臺灣博碩士論文加值系統

醫院是細菌密度極高的地方，醫院內常見細菌可透過直接或是間接接觸已被污染的物品、設備表面而造成院內感染。為了預防感染，醫院內使用化學消毒劑可以有效消毒環境表面並降低感染發生。但化學消毒劑有可能會刺激人體呼吸道黏膜及眼睛且化學消毒劑無法在環境表面維持長時間消毒效果。為了因應這些缺點，本研究以季銨鹽化合物(3-trihydroxysilyl propyl octadecyl dimethyl ammonium chloride)界面活性劑GoldshieldTM5作為研究對象，GS5藉由本身有機矽離子(organo silane)可攜帶正電荷產生共價鍵(covalent bonding)的特性，使得GS5附著之材質表面可以維持長效抗菌能力。
根據本研究結果顯示，醫院內常見衣織品(實驗衣、病人服、隔離衣) 利用GS5浸泡方式處理材質表面後，置入艙內濃度108CFU/m3的三株菌株(S. aureus、A. baumannii與E. faecalis)，衣物表面GS5可維持7天抗菌效果，在這期間內無任何菌落可以被偵測到。
接著模擬院內材質表面(不鏽鋼、玻璃、壓克力板)實驗，分別採用GS5浸泡及擦拭方式附著材料表面後，評估該表面置入艙內暴露不同細菌濃度(106、107CFU/m3) GS5的抗菌能力，並觀察GS5抗菌持久性。結果發現經GS5浸泡後的材質表面分別對於三株菌株可維持3天抗菌持久性；而GS5擦拭後的材質表面分別對於三株菌株可維持1天抗菌持久性。
利用GS5噴灑在外科口罩表面方式，讓口罩表面的GS5產生抗菌效果，表面GS5可維持7天抗菌效果，在這期間內無任何菌落可以被偵測到。
本研究將GS5實際應用在院內環境表面(不鏽鋼、玻璃、壓克力板)，結果顯示不同表面的GS5可維持8小時抗菌效果，GS5抗菌效果優於酒精等界面活性劑。

Hospitals are aggregation high bacterial density areas. The most common bacteria nosocomial infection The hospital is a place where very high bacterial density is concentrated.Common bacteria in hospitals can cause nosocomial infections through direct or indirect contact with contaminated objects and equipment surfaces.
Source of infection by air,droplets and contact with other infection ways to the patient. Hospital use of chemical disinfectants can effectively disinfect of environmental surfaces and reduce the infectious occurrence, but the use of these chemical disinfectants may irritate the human respiratory tract mucosa and eyes, and chemical disinfectants can not maintain long time in the disinfection of environmental surfaces.
To address these shortcomings, this study using quaternary ammonium compounds (3-trihydroxysilyl propyl octadecyl dimethyl ammonium chloride) surfactant GoldshieldTM5 as the object of study, GS5 carry positive charge with the material generated on the surface form of covalent bonding, surface can be maintained long-term surfactant.
In the experiment, hospital clothes (laboratory gown, patient gown, isolation gown) using GS5 attachment surface of the soaking.
Three strains (S. aureus, A. baumannii and E. faecalis) exposed to concentration of 108CFU/m3 maintained an antibacterial effect for 7 days, during which time no colonies could be detected.
The surface of material (stainless steel, glass, polymethyl methacrylate ) , the GS5 soaked and wiped in the surface to attached. In chamber, antibacterial ability of this surface to different bacteria concentrations (106、107CFU/m3) in the exposed capsule was evaluated,
The results the surface of GS5 soaked material maintained at least 3 days antibacterial persistence for the three strains, while the surface of GS5 scrubbed material maintained the antibacterial persistence for three strains at least 1 day.
The study also evaluated the antibacterial ability and persistence of the GS5 spray applied to the surgical mask surface. The results no colonies could be detected during the 7 days test period and the mask filtration effect was not affected by GS5.
Finally, hospital environmental surfaces including stainless steel, glass and polymethyl methacrylate. GS5 can maintain an antibacterial effect at least 8 hours and effect than other surfactants.

