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研究生:方瑱珮
研究生(外文):Tien-Pei Fang
論文名稱:小量噴霧器不同清潔方法的效能評估
論文名稱(外文):Efficiency Evaluation of Different Cleaning Methods for Small-volume Nebulizers
指導教授:洪慶宜洪慶宜引用關係
指導教授(外文):C.Y. Horng
學位類別:碩士
校院名稱:長榮大學
系所名稱:職業安全與衛生研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2007
畢業學年度:95
語文別:中文
論文頁數:85
中文關鍵詞:感染控制病人安全消毒清潔效能小量噴霧器
外文關鍵詞:infection controlpatient safetydisinfectionscleaning efficiencysmall-volume nebulizer
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本研究目的為探討不同清潔液及不同清潔程序對降低小量噴霧器細菌濃度的清潔效能。以高濃度 Escherichia coli 測試菌株污染小量噴霧器,模擬醫療使用後之微生物殘留,分別測試三種不同清潔液 (75% 酒精、3% 過氧化氫、無菌蒸餾水)、五種不同清潔程序 (機械式清洗 10 秒鐘或浸泡 5 分鐘、10 分鐘、20 分鐘或 30 分鐘) 之清潔效果。以清潔前後水樣培養 12 小時之混濁度為指標,比較小量噴霧器表面微生物濃度的變化,評估其清潔效能。
研究結果顯示,75% 酒精和 3% 過氧化氫殺菌效能無顯著差異 (p = 0.534),但兩者皆顯著比無菌蒸餾水有較高的殺菌效能 (p < 0.05);75% 酒精和 3% 過氧化氫在不同清潔程序下的清潔效能無顯著差異,但無菌蒸餾水在不同清潔程序間則有不同。
為保護加護中心內重症或免疫機能不良患者,避免小量噴霧器受到病原體污染,降低肺炎的危險性;又考量臨床使用之便利性和安全性,可於單一病人使用期間採用 75% 酒精或 3% 過氧化氫,執行 10 秒鐘機械式清洗或 5 分鐘浸泡方法,以降低發生設備污染的可能性。
The purpose of this study was to evaluate the cleaning efficiency of three common cleaning agents (75% alcohol, 3% hydrogen peroxide, sterile distilled water) with various cleaning procedures (10-second mechanical cleaning or 5-, 10-, 20-, or 30-minute immersion) on small-volume nebulizers which were contaminated with high concentration of Escherichia coli By using spectrophotometry, we compared the percent reduction of microbes before and after cleaning to compare the cleaning efficiency of different methods.
The results did not indicate significant difference between 75% alcohol and 3% hydrogen peroxide in cleaning efficiency (p = 0.534); however, both agents were significantly better than sterile distilled water for microbial control (p < 0.05 in both comparisons). There was insignificant difference among cleaning procedures for 75% alcohol and 3% hydrogen peroxide. Sterile distilled water, however, showed a significant deviation of cleaning efficiency among different procedures.
For critically ill patients in the intensive care unit and immucompromised patients, contaminations by microganisms must be avoided in order to prevent the pneumonia risk. Considering both convenience and safety, 75% alcohol or 3% hydrogen peroxide, either 10-second mechanical cleaning or 5-minute immersion, should be applied for disinfections during the treatment intervals in order to reduce the chance of small-volume nebulizer contamination.
目錄
誌謝 ii
中文摘要 iii
Abstract iv
目錄 v
圖目錄 viii
表目錄 ix
第一章、前言 1
1.1 研究背景與動機 1
1.2 研究目的 3
1.3 研究流程 3
第二章、文獻探討 4
2.1 小量噴霧器的臨床運用 4
2.2 細菌簡介 6
2.2.1 細菌的構造生理簡介 7
2.2.2 大腸桿菌 (Escherichia coli, E. coli) 介紹 10
2.3 小量噴霧器可能的污染 11
2.3.1 受污染的設備或醫材 12
2.3.2 藥水 12
2.3.3 清潔程序 13
2.3.4 環境 14
2.3.5 病人的分泌物 14
2.4 小量噴霧器的污染病原體 15
2.5 呼吸治療裝置採檢 15
2.5.1 拭子浸潤法 16
2.5.2 管道浸潤法 16
2.5.3 其他採檢方法 18
2.6 噴霧器的污染造成肺炎相關性探討 18
2.6.1 感染的要素 19
2.6.2 微生物與宿主的關係 22
2.6.3 噴霧器的污染和肺炎 23
2.7 醫療物品之清潔消毒 26
2.7.1 降低微生物數目的方法 29
2.7.2 降低微生物數目的作用機轉 29
2.7.3 影響清潔消毒作用的因素 32
2.7.4 測試清潔液介紹 37
2.7.5 小量噴霧器清潔消毒 39
2.8 清潔效能評估 42
2.8.1 清潔效能評估 43
2.8.2 混濁度 (turbidity) 計數簡介 44
第三章、研究方法 48
3.1 研究設計 48
3.1.1 研究假設 48
3.1.2 實驗設計 48
3.2 研究架構 49
3.3 實驗材料 51
3.3.1 藥品試劑 51
3.3.2 實驗儀器設備 51
3.4 實驗步驟 52
3.4.1 前驅試驗 52
3.4.2 測試菌株分離與培養 53
3.4.3 生長曲線測量 54
3.4.4 調整菌液濃度 54
3.5 資料分析 56
第四章、結果 57
4.1 Escherichia coli DH5α 生長曲線 57
4.2 前驅測試結果 59
4.3 實驗室測試結果 60
第五章、討論 65
第六章、結論與建議 69
6.1 結論 69
6.2 研究限制與建議 70
參考文獻 72
圖目錄
圖 2-1 小量噴霧器於噴霧治療時的示意圖 5
圖 2-2 格蘭氏陽性菌和格蘭氏陰性菌細胞壁的比較 9
圖 2-3 肺炎致病機轉 26
圖 2-4 表面作用劑對細胞膜的作用機轉 30
圖 2-5 影響蛋白質功能的作用機轉 32
圖 2-6 主要影響消毒作用的因素 33
圖 2-7 不同微生物對清潔劑的敏感度分類排序 35
圖 2-8 比爾朗伯定律 (Beer Lambert’s Law) 45
圖 2-9 分光光度計 (Spectrophotometer) 光穿透圖 47
圖 3-1 本研究架構流程說明圖 49
圖 3-2 實驗步驟 52
圖 4-1 Escherichia coli DH5α 生長曲線圖 58
圖 4-2 測試菌液不同稀釋度與分光光度計的吸光值之關係 60
圖 4-3 三種不同清潔液間清潔效能 (% reduction) 平均數清潔效能評估 63
圖 4-4 小量噴霧器不同清潔液和不同清潔程序的清潔效能評估 63
表目錄
表 2-1 格蘭氏陽性菌和格蘭氏陰性菌細胞壁差異分析 9
表 2-2 小量噴霧器使用情形調查 17
表 2-3 居家消毒呼吸設備的有效方法 42
表 4-1 Escherichia coli DH5α 不同時間生長速率下的吸光值 58
表 4-2 測試菌液不同稀釋度的吸光值 59
表 4-3 不同清潔方法間清潔效能的檢定 61
表 4-4 清潔劑清潔效能 (% reduction) 平均數的估計 61
表 4-5 清潔程序清潔效能 (% reduction) 平均數的估計 61
表 4-6 清潔劑和清潔程序之清潔效能 (% reduction) 平均數估計 62
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