比較使用兩種皮膚消毒方式執行血液培養之效果

Comparing The Effectiveness of Two Skin Disinfection Methods while Collecting Blood Cultures

血液培養結果可提供菌血症治療依據，若遭汙染可能誤導醫師判斷，或需再次抽血確認，增加檢驗費、延誤治療，甚或延長住院天數。以台灣南部某醫學中心兩個內科病房，自2015年2月1日至9月30日所有需抽取血液培養病人為研究對象，其中1個病房為常規組，採1％ tincture iodine（TI）及75％ alcohol為皮膚消毒劑，另一病房為實驗組，採酒精性2％ chlorhexidine gluconate（CHG），比較兩組血液培養汙染率、汙染菌種差異性。由電腦系統擷取報告，感染專科醫師判讀是否受汙染，以SPSS 20.0版統計分析資料。結果顯示，兩組病人在年齡及性別上皆無顯著差異；血液培養汙染率常規組2.1％、實驗組1.6％；汙染菌種方面，常規組GPC佔66.7％，GPB 33.3％；實驗組GPC 65％、GPB 35％，兩組皆以coagulase negative staphylococci（CoNS）佔多數；兩組在汙染率及汙染菌種上無顯著差異。常規組消毒耗時1.5分鐘／套、耗材費0.24元／ml，實驗組耗時1分鐘／套、耗材費1.61元／ml，實驗組耗材成本雖較高，但在消毒步驟及人力成本上，相對精簡。結論：考量病人安全、檢體採檢汙染率及汙染菌種，兩種皮膚消毒方式並無顯著差異，建議臨床可視病人情況選擇消毒方式。此研究結果可運用於臨床人員皮膚消毒及採集血液培養之相關教育訓練。 Blood culture reports are critical for the treatment of bacteremia. Contaminated specimens may lead to misinterpretation of the culture results, increase the costs for tests, and prolong patients' length of stay in the hospital. The study was conducted in two medical wards in a tertiary teaching hospital in Southern Taiwan from February 1, 2015, to September 30, 2015. About 2% of chlorhexidine gluconate (CHG)-containing alcohol antiseptic was used for disinfection when collecting blood specimens for culture in the intervention ward, and 1% tincture iodine plus 75% alcohol antiseptics were used in the control ward. An infectious specialist blindly reviewed the results of all positive blood cultures in two wards and interpreted whether the results were considered as contamination or not. The contamination rate was compared between the two wards. No significant difference was observed between the patients' age and sex in the two wards. The blood culture contamination rates in the two wards were similar (1.6% in the intervention ward vs. 2.1% in the control ward). In the intervention ward, Gram-positive cocci account for 65% of contaminated bacteria and Grampositive bacilli(GPB), 35%. Gram-positive cocci account for 66.7% of contaminated specimens and GPB 33.3% in the control ward. It took 1 min and cost 1.61 NTD/ mL for each blood culture collected using the intervention method and took 1.5 min and cost 0.24 NTD/ml using the control method. The intervention method costs higher but required less time when performing disinfection. In conclusion, no significant difference was observed in the contamination rate, safety, and contaminated bacteria between CHG-containing alcohol group and 1% TI plus 75% alcohol group. Healthcare workers may choose either one for disinfection. The results of this study can be used to educate clinicians about skin disinfection.