目錄
中文摘要...................................................................I
英文摘要.................................................................III
目錄.....................................................................III
表目錄.........................................................................................................................................VI
圖目錄........................................................................................................................................VII
第一章、前言................................................................................................................................1
一、研究背景與動機....................................................................................................................1
二、文獻探討................................................................................................................................2
1.1院內感染常見的細菌..............................................................................................................2
1.2院內感染在醫院傳染的途徑..................................................................................................3
1.3院內感染控制與常用化學消毒劑之介紹..............................................................................4
1.4界面活性劑性質......................................................................................................................6
1.5 GoldshieldTM5介紹與抗菌機制.............................................................................................7
1.6口罩表面抗菌與過濾效率之重要性......................................................................................8
1.6.1口罩表面去污.......................................................................................................................8
1.6.2口罩表面抗菌重要性...........................................................................................................8
1.6.3口罩表面過濾.......................................................................................................................9
三、研究目的................................................................................................................................9
四、研究架構..............................................................................................................................10
第二章、材料與方法..................................................................................................................11
2.1實驗材料................................................................................................................................11
2.1.1界面活性劑.........................................................................................................................11
2.1.2實驗菌種.............................................................................................................................11
2.1.3細菌培養基與培養液.........................................................................................................11
2.1.4實驗儀器.............................................................................................................................13
2.2測試艙實驗方法與步驟........................................................................................................14
2.2.1測試艙評估表面抗菌實驗.................................................................................................14
目錄
2.2.1.1表面抗菌前處理程序......................................................................................................14
2.2.1.2表面抗菌實驗參數..........................................................................................................14
2.2.1.3表面抗菌實驗步驟..........................................................................................................15
2.2.1.4評估方法..........................................................................................................................15
2.2.2測試艙評估口罩表面抗菌實驗.........................................................................................16
2.2.2.1口罩表面抗菌前處理程序..............................................................................................16
2.2.2.2口罩表面抗菌實驗參數..................................................................................................16
2.2.2.3口罩表面抗菌實驗步驟..................................................................................................17
2.2.2.4評估方法..........................................................................................................................17
2.2.3測試艙評估口罩表面抗菌與口罩過濾實驗.....................................................................17
2.2.3.1評估生物氣膠暴露艙中氣膠粒徑..................................................................................17
2.2.3.2口罩表面過濾前處理程序.............................................................................................17
2.2.3.3口罩過濾實驗參數..........................................................................................................18
2.2.3.4口罩過濾實驗步驟..........................................................................................................18
2.2.3.5評估方法..........................................................................................................................19
2.2.4紅血球溶血試驗.................................................................................................................20
2.2.4.1紅血球溶血實驗步驟......................................................................................................20
2.2.4.2評估方法..........................................................................................................................20
2.2.5實際環境應用GS5之測試................................................................................................21
2.2.5.1實際環境應用GS5之測試實驗步驟.............................................................................21
2.2.5.2評估方法..........................................................................................................................22
2.3統計分析................................................................................................................................22
2.3.1使用軟體.............................................................................................................................22
2.3.2統計方法.............................................................................................................................22
第三章、結果..............................................................................................................................24
3.1表面浸泡GS5之測試艙測試...............................................................................................24
3.1.1浸泡GS5後之衣織品對S.aureus抗菌測試....................................................................24
目錄
3.1.2浸泡GS5後之衣織品對A.baumannii抗菌測試.............................................................25
3.1.3浸泡GS5後之衣織品對E.faecalis抗菌測試..................................................................26
3.1.4浸泡GS5後之一般材質表面對S.aureus抗菌測試........................................................26
3.1.5浸泡GS5後之一般材質表面對A. baumannii抗菌測試................................................29
3.1.6浸泡GS5後之一般材質表面對E.faecalis抗菌測試......................................................31
3.2擦拭GS5後之一般材質測試艙測試...................................................................................33
3.2.1擦拭GS5後之一般材質表面對S. aureus抗菌測試.......................................................33
3.2.2擦拭GS5後之一般材質表面對A.baumannii抗菌測試.................................................35
3.2.3擦拭GS5後之一般材質表面對E.faecalis抗菌測試......................................................37
3.3噴霧罐噴灑GS5後之口罩表面抗菌測試...........................................................................39
3.4噴霧罐噴灑GS5後之口罩過濾效率測試...........................................................................41
3.4.1噴霧罐噴灑GS5後之口罩外層過濾效率........................................................................41
3.4.2噴霧罐噴灑GS5後之口罩中層過濾效率........................................................................42
3.4.3噴霧罐噴灑GS5後之口罩內層過濾效率........................................................................42
3.5噴霧罐噴灑GS5後之口罩抗菌測試...................................................................................43
3.5.1噴霧罐噴灑GS5後之口罩對於無處理之口罩抗菌測試................................................43
3.5.2噴霧罐噴灑GS5後之口罩對於噴灑無菌水之口罩抗菌測試........................................44
3.6紅血球溶血試驗....................................................................................................................44
3.7環境實際應用GS5之測試...................................................................................................45
第四章、討論..............................................................................................................................47
4.1材質表面浸泡GS5後對於三種菌株在測試艙中測試結果...............................................47
4.2材質表面經擦拭GS5後對於三種菌株在測試艙中測試結果...........................................47
4.3口罩表面抗菌及表面過濾效率............................................................................................48
4.4環境實際應用........................................................................................................................48
參考文獻......................................................................................................................................50

