燙傷中心水療室啟用前水放流時間對水中菌落數之影響

The Impact of Pre-use Free-flow Duration on Bacterial Carriage of Hydrotherapy Facilities in a Burn Center

水治療法（Hydrotherapy，簡稱水療），被廣泛地使用在燒燙傷傷口照護，病人二度以上燙傷，經醫師評估後可考慮進行水療。其透過的機轉包括降低傷口的細菌量、移除滲液及軟化痂皮、刺激血液循環及潔淨傷口表面…等。水中菌落數表示水中好氧及兼性厭氧異營菌的菌量，若水療水質的水中菌落數過高，對於燒燙傷傷口會產生相對的感染風險。因此水療用水的水質管理與監測是感染管制的重要議題。為確保用水品質降低水中菌落數，在自來水入水龍頭前裝置簡易過濾設備及紫外線消毒燈外，本實驗針對不同水療設備以及使用頻率，做水中菌落數和帶菌種類的連續性監測，然後利用不同的放流時間來控制水中總菌落數。結果發現水療床比水療浴室有較高的菌落數，間歇使用（超過三天以上）和每日使用比較起來，也有較高的機會使水中總菌落數升高。而高帶菌量可在使用前水放流來降低水中菌落數，以符合行政院環境保護署飲用水管理條例「總菌落數」參考值＜100CFU／mL之標準，較高的水中菌落數需要較長的放流時間才能達到水中帶菌去移生的效果。由本實驗結果可知，水療設備不論當日有無執行水療，水療室每日執行用水放流，可以避免中斷使用帶來的高帶菌量，每日第一例病人開始治療前先做常規的水放流，也有利於降低水中菌落數。放流對水中總菌落數能有效的控制，但因水質、管路及地理環境等因素的差異，不同院所機構應針對放流時間做因地制宜規範，避免水污染造成病人傷口感染，確保病人安全。

Hydrotherapy is widely used in burn wound care. However, hydrotherapy also has the potential to cause nosocomial infection, especially in burn patients without an intact skin barrier. Therefore, the quality of hydrotherapy water is an important infection control issue. Our study investigated factors associated with bacterial carriage load in water used for hydrotherapy, including the type of hydrotherapy facility, interruption duration, and free flow duration before use. The results revealed that hydrotherapy baths had more bacterial contamination than hydrotherapy showers. Interruption in use for more than 3 days also correlated with greater bacterial colonization than everyday use. More bacterial colonization required longer pre-use free flow duration to achieve standards for either total bacterial load (< 100 CFU/mL) or specific pathogen load, such as Pseudomonas aeruginosa (< 1 CFU/100 mL) and Legionella species (< 100 CFU/L). Based on our results, we propose two infection control policies. First, water flow should be maintained for at least 5 minutes every day, irrespective of whether hydrotherapy is scheduled, to avoid interruption of use. Second, free flow for 5 minutes is suggested before daily use of hydrotherapy for de-colonization and prevention of nosocomial infection. Otherwise, routine monitoring of water quality for hydrotherapy is mandatory to ensure adherence to the infection control policies in burn centers.