Construction of risk management for infection control in home care settings

为了了解家庭护理环境中感染的实际情况，并考虑制定预防措施，本研究进行了三项研究（1 - 3）。1.针对三种家访服务的问卷调查：家访护理（2004年东京有134个上门护理服务站，2005年东京以外地区有523个服务站）、家庭助手服务（2006年有344个上门护理服务站）和1 208个上门洗浴服务。(1)感染病人的存在情况：在55%的探访护士服务站、30%的探访护理服务站和60%的探访洗浴服务站中，护理人员正在照顾传染病病人。肝炎以B型和C型最多见。(2)CDC标准预防措施感染控制策略：各服务单位均给予合理答复。但感染者的存在与所采取的策略无关。(3)护理人员的保健：约80%的工作站建议接种疫苗，其中95%的工作站建议接种流感疫苗。2.无水摩擦消毒剂的实际使用实验：市场上的消毒剂的涂布量是可变的，为了获得有效的洗手效果，一些产品的容器特性不合适。3.访问美国德克萨斯州，了解家庭护理机构的感染控制系统：对家庭护理人员进行了必要的系统教育，感染是影响医疗质量和患者生活质量的重要障碍之一，管理部门应尽快制定有效的家庭护理感染控制教育策略。

To find an actual situation of infection in home care settings and to consider a provision against it, three studies(1〜3) were performed in this research. 1. Questionnaire against three kinds of home-visit services; home-visit nursing (134 visiting nurse service stations at Tokyo in the year of 2004, 523 stations in areas out of Tokyo in 2005), home-helper service (344 visiting care service stations in 2006) and 1208 visit -bath services. (1) Existence of patients with infection: In cases of 55% of visiting nurse service stations, 30% of visiting care service stations and 60% of visit-bath services, care-workers were giving care to patients with infectious diseases. Hepatitis, both type B and type C were most frequently existed in visiting nurse service stations.(2) Infection control strategies of standard precautions under CDC : There were reasonable replies by every service. But there was no relationship between existence of infected patients and performed strategies. (3) Health care for care-worker: About 80% of stations recommended vaccination, and 95% of them did recommend Influenza vaccine. 2. Experiment for practical use of waterless, rubbing antiseptics: Spreading volume of antiseptics which is on the market was variable and for to get effective result to hand washing, some of the products had not suitable characteristics of their container. 3. Visit to Texas, USA, to learn infection control system in home care settings: There were indispensable and systematic educations to personnel in home visit system.Infection is one of the important barriers against quality of medicine and patient's QOL Effective strategy of education on infection control in home-visit service should be designed by the administration in near future.