表目錄
表一、2004至2012年第三季醫學中心/區域醫院的加護病房院不分部位與部分常見之院內感
染菌株排名..........................................................................................................................................2
表二、各種消毒劑優、缺點之比較..................................................................................................6
表三、實驗儀器列表........................................................................................................................13
表四、浸泡GS5的衣織品經S.aureus測試....................................................................................25
表五、浸泡GS5的衣織品經A.baumannii測試.............................................................................26
表六、浸泡GS5的衣織品經E. faecalis測試.................................................................................27
表七、浸泡GS5的不鏽鋼、玻璃與壓克力板經S.aureus測試....................................................28
表八、浸泡GS5的不鏽鋼、玻璃與壓克力板經A.baumannii測試.............................................30
表九、浸泡GS5的不鏽鋼、玻璃與壓克力板經E.faecalis測試..................................................32
表十、擦拭GS5的不鏽鋼、玻璃與壓克力板經S.aureus測試....................................................34
表十一、擦拭GS5的不鏽鋼、玻璃與壓克力板經A. baumannii測試........................................36
表十二、擦拭GS5的不鏽鋼、玻璃與壓克力板經E.faecalis測試..............................................38
表十三、GS5噴灑在口罩分別經S.aureus、A.baumannii、E. faecalis測試...............................40
表十四、噴霧罐噴灑GS5、無菌水後之口罩外層過濾效率........................................................41
表十五、噴霧罐噴灑GS5、無菌水後之口罩中層過濾效率........................................................42
表十六、噴霧罐噴灑GS5、無菌水後之口罩內層過濾效率........................................................42
表十七、噴霧罐噴灑GS5後之口罩對於無處理之口罩抗菌效率...............................................43
表十八、噴霧罐噴灑GS5後之口罩對於噴灑無菌水後之口罩抗菌效率...................................44
表十九、ICU病房環境實際應用....................................................................................................46







圖目錄
圖一、GoldshieldTM5表面作用機制：(1)長碳鏈 (2)氮離子 (3)有機矽離子.....................................7
圖二、實驗架構圖...............................................................................................................................10
圖三、GS5噴在纖維布料進行擦拭處理方式...................................................................................14
圖四、口罩架設在口徑9 × 9cm2壓克力板裝置在測試艙中............................................................18
圖五、貼片培養基貼採集口罩表面細菌...........................................................................................19
圖六、Andersen sampler收集測試艙細菌氣膠濃度..........................................................................20
圖七、此步驟為實驗的前測，測試不鏽鋼表面，評估表面上細菌總數.......................................21
圖八、此步驟為實驗的前測，測試鏡檯表面，評估表面上細菌總數...........................................21
圖九、此步驟為實驗的前測，測試桌子表面，評估表面上細菌總數...........................................22

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