Evaluation of ADL and analysis of problems of patients under home oxygen therapy

在宅酸素療法（HOT）施行中の慢性呼吸不全患者8例を対象に，日常生活動作（ADL）と生活の質（QOL）を評価し，24時間経皮的酸素飽和度モニタリングにより，HOTの問題点を解析した。ADLは入浴，外出，階段で低下しており，HOTにより自宅療養が可能になったにもかかわらず，行動は制限されていた。QOLを向上させるためには，それぞれの患者の日常生活における問題点を考慮した治療とケアが必要であり，患者を支えるソーシャルサポートシステム作りも必要と思われた．We analyzed the activities of daily living （ADL) and the quality of life (QOL) of eight patients with chronic respiratory failure under home oxygen therapy （HOT)， and we also investigated the SpO2 of the patients using a pulse oximeter for 24 hours. The ADL was low at bathing, outing or going upstairs. Although patients became able to be treated at home by HOT, which limited the activities of patients in some occasion. To improve the QOL of patients, we should treat and care considering the individual problems of daily living, and a social support system is needed

Study of Nurses’ Performance of Preventing Hospital Infection

メチシリン耐性黄色ブドウ球菌（MRSA）感染あるいは保菌患者に対する院内感染防止対策を検討するために看護婦334名を対象に，9項目のケア前後の手洗い（頻度，方法，時間），手袋・マスク・ガウン着用の実践状況を調査した．ケア前に比べてケア後の手洗いの実施頻度は有意に高かった．看護者が菌を伝播する可能性もあり，ケア前の手洗いを徹底する必要性があると考える．手洗い方法は患者との接触度の高いケアでは消毒薬が，接触度が低いケアは速乾性擦式消毒薬による方法が多かった．ケア前後の手洗い時間は全てのケアにおいて半数以上の者が10～29秒であった．手袋は手指が汚染される機会が特に高いと思われるケアで着用は高かった．マスクについては痰，分泌物が飛沫するケア時の着用をより徹底する必要があると思われた．ガウンの着用率は高かった．Methicillin-resistance Staphylococcus aureus (MRSA) is one of the most common nosocomial pathogens. Handwashing is the most important means to prevent hospital infection. The purpose of this study is to investigate the performance of nurses in preventing contamination on care of MRSA-infected patients. We investigated the performance of handwashing, wearing gloves, mask and gown on nine items of nursing cares of MRSA-infected patients. The data were collected using the questionnaire made by the researchers. The subjects of this study were 334 nurses who work at Nagasaki University School of Medicine Hospital and Clinics. The degree of handwashing after care of the patients was significantly hihger than before care. Nurses should wash hands before care not to carry microbes to patients. Nurses washed, hands with antiseptic and running water at heavy contacts with the patients, on the other side, they washed hands with quick drying rub sterilizer at light contacts with the patients. The time of handwashing was 10～29 seconds before and after care in more than half of the subjects. The score of performance of wearing gloves was higher on nursing cares with heavy contact. It is necessary to wear mask on nursing cares of patients with droplets of sputa or secrtions. Nurses weared gown thoroughly on care of MRSA-infected patients

Surveillance of Methicillin-resistant Staphylococcus aureus in the University Hospital and the Community Hospital

大学病院および市中病院の内科病棟において細菌学的環境調査を行い，とくにメチシリン耐性黄色ブドウ球菌（MRSA）による汚染状況の両病院における差異とその要因について検討した．また，両病院のスタッフのシューズ底面のMRSA汚染状況の調査も行った．その結果，1．大学病院では，MRSA保菌者隔離病室からMRSAが検出されたが，一般病室からは検出されなかった．2．市中病院では，隔離病室だけでなく一般病室からもMRSAが検出された．3．両病院で，処置室・看護室からMRSAが検出された．4．スタッフのシューズ底面からは，大学病院では18.2％，市中病院では85.7％からMRSAが検出された．5．エタノール消毒後のシューズ底面からは，MRSAは検出されなかった．We examined Methicillin-resistant Staphylococcus aureus (MRSA) colonization of environment and medical staff\u27s shoes at two different hospitals, the university hospital and the community hospital in Nagasaki city. In the university hospital, MRSA was detected from isolation rooms, where MRSA carriers were admitted, and a nurse station. In the community hospital, MRSA was detected from both isolation rooms and ordinary rooms, and a nurse station. In Addition, the positive rate of MRSA of medical staff\u27s shoes were18.2％ in the university hospital And 85.7％ in the community hospital, respectively. These results indicate that the medical staff may transmit MRSA by their shoes, and asymptomatic MRSA carrier may exist in ordinary rooms. Therefore, regardless of the deletion of MRSA, it is necessary to practice the standard precautions for every patients and environment in hospital

