ICUに勤務する看護師の気管吸引処置における感染予防行動に関する実態調査
本研究では，人工呼吸器を装着した患者が多く入室し，医療関連感染のリスクが高いICUにおける気管吸引処置に関する看護師の感染予防行動の特徴を明確にして，必要とされる教育の示唆を得ることを目的とする．ICUの看護師42名を対象として126回の気管吸引処置の行動観察と患者11人の周囲環境の細菌学的調査，質問紙による認識と自己申告による態度の調査を行った． 観察調査では，手袋の適正な使用割合は高いが，手指衛生の適正な実施割合は低かった．手指衛生は吸引処置前より処置後に実施率が高い傾向がみられた．そして，一連の行動として吸引処置開始から終了までの手指衛生の実施と手袋の扱いが適正に実施できたのは15.9...
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| Published in | 日本看護技術学会誌 Vol. 13; no. 1; pp. 56 - 65 |
|---|---|
| Main Authors | , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本看護技術学会
2014
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1349-5429 2423-8511 |
| DOI | 10.18892/jsnas.13.1_56 |
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| Abstract | 本研究では，人工呼吸器を装着した患者が多く入室し，医療関連感染のリスクが高いICUにおける気管吸引処置に関する看護師の感染予防行動の特徴を明確にして，必要とされる教育の示唆を得ることを目的とする．ICUの看護師42名を対象として126回の気管吸引処置の行動観察と患者11人の周囲環境の細菌学的調査，質問紙による認識と自己申告による態度の調査を行った． 観察調査では，手袋の適正な使用割合は高いが，手指衛生の適正な実施割合は低かった．手指衛生は吸引処置前より処置後に実施率が高い傾向がみられた．そして，一連の行動として吸引処置開始から終了までの手指衛生の実施と手袋の扱いが適正に実施できたのは15.9％であった．すべての項目の実施によって感染予防が可能となるため，一連の行動として実施できる技術を修得する必要がある． また，看護師は汚染を予測してもその部位を清掃するにはいたっていなかった．認識している事象に対して，看護師自身ができることについてのフィードバックや自身の行動を振り返ることができる教育支援が必要である示唆を得た． |
|---|---|
| AbstractList | 本研究では，人工呼吸器を装着した患者が多く入室し，医療関連感染のリスクが高いICUにおける気管吸引処置に関する看護師の感染予防行動の特徴を明確にして，必要とされる教育の示唆を得ることを目的とする．ICUの看護師42名を対象として126回の気管吸引処置の行動観察と患者11人の周囲環境の細菌学的調査，質問紙による認識と自己申告による態度の調査を行った． 観察調査では，手袋の適正な使用割合は高いが，手指衛生の適正な実施割合は低かった．手指衛生は吸引処置前より処置後に実施率が高い傾向がみられた．そして，一連の行動として吸引処置開始から終了までの手指衛生の実施と手袋の扱いが適正に実施できたのは15.9％であった．すべての項目の実施によって感染予防が可能となるため，一連の行動として実施できる技術を修得する必要がある． また，看護師は汚染を予測してもその部位を清掃するにはいたっていなかった．認識している事象に対して，看護師自身ができることについてのフィードバックや自身の行動を振り返ることができる教育支援が必要である示唆を得た． |
| Author | 神谷, 和人 渡邉, 順子 藤井, 徹也 東野, 督子 |
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| Copyright | 2014 日本看護技術学会 |
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| References | Erasmus, V., Daha, T. J., Brug, H. et al. (2010) : Systematic review of studies on compliance with hand hygiene guidelines in hospital care, Infection Control and Hospital Epidemiology, 31 (3), 283-294. Terpenning, M.S., Taylor, G.W., Lopatin, D.E. et al. (2001) : Aspiration pneumonia : Dental and oral risk factors in an older veteran population, Journal of the American Geriatrics Society, 49 (5), 557-563. Pittet, D., Hugonnet, S., Harbarth, S. et al. (2000) : Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Lancet, 356, 1307-1312. CDC (2007) : Guideline for isolation precautions : Preventing transmission of infectious agents in healthcare settings, http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/Isolation2007.pdf (2014.1.10) Novoa, A.M., Pi-Sunyer, T., Sala, M. et al. (2007) : Evaluation of hand hygiene adherence in a tertiary hospital, American Journal of Infection Control, 35 (10), 676-683. Takahashi, Y., Takeshita, A., Endo, M. et al. (2002) : Bacterial contamination on hands after various nursing procedures, Biocontrol Science, 7 (3), 163-171. Sexton, T., Clarke, P., O’Neill, E. et al. (2006) : Environmental reservoirs of methicillin-resistant staphylococcus aureus in isolation rooms : Correlation with patient isolates and implications for hospital hygiene, The Journal of Hospital Infection, 62, 187-194. Department of Health (NHS) (2007) : Saving Lives : reducing infection, delivering clean and safe care, High impact intervention No.5, London. Boyce, J. M., Potter-Bynoe, G., Chenevert, C. et al. (1997) : Environmental contamination due to methicillin-resistant staphylococcus aureus : Possible infection control implications, Infection Control and Hospital Epidemiology, 18 (9), 622-627. Ishikawa, A., Yoneyama, T., Hirata, K. et al. (2008) : Professional oral health care reduces the number of oropharyngeal bacteria, Journal of Dental Research, 87 (6), 594-598. 