用什么样的证据可以说明脱手套后也需要洗手？

缭绕

这个问题是不是很幼稚？
今天在血透室巡视，看见护士在不同病人间换手套，但未使用手消，我与其沟通，她表示她作第一个操作起的手就是干净的，反正也没有被污染过，就没有洗手。我看到她手上满是滑石粉，只得牵强地说，长时间戴着手套，手上还是要滋生细菌。可是，我拿不出更有力的证据来！
谁有？

阳光

就穿手套前，脱手套后进行采样吧。

依依

记得在07年深圳会议有一位老师讲课，他们做过试验，试验人员戴上一次性手套后，在其外面涂抹红色颜料，然后摘去手套，结果手上布满了红色印记。不知此种方法是否有说服力。

阳光

个方法真好哎！简单易行，回头一定试试。就是不知道使用啥样的颜料，墨水行不？

绿茵场

套并不是完全闭而不漏的，依依 老师所说，我也有此印象。下次找到这方面的资料可以分享下！:handshake

依依

时是厂家老师讲得课，时间比较紧，可惜没有留下照片。

樵夫

HO的手卫生指南上面有提到摘手套后要手卫生的参考文献：
1.Pessoa-Silva CL  et  al. Dynamics  of  bacterial  hand  contamination  during  routine  neonatal care. Infection Control and Hospital Epidemiology, 2004, 25:192-197.
OBJECTIVE: To evaluate the dynamics of bacterial contamination ofhealthcare workers' (HCWs) hands during neonatal care. SETTING: The20-bed neonatal unit of a large acute care teaching hospital in Geneva,Switzerland. METHODS: Structured observation sessions were conducted. Asequence of care began when the HCW performed hand hygiene and endedwhen the activity changed or hand hygiene was performed again.Alcohol-based handrub was the standard procedure for hand hygiene. Animprint of the five fingertips of the dominant hand was obtained beforeand after hand hygiene and at the end of a sequence of care. Regressionmethods were used to model the final bacterial count according to thetype and duration of care and the use of gloves. RESULTS: One hundredforty-nine sequences of care were observed. Commensal skin floracomprised 72.4% of all culture-positive specimens (n = 360). Othermicroorganisms identified were Enterobacteriaceae (n = 55, 13.8%);Staphylococcus aureus (n = 10, 2.5%); and fungi (n = 7, 1.8%). Skincontact, respiratory care, and diaper change were independentlyassociated with an increased bacterial count; the use of gloves did notfully protect HCWs' hands from bacterial contamination. CONCLUSIONS:These data confirm that hands become progressively contaminated withcommensal flora and potential pathogens during neonatal care, andidentify activities at higher risk for hand contamination. They alsoreinforce the need for hand hygiene after a sequence of care, beforestarting a different task, and after glove removal.



Dynamics of bacterial hand contamination during routine neonatal care.pdf (88.38 KB, 下载次数: 16)

2009-12-24 18:03 上传

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樵夫

.Tenorio AR et al. Effectiveness of gloves in the prevention of hand carriage of vancomycin-resistant enterococcus species by health care workers after patient care. Clinical  Infectious Diseases, 2001, 32:826-829



Resistant Enterococcus Species by Health Care Workers after Patient Care.pdf (88.38 KB, 下载次数: 20)

2009-12-24 18:10 上传

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樵夫

.
Department of Internal Medicine, University of Geneva Hospitals, Switzerland.
BACKGROUND:Intravascular devices are a leading cause of nosocomial infection.Specific prevention strategies and improved guidelines for the use ofintravascular devices can decrease the rate of infection; however, theimpact of a combination of these strategies on rates of vascular-accessinfection in intensive-care units (ICUs) is not known. We implemented amultiple-approach prevention programme to decrease the occurrence ofvascular-access infection in an 18-bed medical ICU at a tertiarycentre. METHODS: 3154 critically ill patients, admitted betweenOctober, 1995, and November, 1997, were included in a cohort study withlongitudinal assessment of an overall catheter-care policy targeted atthe reduction of vascular-access infections and based on an educationalcampaign for vascular-access insertion and on device use and care.Incidence of ICU-acquired infections was measured by means of on-sitesurveillance. FINDINGS: 613 infections occurred in 353 patients (19.4infections per 100 admissions). The incidence density of exit-sitecatheter infection was 9.2 episodes per 1000 patient-days before theintervention, and 3.3 episodes per 1000 patient-days afterwards(relative risk 0.36 [95% CI 0.20-0.63]). Corresponding rates forbloodstream infection were 11.3 and 3.8 episodes per 1000 patient-days,respectively (0.33 [0.20-0.56]) due to decreased rates of bothmicrobiologically documented infections and clinical sepsis. Rates ofrespiratory and urinary-tract infections remained unchanged, whereasthose of skin or mucous-membrane infections decreased from 11.4 to 7.0episodes per 1000 patient-days (0.62 [0.41-0.93]). Overall, theincidence of nosocomial infections decreased from 52.4 to 34.0 episodesper 1000 patient-days (0.65 [0.54-0.78]). INTERPRETATION: Amultiple-approach prevention strategy, targeted at the insertion andmaintenance of vascular access, can decrease rates of vascular-accessinfections and can have a substantial impact on the overall incidenceof ICU-acquired infections.

潮水

2# 阳光
使用手套前后做个比较应该很有说服力！

莱素芳消毒

手套渗透（或破损），可以解释这个问题

婉若秋水

记得一次听课时，专家讲到戴手套后对手部的保护意识放松，手部受污染的机会加大，手套有微小破孔不易察觉，还讲到戴手套后手部依然有20％的受污染机会。
所以摘手套后仍要洗手。

拙凌

我曾经进行过监测，一个脱手套后没有洗手，另一个是洗手后的，前者的培养结果比较触目惊心。因为这个监测只是做个比对不做具体报告，所以直接将手掌印在平板上，也不需要按操作规范采样，这样培养出来的结果比较直观。

绿茵场

我曾经进行过监测，一个脱手套后没有洗手，另一个是洗手后的，前者的培养结果比较触目惊心。因为这个监测只是做个比对不做具体报告，所以直接将手掌印在平板上，也不需要按操作规范采样，这样培养出来的结果比较直观 ...
拙凌 发表于 2009-12-28 11:04

                               
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不知道 脱手套后未洗手 培养出来的是 皮肤暂居菌 还是 “外来菌”？

拙凌

暂居菌和外来菌应该是同一个概念吧？脱手套后未洗手培养出来的更可能是常居菌吧？

课主任

如果是手部固有菌群（常居菌）那应该没有问题，但是上面的文章是说有大肠杆菌，这就有问题了，说明手套不能百分百保护了