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

在这个项目中进行了两类研究。我们进行了一项前瞻性流行病学研究，以确定TPN管理与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本。无菌条件下药房配制的输液未发现细菌污染。另一方面，在没有无菌条件的普通病房制备的输液中发现了污染物。我们还发现了在注射到管道中或/并通过管道枢纽采集血液样本后收集的输液中的污染物，但没有通过没有以这些方式使用的管道枢纽发现污染物。本研究表明，在无菌条件下制备输液液和在线静脉注射对于降低输液液的污染风险都很重要。基于这些结果，我们对重症监护室护士在静脉导管护理过程中的行为进行了观察性调查，并对环境微生物进行了研究。在护理过程中，我们发现其行为存在感染风险：1)混合静脉输液时的手卫生，2)工作台及其环境的清洁，3)个人防护装备的使用，4)药物制备时的无菌技术，5)启动措施，6)更换注射线时的预防措施，7)个人防护装备的使用，8)经线注射时的无菌技术存在感染风险。对气管吸管的研究表明，吸管护理方法可能引起细菌污染，如导管干燥法和浸泡法。在讨论了这些研究结果之后，新开发了护理手册。

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.