采血室护士连续多次采血手卫生策略  

Hand hygiene strategies for continuous blood collection by nurses of blood collection rooms

作　　者：李欢 闻智[2] 周丽丽[2] 刘伯伟 张晓明 李佳熹 于正浩 刘运喜 杜明梅 LI Huan;WEN Zhi;ZHOU Li-li;LIU Bo-wei;ZHANG Xiao-ming;LI Jia-xi;YU Zheng-hao;LIU Yun-xi;DU Ming-mei(The First Medical Center,Chinese PLA General Hospital,Beijing 100039,China)

机构地区：[1]中国人民解放军总医院第一医学中心疾病预防控制科,北京100039 [2]中国人民解放军总医院门诊综合治疗室,北京100039

出　　处：《中华医院感染学杂志》2024年第18期2838-2842,共5页Chinese Journal of Nosocomiology

基　　金：国家卫生健康委卫生发展研究中心医疗机构感控措施证据循证评价及示范基地建设项目(2020-53)。

摘　　要：目的探讨连续采血过程中单副手套的最佳更换时机,评价免洗手消毒液和医用湿巾对手套的消毒效果。方法以2023年10-12月北京市某三甲医院采血室带教护士和实习护士为研究对象,连续采血过程中不更换手套,使用免洗手消毒液(手消组)和医用湿巾(湿巾组)对手套进行消毒,连续消毒次数1、3、5、10和20次后,采用潜血实验和微生物学方法对手套表面残留的血红蛋白和细菌进行检测。结果在手消组中,潜血实验显示带教护士连续操作5、10和20次时,手套上残留血红蛋白的检出阳性率分别为6.45%、37.50%和80.95%,实习护士连续操作1、3、5和10次时,手套上残留血红蛋白的检出阳性率分别为8.89%、10.00%、44.44%和75.76%;微生物学结果显示除实习护士10次操作有细菌超标外(11.43%),其他频次组的细菌合格率均为100%;在手消组中,抽取动脉血气后手套样本的残留血红蛋白检出阳性率为91.18%,无细菌检出;带教护士连续静脉采血10次时,湿巾组、手消组中的残留血红蛋白的检出阳性率分别为15.38%vs.37.5%(P<0.05);实习护士连续静脉采血5次和10次时,湿巾组、手消组中的残留血红蛋白的检出阳性率分别为3.13%vs.44.44%(P<0.05)和3.85%vs.75.76%(P<0.05)。结论在连续采静脉血的过程中使用免洗手消毒液,带教护士和实习护士更换手套频次分别为5次和3次;抽取动脉血气后,护士应立即更换手套;相比于免洗手消毒液,医用湿巾擦除手套上残留血红蛋白的效果更好。OBJECTIVE To explore the best time to replace single gloves in the process of continuous blood collection and evaluate the effect of rinse-free hand sanitizer and medical wipes on disinfection of gloves.METHODS From Oct 2023 to Dec 2023,the teaching nurses and practice nurses of blood collection rooms in a three A hospital in Beijing were recruited as the research subjects,and the gloves were not changed during the process of continuous blood collection.The gloves were disinfected with rinse-free hand sanitizer(the hand disinfection group)and medical wipes(the wipe group).The residual hemoglobins and bacteria on the surfaces of the gloves were detected by an occult blood experiment and microbiologic method after the hands of the nurses were continuously disinfected for 1,3,5,10 and 20 times.RESULTS In the hand disinfection group,the result of the occult blood experiment showed that the positive rates of detection of residual hemoglobin on the gloves were respectively 6.45%,37.50%and 80.95%when the teaching nurses operated continuously for 5,10 and 20 times;the positive rates of detection of residual hemoglobin on the gloves were respectively 8.89%,10.00%,44.44%and 75.76%when the practice nurses operated continuously for 1,3,5 and 10 times.The microbiological results indicated that the qualified rates of bacteria of all the groups of frequencies were 100%except that the bacteria exceeded the standard when the practice nurses operated for 10 times(11.43%).In the hand disinfection group,the positive rate of detection of residual hemoglobin on gloves samples was 91.18%after arterial blood gases were extracted,and no bacteria were detected.When the teaching nurses continuously collected venous blood for 10 times,the positive rate of detection of residual hemoglobin was 15.38%in the wet wipe group,37.5%in the hand disinfection group(P<0.05).When the practice nurses continuously collected venous blood samples for 5 times,the positive rate of detection of residual hemoglobin was 3.13%in the wet wipe group,3.85%in the han

关 键 词：连续采血 手套 手卫生 残留血红蛋白 消毒 

分 类 号：R187[医药卫生—流行病学]