手術後病人使用小量噴霧器汙染之相關因素

Correlation Factors of Small-Volume Nebulizers on Postsurgical Contamination

10.6142/VGHN.201812_35(4).0009

諶欣瑜(Shin-Yu Chen)；陳瑛瑛(Yin-Yin Chen)

汙染 ； 小量噴霧器 ； 相關因素 ； contamination ； small-volume nebulizer ； correlation factor

榮總護理

35卷4期（2018 / 12 / 01）

409 - 418

繁體中文

手術後病人常使用噴霧治療來促進肺部擴張，但噴霧器可能因外源性途徑造成汙染，增加病人呼吸道菌種移生(colonization)或感染的風險，故落實噴霧治療之臨床照護對病人安全而言相當重要。本研究目的在探討導致噴霧器受細菌汙染相關因素，以減少病人因噴霧器汙染增加呼吸道菌種移生或感染之風險。採前瞻性追蹤觀察研究法，以2014年7月至2015年2月某醫學中心外科病房術後病人為對象，於病人接受噴霧治療前24小時內作口咽採檢和噴霧器使用後之檢驗，並實地訪查噴霧器清潔維護狀況，比較噴霧器汙染組與未汙染組之相關因素。共收案210位，74位(35.2%)曾發生噴霧器污染；影響噴霧器污染之顯著因素，經單變項分析有噴霧治療前口咽菌種移生和噴霧治療天數較長(7天)(p＜ .05)；再經多變項分析發現，每增加一天噴霧治療則噴霧器汙染風險增加14% (p= .004)。建議醫護人員應每日評估病人是否有噴霧治療之適應症，若無適應症時應儘早停止治療醫囑，減少噴霧治療天數，以杜絕噴霧器污染之風險。

Aerosol therapy is widely used to induce expectorant action in patients after surgery. However, small-volume nebulizers can be contaminated through the exogenous route, increasing the risk of respiratory tract colonization or infection. Aerosol therapy care must be implemented in the clinic. This study aimed to examine the correlation factors of nebulizers for contamination and to reduce the risk of respiratory tract colonization or infection. This prospective study was conducted in the surgical ward of a medical center. Patients who underwent aerosol therapy after surgery between July 2014 and February 2015 were included. Oropharyngeal cultures were taken within 24 hours before patients undertook aerosol treatment, and nebulizer cultures were taken after the patients had used the nebulizers. Data on patients' practices of cleaning and maintaining nebulizers were collected to investigate the correlation factors of nebulizers for contamination. In total, 210 subjects were enrolled, among whom 74 (35.2%) experienced nebulizer contamination. Univariable analysis identified oral colonization and patients who underwent longer periods (e.g., ＞7 days) of aerosol therapy as two statistically significant correlation factors (p ＜ .05). Multivariable analysis of correlation factors revealed that the number of days of aerosol therapy had a significant effect on nebulizer contamination. Each additional day of aerosol therapy increased the contamination rate of nebulizers by 14% (p = .004). We recommend that nurse educate patients before offering them aerosol therapy to improve daily posttherapy nebulizer cleaning compliance. In addition, doctors and nurses should evaluate patients daily, and if aerosol therapy is no longer appears necessary, discontinue it to reduce the days of aerosol therapy and contamination risks.

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