| ObjectiveFirst,we did an clinical observation to survey what kinds of skin disinfection procedures were clinically applied before ordinary hand-back infusion; second, we did clinical trials based on the results of clinical observation,to test the efficacy of clinically used hand-back skin disinfection procedures, so as to provide clinical nurses some evidence when choosing proper hand-back skin disinfection procedures.MethodsThe clinical observation: In a comprehensive grade A class 3 hospital, we randomly chose over 20 clinical wards, and then we chose 3 to 5 volunteered nurses, who were to do hand-back ordinary infusion for patients. We observed each nurse of their two cases of hand-back skin disinfection practices. There were 107 nurses observed and 214 cases in total. The observation indexes mainly included the swabbing time, the exposure time, the swabbing ways and the swabbing frequencies.The clinical trials: In a comprehensive grade A class 3 hospital, we randomly chose over 20 clinical wards,where we recruited a total of 391 hospitalized patients and their families as qualified participants for our clinical trials. There were four research factors, the swabbing ways, the swabbing frequencies,the sampling areas and the skin disinfectant exposure time. When the skin disinfectant time was 1 minute: there were 2 levels for swabbing ways, which were spiral direction swabbing and vertical direction swabbing; there were 3 levels for the swabbing frequencies, which were 1 swab cotton/time × 1 time, 1 swab cotton/time × 2 times, 2 swab cottons/time × 1 time. Different swabbing ways and frequencies formed 6 kinds of disinfection methods. Each kind of disinfection procedures had two kinds of sampling areas, which were 5cm×5cm and 3 cm × 3 cm. When the skin disinfectant exposure time was 20 seconds, the disinfection procedures applied was “1 swab cotton/time × 1 time, vertical direction swabbing”, and with an sampling area of 5 cm × 5 cm. Microbial samplings and cultures were operated in accordance with the requirements of the Technical Standards for Disinfection of Medical Institutions.ResultsAccording to our observation: when comes to clinical nurses’ hand-back skin disinfection,the swabbing time used was(7.8±5.4)s; the exposure time was(24.2±12.1)s;when comes to the swabbing ways, it was 85.5%(183/214)for spiral direction swabbing, and 14.5%(31/214)for vertical direction swabbing. The rate was 46.7%(100/214)of swabbing twice in a spiral direction, and waiting for naturally dry before venipuncture.According to our clinical trials: when the skin disinfectant exposure time was 1 minute and the sampling area was 5 cm × 5 cm: for the swabbing frequency of 1 swab cotton/time × 1 time, the eligible rates for the spiral and vertical direction swabbing were separately 96.23%( 51/53) and 98.11%(52/53),P=0.317; for the swabbing frequency of 1 swab cotton/time × 2 times, the eligible rates for the spiral and vertical direction swabbing were both 100%; for the swabbing frequency of 2 swab cottons/time × 1 time, the eligible rates for the spiral and vertical direction swabbing were separately 96.15%(50/52)and 100%(52/52),P=0.157. For the three kinds of swabbing frequencies, their eligible rates were separately 97.17%(103/106) for 1 swab cotton/time × 1 time,100%(104/104)for 1 swab cotton/time × 2 times, and 98.08%(102/104) for 2 swab cottons/time × 1 time, P=0.249.For the two kinds of sampling areas 3 cm × 3 cm and 5 cm × 5 cm, their sterilization rates were separately 55.39%(113/204)and 37.26%(117/314),P=0.000; their eligible rates were separately 99.51%(203/204)and 98.41%(309/314),P=0.252.When the skin disinfectants exposure time was 20 seconds, all samples’ average colony counts after disinfection was(1.41±2.8427) CFU/cm2; their total eligible rate was 94.55%(191/202); which might acquire a killing rate of over 90% when the average colony counts of all samples was over 14.1 CFU/cm2, according to the formula of killing rate. We compared the efficacy skin disinfectant exposure time of 1min and 20 s, P=0.008.conclusionsThe hand-back skin disinfection procedure clinically applied varied a lot from the existed operating standards.For Aierdian skin disinfectant, to be applied to human hand-back with an exposure time of 1 minute: the skin disinfection efficacy would not be affected by the swabbing ways and the swabbing frequencies. Sampling areas could affect the sterilization rates but not the eligible rates of hand-back skin disinfection. Smaller sampling area tended to result in better skin disinfection results; and the center of disinfection area might bear better disinfection results.The skin disinfectant exposure time did affect skin disinfection efficacy, and the results of 1 min preferred to that’s of 20 s. Also, the skin disinfection efficacy will meet the requirements of existed standards, when the skin disinfectant exposure time is 20 s. |
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