2010). Warter for haemodialysis and related therapies: Recent standards and emerging issues. Blood Purify, 29(2), 81-85. doi: 10.1159/000249212

Montanari, L. B., Sartori, F. G., Cardoso, M. J., Varo, S. D., Pires, R. H., Leite, C. Q..., & Martins, C. H. (2009). Microbiological contamination of a hemodialysis center water distribution system. Revista do Instituto de Medicina Tropical de Sao Paulo, 51(1), 37-43. doi: 10.1590/S0036-46652009000100007.

Varo, S. D., Martins, C. H., Cardoso, M. J., Sartori, F. G., Montanari, L. B., & Pires-Goncalves, R. H. (2007). Isolation of filamentous fungi from water used in a hemodialysis unit. Revista da Sociedade Brasileira Medicina Tropical, 40(3), 326-331. doi: 10.1590/S0037-86822007000300015