酒精乾洗手液分裝效期與細菌殺菌效果探討

Investigation of Effective Duration and Antimicrobial Efficacy of Alcohol-based Hand-Rub Solution Aliquots

洗手是預防感染最有效最簡單的方法之一。台灣疾病管制局在國內已經成功推動洗手風潮並呼應WHO 2009年洗手指引，從系統上改變廣設酒精性乾洗手液，而分裝的乾洗手液該多久丟棄也成為醫院在追求成本控制下值得探究的問題。本研究將75%酒精分裝至欲盛裝使用之500 ml乾洗手液瓶器中，並於分裝後2週、4週、6週、8週、10週及12週，分別測試酒精濃度及酒精與Staphylococcus aureus、Vancomycin-resistant Enterococcus spp.、Acinetobacter baumannii、extensively drug-resistant Acinetobacter baumannii、Pseudomonas aeruginosa、Escherichia coli及Candida albicans接觸20秒至60秒後的殺菌效力測試。研究結果發現，即便是分裝12週後，酒精仍維持在有效殺菌的濃度，並可以短至20秒的時間內殺死測試菌種，同時也未發現該酒精溶液或分裝過程中有被其他細菌汙染。所以建議可參酌本實驗結果，將符合衛署許可認證之酒精乾洗手液分裝後的更換時間修改為一至三個月，如此一來可降低頻繁更換及清洗的人力負擔和酒精購買成本。

Hand hygiene is one of the most effective and simple methods for preventing healthcare-associated infections. The Taiwan Center for Disease Control successfully completed a hand hygiene program, domestically, in conformance with WHO 2009 Guidelines on Hand Hygiene in Healthcare and systematically promoted the installation of alcohol-based hand-rub solutions in healthcare facilities. However, the issues regarding the disposal of aliquots of a hand-rub solution and its effective shelf life in order to manage operational costs still remain. A commercial 75% ethanol solution was divided and filled in several 500 ml hand-rub solution containers. Then, at durations of 2, 4, 6, 8, 10, and 12 weeks, the ethanol solution was collected and examined for ethanol concentration, and antimicrobial efficacy studies with Staphylococcus aureus, vancomycin-resistant Enterococci, Acinetobacter baumannii, extensively drug-resistant Acinetobacter baumannii, Pseudomonas aeruginosa, Escherichia coli, and Candida albicans, for 20 to 60 seconds, were performed. Our results demonstrated that even after using for 12 weeks, the ethanol concentration of an aliquot of the hand-rub solution was within the range required for an effective bactericide, and it could kill tested strains within as less as 20 seconds of exposure. In addition, we did not find any spore contamination that may have occurred during the manufacturing or aliquoting processes. Therefore, we suggest that hospitals could purchase hand-rub products from reputable PIC/S GMP manufacturers. Further, based on the environmental conditions and our results, we conclude that the retention period of hand rubs varies from 1 month to 3 months. Our results help in effectively decreasing the cost of purchasing hand rubs, prevent waste, and reduce workload of cleaning reused bottles.