探討應用氯化合物消毒錠(Sodium dichloroisocyanurate, NaDCC tablets)稀釋溶液進行加護中心環境消毒之成效Application of Standardized and Use of Sodium Dichloroisocyanurate Tablets for Environmental Disinfection

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2018-09-21 已刊登
新刊登 綜 整 預防/治療/介入類型

作  者

邱春榕* 呂宗憲 謝秉軒

實證知識類別

B 類:實證健康照護應用

PICO

治療/預防性問題

治療/介入措施

胸腔暨重症加護醫學 Pulmonary and Critical Care Medicine

科別

  • 病人安全 Patient Safety
  • 感染/傳染性疾病護理 Infectious / Communicable Disease Nursing

中文關鍵詞

醫療環境及設備消毒 二氯異氰尿酸鈉消毒錠 感染控制

英文關鍵詞

disinfection Sodium dichloroisocyanurate troclosene tablets Infection control

機構名稱

三軍總醫院

申請單位

護理部35病房

中文摘要

形成臨床提問:
臨床問題為:探討使用NaDCC消毒錠(Sodium dichloroisocyanurate) 醫療環境及設備消毒之效益分析? PICO- P:醫療環境及設備消毒、I:使用NaDCC tablets、C:漂白水或非NaDCC tablets清潔、O:感染密度。
文獻搜尋的方法與分析:
本文形成一個「PICO」問題,並依據其同義字搜尋Pubmed、Cochrane Database、 EBSCO HOST、中國知識網、CEPS中文電子期刊等資料庫進行搜尋。以P、I、C、O關鍵字,包括關鍵字(MeSH)及同義字(Synonyms),利用布林字元「OR」、「AND」、篩選以語言為中英文,由於本研究主題相關文獻資料較少,故亦納入個案對照研究(Case control study)範圍進行搜尋。另搜尋美國、歐洲及台灣疾病管制單位之照護指引,遴選 Guideline for Disinfection and Sterilization in Healthcare Facilities (2008) 為臨床指引採用AGREE進行評讀。
文獻的品質評讀:
搜尋結果:中英文文獻資料庫共42篇,無系統性文獻回顧及RCT文章,其中排除並刪除文獻後,共評讀4篇文獻,採用2013年版的CASP作為個案對照研究的評讀工具。
證據之臨床應用:
運用實證知識轉譯之7步驟進行改善,推行同時進行結果分析。研究設計為前後對照研究(Controlled before-and-after study ),研究期間自104年1月1至104年6月30日及104年10月至105年3月,研究地點採立意取樣,選擇北部某醫學中心之9個成人加護病房,介入期間以NaDCC替代漂白水進行環境消毒。
成效評值:
以統計分析的方式,比較前後對照期間醫療照護相關感染密度、血流感染密度及成本效益。自2014年10月~2015年3月,於NaDCC環境清潔措施介入後,收案2159名新病人中,減少95人次醫療照護相關感染人次。經pair-t檢定後,NaDCC組之醫療照護相關感染密度低於常規漂白水組t = -4.53 (P<.001);NaDCC組之血流相關感染密度低於常規漂白水組 t = -2.28 (P<.03)。
結論與建議:
經由NaDCC環境清潔措施介入後,不僅可有效減少發生醫療照護相關感染發生密度及人次,且減少住院天數以及減少醫療成本浪費,亦降低消毒溶液使用成本。研究結果可提供各醫療機構於環境消毒及感染控制上之參考。

英文摘要

Ask an answerable question (PICO):
NaDCC tablet solution has more bactericidal persistence, longer preservation time and stronger bactericidal power than sodium hypochlorite does. This paper is intended to explore whether NaDCC tablet solution is more effective in disinfection and reducing the density of medical care-related infections.
The Method and Analysis of Literature Review:
The Critical Appraisal Skills Programme AGREE was used to appraise the quality of the Guideline. In addtion, the authors searched the Cochrane、EBSCO HOST、PubMed and CEPS databases for relevant articles that were published before May, 2016.
Critical Appraisal:
Forty two studies were identified and four evidence-based references were selected for follow-up assessment.The Critical Appraisal Skills Programme(CASP, 2013) was used to appraise the quality of the reviewed studies.
Clinical Application of Evidence:
A prospective study design was conducted in the 9 adult intensive care units of a medical center in northern Taiwan from Jan 1 to May 30, 2015 and from October 2015 to March 2016. During the intervention, NaDCC tablet solution was used to replace sodium hypochlorite for environmental disinfection.
Evaluation of Effectiveness:
The paired t-test was used. The infection rate of the Healthcare-associated infection in the NaDCC group was lower than that in the conventional bleach group t = -4.53 (P <.001); the medical care-related infection in the NaDCC group was lower than that in the conventional bleach group t = -4.61 (P <.001).
Conclusions and Recommendations:
Use of NaDCC for environmental disinfection has a positive effect in decreasing Healthcare-associated infection rate. This result can be a reference for medical facilities to effectively enhance the quality of healthcare and improve patient safety.