Construction of risk management for infection control in home care settings

为了找出家庭护理环境中感染的实际情况，并考虑针对它的规定，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个护士服务站，2005年东京以外地区有523个服务站）、家政服务（2006年有344个护理服务站）和1208个洗浴服务。(1)感染患者的存在：在55%的护士服务站、30%的护理服务站和60%的洗浴服务站中，护理人员对传染病患者进行了护理。就诊护士服务站以乙型肝炎和丙型肝炎居多。(2) CDC标准预防措施的感染控制策略：各服务机构均有合理回复。但感染患者的存在与所执行的策略之间没有关系。(3)护理人员的卫生保健：约80%的服务站推荐接种疫苗，95%的服务站推荐接种流感疫苗。2. 无水搓洗消毒剂的实际使用实验：市场上的消毒剂的涂抹量是可变的，为了达到有效的洗手效果，有些产品的容器特性不适合。3. 赴美国得克萨斯州学习家庭护理机构感染控制系统：对家访人员进行系统的教育是必不可少的。感染是影响医疗质量和患者生活质量的重要因素之一，医院管理部门应在近期设计有效的家访感染教育策略。

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.