静脈穿刺前の滅菌手袋のルーチン化で血液培養のコンタミネーションが減少


f:id:MotoNesu:20110223233620p:image

 血培の疑陽性(本当は陰性なのに陽性と判断)は、不要な抗生剤の投与、医療費のコストとなる。ランダム化比較試験で、滅菌手袋をルーチンで使用すると血液培養のコンタミネーションを減少させたという報告。

Effect of Routine Sterile Gloving on Contamination Rates in Blood Culture

A Cluster Randomized Trial

Ann Intern Med. 2011;154:145-151. *全文が読めます


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Background: Blood culture contamination leads to inappropriate or unnecessary antibiotic use. However, practical guidelines are incon- sistent about the routine use of sterile gloving in collection of blood for culture.

Objective: To determine whether the routine use of sterile gloving before venipuncture reduces blood culture contamination rates.

Design: Cluster randomized, assessor-blinded, crossover trial (ClinicalTrials.gov registration number: NCT00973063).

Setting: Single-center trial involving medical wards and the inten- sive care unit.

Participants: 64 interns in charge of collection of blood for culture were randomly assigned to routine-to-optional or optional-to- routine sterile gloving groups for 1854 adult patients who needed blood cultures.

Intervention: During routine sterile gloving, the interns wore sterile gloves every time before venipuncture, but during optional sterile gloving, sterile gloves were worn only if needed.

Measurements: Isolates from single positive blood cultures were classified as likely contaminant, possible contaminant, or true pathogen. Contamination rates were compared by using general- ized mixed models.

Results: A total of 10 520 blood cultures were analyzed: 5265 from the routine sterile gloving period and 5255 from the optional sterile gloving period. When possible contaminants were included, the contamination rate was 0.6% in routine sterile gloving and 1.1% in optional sterile gloving (adjusted odds ratio, 0.57 [95% CI, 0.37 to 0.87]; P 􏰀 0.009). When only likely contaminants were included, the contamination rate was 0.5% in routine sterile gloving and 0.9% in optional sterile gloving (adjusted odds ratio, 0.51 [CI, 0.31 to 0.83]; P 􏰀 0.007).

Limitation: Blood cultures from the emergency department, surgi- cal wards, and pediatric wards were not assessed.

Conclusion: Routine sterile gloving before venipuncture may re- duce blood culture contamination.

Primary Funding Source: None.

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これから)短時間の発言しかできない会議で、何をいうのか?。連日連敗している。事前にテーマのラインがわかっていて、参加者の温度がキャッチできればいいのだが、次の行動を発言できる。しかし、重要と呼ばれる会議ほど、そうではない。つまり、テーマラインは瞬間で変わり、知らない参加者がいて、次の行動というには大きすぎる。そこを踏まえて、どうするか?、だ。

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