以隨機對照先驅試驗比較三種消毒劑於急診成人血液培養的成效

Randomized Controlled Pilot Trial for Efficacy of Chlorhexidine Gluconate, Iodine Tincture, and Alcohol on Blood Culture Sampling of Adults in Emergency Department

郭素真(Shu-Chen Kuo) ； 孫婉慈(Wan-Tzu Sun) ； 張靜怡(Ching-I Chang) ； 蕭雯文(Wen-Wen Hsiao) ； 徐德福(Teh-Fu Hsu)

《榮總護理》 35卷4期 (2018/12) Pp. 343-354

https://doi.org/10.6142/VGHN.201812_35(4).0002

摘要

急診護理工作常需處理到院者危急或突發狀況，同時段內需在不同病人間轉換任務，時間壓力極大，故採取血液培養時容易忽略足夠的等待消毒乾燥時間，導致污染率上升。國內外有多篇研究比較不同消毒劑的消毒效果，但國內缺乏探討酒精對血液培養的果效。本研究目的在探討三種消毒劑對血液培養的成效，採單一中心三組隨機對照先驅試驗，選取台北市某醫學中心急診室92位20歲以上需要採取血液培養病人，使用三種不同的皮膚消毒劑，即2%葡萄糖酸氯己定、10%碘酊與75%酒精，依隨機組別之標準作業程序抽取血液培養。結果顯示三種消毒劑，在血液培養污染率無顯著差異；以75%酒精組平均乾燥時間11.35±3.56秒最短且所花費的成本0.05元/ml最少。本研究結果發現血液培養時，75%酒精在時間與成本方面最具效益，可提供日後擬訂抽取血液培養流程做參考。

關鍵字

血液培養 ； 污染率 ； 葡萄糖酸氯己定 ； 碘酊 ； 75%酒精

並列摘要

Emergency department nurses serve critical roles in supporting patients in the emergency department. Nursing workloads of emergency department nurses are heavy because they are required to rapidly handle patients. These nurses face several challenges, of which the most substantial is the rapid care of patients, which might lead to patients being subjected to unnecessary treatments. The most common unnecessary treatments are administered due to false results obtained from contaminated blood cultures. Contaminated blood cultures remain a serious concern. This prospective, randomized, investigator-blinded pilot trial compared the efficacies of venipuncture site disinfection by using 2% chlorhexidine gluconate, 10% iodine tincture, and 75% alcohol for preventing blood culture contamination. In total, 92 adult patients (aged ＞20 years) were included from the emergency department of a medical center in Taipei. Venipuncture sites were disinfected with 2% chlorhexidine gluconate, 10% iodine tincture, and 75% alcohol; the blood cultures were taken by nurses. Analysis was performed using Statistical Package for the Social Sciences (version 16 for Windows). Categorical variables with percentages and continuous variables with means and standard deviations were obtained for all parameters. Chi-square test and analysis of variance were used, all at 5% significance. Comparison of the three antiseptics revealed that 75% alcohol required the significantly shortest drying time (11.35 ± 3.56 s), at a cost of only NT$0.05 per mL. No significant differences were observed among the contamination rates of the three antiseptics.

並列關鍵字

alcohol ； blood culture ； chlorhexidine gluconate ； contamination rate ； iodine tincture

參考文獻

陳郁文、陳志榮(2014)．Chlorhexidine在預防醫療照護相關感染的應用及分析．感染控制雜誌，24(2)，85-91。

陳瀅淳、林進福、施智源、李素芬(2014)．比較不同碘酒消毒時間對血液培養污染率的影響．台灣醫學，18(4)，397-402。

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