某醫學中心門診醫檢人員戴手套抽血執行酒精性乾洗手之評估

Evaluation of Hand Rubbing on Gloves in an Outpatient Phlebotomy Station in a Medical Center

2009年WHO手部衛生指引提及手套可重複使用幾次、何種類型可重複使用、不同病人間手套如何去汙，仍是未解決議題。台灣地區醫院門診每天需面臨病人周血檢驗，醫檢人員於時間緊迫下，確實於接觸不同病人穿脫手套及手部衛生有實際執行困難。因此本研究評估門診醫檢人員抽血戴乳膠檢診手套施行含酒精性洗手液執行手部衛生之效果及手套完整性。本研究設計實驗組（戴手套，不同病人間施行酒精性乾洗手）、對照組A（WHO標準，戴手套，不同人次間，更換手套後乾洗手再戴新手套）對照組B（戴手套，不同人次間，不洗手不更換手套），分別於抽血5位、10位、20位人次測量手套上細菌菌落數、脫除手套後雙手上細菌菌落數、常見致病菌（GNB、Staphylococcus aureus）及手套完整性。參與測試之醫檢人員有8位，每位均完成3組試驗且紀錄時間。結果實驗組及對照組A，B於手套上總菌落數2，605，1160 CFU，中位數0，44.5，114；脫除手套後雙手上菌落數則分別為105（1），29（0），且對照組B發現金黃色葡萄球菌（Staphylococcus aureus* 2 CFU）及抗甲氧西林金黃色葡萄球菌（MRSA* 6 CFU），抽血5人次後手套上菌落數，對照組B高於實驗組，據統計差異（p=0.034）。抽血5～20位人次後手套總菌落數比較，實驗組明顯低於對照組A，具統計差異（p＜0.001），但脫除手套後，雙手整體總菌落數，兩者無顯處差異（p=0.08）。手套完整於實驗組83.3%（45／54）低於對照組A 97.8%（391／400）（p＜0.001）。因此門診醫檢人員面對大量人次抽血時，以戴手套乾洗手方式與連續更換手套之行為比較，手套的菌落數可以有效移除，但手套完整率較低。

The reuse of gloves is currently a controversial issue and is not recommended in the 2009 WHO hand hygiene guidelines. Important questions such as how many times gloves can be reused and how to effectively decontaminate gloved hands between patients while maintaining patient safety and the protective function of the gloves remain unanswered. In Taiwan, laboratories in the outpatient clinic face an enormous patient load requiring phlebotomy. Adherence to hand hygiene in accordance with the World Health Organization (WHO) guidelines becomes unfeasible in practice due to the time constraint and heavy workload. The aim of this study was to evaluate glove integrity and the microbial efficacy of decontamination by alcohol hand rubbing on latex examination-gloved hands between patients. In the setting of performing phlebotomies in outpatient clinics, the experimental group wore gloves without change while using alcohol hand rubs between patients. Control group A followed the WHO guidelines, changing gloves and performing alcohol hand rubs between patients. Control group B neither changed gloves nor practiced hand hygiene between patients. After phlebotomies were performed in 5, 10, and 20 patients, the gloved and degloved hands were cultured for common pathogens (gram-negative bacteria and Staphylococcus aureus). Glove integrity was tested by filling the gloves with ink-stained water. Eight phlebotomy technicians participated in the study, each performing the protocol in the experimental and control A and B groups, timing each protocol. The median total bacterial colony count of gloved hands in the experimental and control A and B groups were 2, 605, and 1160 colony-forming units (CFU). The bacterial colony counts found for the degloved hands were the reverse of this. In control group B, S. aureus (2 CFU) and methicillin-resistant S. aureus (6 CFU) were cultured from degloved hands. In the experimental group, there was a significant increase in bacterial colony count on gloved hands after performing phlebotomy on 5 patients as compared to that of control group B (p = 0.03) and in the total bacterial colony count between the experimental group and control group A (p < 0.001). However, there was no significant difference in the bacterial counts on degloved hands in either group (p = 0.08). Glove integrity was lower in the experimental group (83.3%) than in control group A (97.8%) (p < 0.001). Decontamination by using alcohol hand rubs on gloved hands between patients effectively lowers bacterial counts, but at the cost of its protective efficacy, reducing glove integrity.