小林寛伊，黒須一見 (2011) : 2009年度のmethicillin-resistant staphylococcus aureus 病院感染症サーベイランス，環境感染誌，26 (2), 117-118. Bhalla, A., Pultz, N.J., Gries, D.M. et al. (2004) : Acquisition of nosocomial pathogens on hands after contact with environmental surfaces near hospitalized patients, Infection Control and Hospital Epidemiology, 25 (2), 164-167. Jenner, E.A., Fletcher, B.C., Watson, P., et al. (2006) : Discrepancy between self-reported and observed hand hygiene behaviour in healthcare professionals, The Journal of Hospital Infection, 63 (4), 418-422. Ehrenkranz, N.J., Alfonso, B.C. (1991) : Failure of bland soap handwash to prevent hand transfer of patient bacteria to urethral catheters, Infection Control and Hospital Epidemiology, 12 (11), 654-662. Zack, J.E., Garrison, T., Trovillion, E. et al. (2002) : Effect of an education program aimed at reducing the occurrence of ventilator-associated pneumonia, Critical Care Medicine, 30 (11), 2407-2412. Eveillard, M., Hitoto, H., Raymond, F. et al. (2009) : Measurement and interpretation of hand hygiene compliance rates : Importance of monitoring entire care episodes, The Journal of Hospital Infection, 72, 211-217. Gould, D., Chamberlain, A. (1997) : The use of a ward-based educational package to enhance nurses’ compliance with infection control procedures, Journal Clinical Nursing, 6, 55-67. Benner, P. (2001) ; 井部俊子，他訳 (2005) : ベナー看護論新訳版 初心者から達人へ (初版)，医学書院，東京 大須賀ゆか (2005) : 看護師の手洗い行動に関係する因子の検討，日看科会誌，25 (1), 3-12. Huang, J., Jiang, D., Wang, X. et al. (2002) : Changing knowledge, behavior, and practice related to universal precautions among hospital nurses in china, Journal of Continuing Education in Nursing, 33 (5), 217-224. Moongtui, W., Gauthier, D.K., Turner, J. G. (2000) : Using peer feedback to improve handwashing and glove usage among thai health care workers, American Journal of Infection Control, 28 (5), 365-369. Hayden, M.K., Blom, D.W., Lyle, E.A. et al. (2008) : Risk of hand or glove contamination after contact with patients colonized with vancomycin-resistant enterococcus or the colonized patients’ environment, Infection Control and Hospital Epidemiology, 29 (2), 149-154. Pittet, D., Allegranzi, B., Boyce, J. et al. (2009) : The world health organization guidelines on hand hygiene in health care and their consensus recommendations, Infection Control and Hospital Epidemiology, 30 (7), 611-622. 厚生労働省 (2012) : ICU 部 門 2012 年 報，http://www.nih-janis.jp/ (2013.09.20) Kuzu, N.,Özer, F., Aydemir, S. et al. (2005) : Compliance with hand hygiene and glove use in a university-affiliated hospital, Infection Control and Hospital Epidemiology, 26 (3), 312-315. Vincent, J.L., Rello, J., Marshall, J. et al. (2009) : International study of the prevalence and outcomes of infection in intensive care units, JAMA, 302 (21), 2323-2329. Chang, S., Sethi, A. K., Stiefel, U. et al. (2010) : Occurrence of skin and environmental contamination with methicillin-resistant staphylococcus aureus before results of polymerase chain reaction at hospital admission become available, Infection Control and Hospital Epidemiology, 31 (6), 607-612. |
| References_xml | – reference: Sexton, T., Clarke, P., O’Neill, E. et al. (2006) : Environmental reservoirs of methicillin-resistant staphylococcus aureus in isolation rooms : Correlation with patient isolates and implications for hospital hygiene, The Journal of Hospital Infection, 62, 187-194. – reference: Ehrenkranz, N.J., Alfonso, B.C. (1991) : Failure of bland soap handwash to prevent hand transfer of patient bacteria to urethral catheters, Infection Control and Hospital Epidemiology, 12 (11), 654-662. – reference: Hayden, M.K., Blom, D.W., Lyle, E.A. et al. (2008) : Risk of hand or glove contamination after contact with patients colonized with vancomycin-resistant enterococcus or the colonized patients’ environment, Infection Control and Hospital Epidemiology, 29 (2), 149-154. – reference: CDC (2007) : Guideline for isolation precautions : Preventing transmission of infectious agents in healthcare settings, http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/Isolation2007.pdf (2014.1.10) – reference: Zack, J.E., Garrison, T., Trovillion, E. et al. (2002) : Effect of an education program aimed at reducing the occurrence of ventilator-associated pneumonia, Critical Care Medicine, 30 (11), 2407-2412. – reference: Vincent, J.L., Rello, J., Marshall, J. et al. (2009) : International study of the prevalence and outcomes of infection in intensive care units, JAMA, 302 (21), 