Practical Study on Optimal Catheter Care to Reduce Risk of Nosocomial Infections

在这个项目中进行了两种类型的研究。我们进行了一项前瞻性流行病学研究，以确定TPN管理和输液污染之间的关系。我们检查了普通病房的静脉输液袋样品。在药房无菌条件下配制的输液未发现细菌污染。另一方面，污染物来自普通病房在无菌条件下制备的输液。我们还发现了输注液中的污染物，这些污染物是在注射到管路中或/和通过管路座采集血样后收集的，但未通过未以这些方式使用的管路座发现污染物。本研究以重症监护病房（ICU）为研究对象，通过对ICU环境的微生物学调查和护理人员在静脉留置针护理过程中的行为观察，发现输液准备和静脉注射均应在无菌条件下进行，以降低输液的污染风险。在护理过程中，我们发现一些感染风险的行为，如1）混合静脉输液时的手卫生，2）工作台及其环境的清洁，3）PPE的使用，4）药物配制中的无菌技术，5）预充措施，6）更换注射管路时的预防措施，7）PPE的使用，8）无菌技术，而通过线注射有感染的风险。有关气管吸引导管的研究表明，细菌污染可能是由吸引导管护理方法引起的，如导管护理的干燥方法和浸泡方法。在讨论了这些研究结果之后，新制定了护理手册。

Two types of studies were conducted in this project. We carried out a prospective epidemiological study to identify the association between management of TPN administration and contamination of infusion. We examined intravenous infusion samples from bags in general wards. No bacterial contamination was found from infusions prepared at pharmacy with aseptic condition. On the other hand, the contaminants were found from infusions prepared at general ward without aseptic condition. We also found contaminants from infusions which were collected after injecting into the line or/and taking blood samples through the line hub, but contaminants were not found through the line hubs which were not used in those ways. This research indicated that both preparation of infusion fluid and IV injection via line in aseptic condition is important to reduce the contamination risks of infusion fluids.Based on these results, an observational investigation of nurses' behaviors during IV catheter care and microbiological studies of the environment in Intensive Care Unit were conducted. During the nursing care, we found some infection risks among their behaviors such as 1) hand hygiene while mixing intravenous fluid, 2) cleanliness of working tables and its environments, 3) use of PPE, 4) aseptic techniques in drug preparation, 5) priming measures, 6) preventive measures during changing injection line, 7) usage of PPE, 8) aseptic techniques while injecting via line have infection risks were indicated. The studies about the tracheal suction catheters suggested that the bacterial contamination may be caused by suction catheter care methods such as both the dry method of catheter care and the soaking method. After discussing those research findings, care manuals were newly developed.