2323-2329. – reference: Eveillard, M., Hitoto, H., Raymond, F. et al. (2009) : Measurement and interpretation of hand hygiene compliance rates : Importance of monitoring entire care episodes, The Journal of Hospital Infection, 72, 211-217. – reference: Pittet, D., Allegranzi, B., Boyce, J. et al. (2009) : The world health organization guidelines on hand hygiene in health care and their consensus recommendations, Infection Control and Hospital Epidemiology, 30 (7), 611-622. – reference: 大須賀ゆか (2005) : 看護師の手洗い行動に関係する因子の検討，日看科会誌，25 (1), 3-12. – reference: Novoa, A.M., Pi-Sunyer, T., Sala, M. et al. (2007) : Evaluation of hand hygiene adherence in a tertiary hospital, American Journal of Infection Control, 35 (10), 676-683. – reference: Moongtui, W., Gauthier, D.K., Turner, J. G. (2000) : Using peer feedback to improve handwashing and glove usage among thai health care workers, American Journal of Infection Control, 28 (5), 365-369. – reference: Gould, D., Chamberlain, A. (1997) : The use of a ward-based educational package to enhance nurses’ compliance with infection control procedures, Journal Clinical Nursing, 6, 55-67. – reference: 小林寛伊，黒須一見 (2011) : 2009年度のmethicillin-resistant staphylococcus aureus 病院感染症サーベイランス，環境感染誌，26 (2), 117-118. – reference: Department of Health (NHS) (2007) : Saving Lives : reducing infection, delivering clean and safe care, High impact intervention No.5, London. – reference: 厚生労働省 (2012) : ICU 部 門 2012 年 報，http://www.nih-janis.jp/ (2013.09.20) – reference: Bhalla, A., Pultz, N.J., Gries, D.M. et al. (2004) : Acquisition of nosocomial pathogens on hands after contact with environmental surfaces near hospitalized patients, Infection Control and Hospital Epidemiology, 25 (2), 164-167. – reference: Boyce, J. M., Potter-Bynoe, G., Chenevert, C. et al. (1997) : Environmental contamination due to methicillin-resistant staphylococcus aureus : Possible infection control implications, Infection Control and Hospital Epidemiology, 18 (9), 622-627. – reference: Chang, S., Sethi, A. K., Stiefel, U. et al. (2010) : Occurrence of skin and environmental contamination with methicillin-resistant staphylococcus aureus before results of polymerase chain reaction at hospital admission become available, Infection Control and Hospital Epidemiology, 31 (6), 607-612. – reference: Pittet, D., Hugonnet, S., Harbarth, S. et al. (2000) : Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Lancet, 356, 1307-1312. – reference: Benner, P. (2001) ; 井部俊子，他訳 (2005) : ベナー看護論新訳版 初心者から達人へ (初版)，医学書院，東京． – reference: Jenner, E.A., Fletcher, B.C., Watson, P., et al. (2006) : Discrepancy between self-reported and observed hand hygiene behaviour in healthcare professionals, The Journal of Hospital Infection, 63 (4), 418-422. – reference: Kuzu, N.,Özer, F., Aydemir, S. et al. (2005) : Compliance with hand hygiene and glove use in a university-affiliated hospital, Infection Control and Hospital Epidemiology, 26 (3), 312-315. – reference: Erasmus, V., Daha, T. J., Brug, H. et al. (2010) : Systematic review of studies on compliance with hand hygiene guidelines in hospital care, Infection Control and Hospital Epidemiology, 31 (3), 283-294. – reference: Huang, J., Jiang, D., Wang, X. et al. (2002) : Changing knowledge, behavior, and practice related to universal precautions among hospital nurses in china, Journal of Continuing Education in Nursing, 33 (5), 217-224. – reference: Takahashi, Y., Takeshita, A., Endo, M. et al. (2002) : Bacterial contamination on hands after various nursing procedures, Biocontrol Science, 7 (3), 163-171. – reference: Terpenning, M.S., Taylor, G.W., Lopatin, D.E. et al. (2001) : Aspiration pneumonia : Dental and oral risk factors in an older veteran population, Journal of the American Geriatrics Society, 49 (5), 557-563. – reference: Ishikawa, A., Yoneyama, T., Hirata, K. et al. (2008) : Professional oral health care reduces the number of oropharyngeal bacteria, Journal of Dental Research, 87 (6), 594-598. |
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| Title | ICUに勤務する看護師の気管吸引処置における感染予防行動に関する実態調査 |
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