Satisfaction of the nursing care for dying patients and their families in a palliative care unit-a questionnaire survey-

緩和ケア病棟に対する家族の満足度から今後の緩和ケアの在り方を検討する目的で，長崎市内の緩和ケア病棟において死亡退院患者の遺族を対象とし，郵送によるアンケート調査を行なった．　結果，患者への告知率は29％と低く，告知の有無により満足度に有意な差は認められなかった．入院時の選択理由は「身体的苦痛が軽減されると思ったから」が最も多く，71％が入院中の苦痛の緩和，スタッフの対応に満足とし，入院は最善であったと答えていた．家族へのケアは63％が十分であったと答え，提供されるケアや施設環境に満足感を多く得ていた．一方，スタッフとの人間関係の困難さ，夜間のケアが十分に受けられない，付き添い者にとっての設備の不足などが不満とされていた．The purpose of this study is to investigate how nursing care for cancer patients in the terminal stage of life. The subjects were bereaved families of the patients who admitted to a hospital-based palliative care unit in Nagasaki. Data were obtained from a questionnaire sent by mail. As a result, the care of informing the diagnosis to the patients was low (29％). There were no significant differences between the satisfaction of the informed and the not-informed. The major reason for the choice of the palliative care was relief from pain, and 71％ of the families were satisfied with pain management and nursing care, and hospitality of the palliative care unit. Concluding that their choice was the best. Sixty-three percent of the families answered that the care to the family was sufficient, and were satisfied with the care and conveniences for patients. On the otherhand, some of the families were not satisfied because of uncomfortable relationship with the medical staff, the insufficient nursing care at night, and the poor conveniences for families

Microbiological Investigation of Environment in the Radiology Ward

外来患者や入院患者など多くの患者が利用している長崎大学医学部附属病院の放射線部において，清潔区域である血管造影室とその他の放射線部検査室の細菌学的環境調査を実施した．特に，最近問題となっているメチシリン耐性黄色ブドウ球菌（MRSA）に注目して調査を行い，以下の結果が得られた．　1．清潔区域である血管造影室の床からは，2人の患者の検査後に準清潔区域と同程度の菌が検出されたが，検査台は検査後も清潔が保たれていた．　2．X線撮影室，CT室，トイレなど全検体の9.1％（5／55）から黄色ブドウ球菌が検出されたが，すべてメチシリン感受性黄色ブドウ球菌（MSSA）であり，MRSAは検出されなかった．We made a microbiological investigation of environment of the clean zone, angiography rooms, and the semi-clean zone, other radiology rooms, in Nagasaki University Hospital, which were used for radiological examinations of many outpatients and inpatients. Methicillin-resistant Staphylococcus aureus （MRSA）, an important pathogen of hospital infection, was focused in this study. The results obtained are as follows： 1．Almost the same level of contaminated bacteria was detected after the examination of two patients as one patients, however, the examination beds were maintained clean in angiography rooms. 2．Staphylococcus aureus was isolated from five of 55 samples (9.1％) in the radiology ward, however, all of which were methicillin-sensitive (MSSA)

Analysis of the incidences of sero positive students against rubella, measles, varicella, and mumpus

長崎大学医療技術短期大学部看護学科学生の風疹，麻疹，水痘，ムンプスに対する血清抗体保有状況を調査した．対象は，男性13人と女性216人の229人で，抗体の測定は，風疹，麻疹，ムンプスは赤血球凝集抑制試験（HI法）で，水痘は補体結合反応（CF法）で行った．抗体陽性率は，風疹93．7％，麻疹42．5％，水痘38．3％，ムンプス76．9％だった．各ウイルス抗体陽性率に男女間，学年間の有意差は認められなかった．ウイルス抗体陽性者の抗体価は，風疹では高かったが，麻疹，水痘，ムンプスでのは低かった．また，抗体保有状況は既往歴の有無には一致しなかった．従って，既往歴もなく，抗体陰性の学生に対し，ワクチン接種を勧奨した．We have examined the antibodies against rubella, measles, varicellaand mumpus in sera of nursing students of the School of Allied Medical Sciences, Nagasaki University. The number of them was 229, 13 male and 216 female. The antibodies were measured by hemagglutination inhibition test for rubella, measles and mumpus, or by a complement fixation reaction for varicella. The incidences of sero positive students against rubella, measles, varicella and mumpus were 93.7％, 42.5％, 38.3％ and 76.9％, respectively. There were no significant differences between male and female or among classes. The titers of rubella antibody were relatively high, but those of measles, varicella and mumpus were low. Some students who answered that they had suffered from the diseases did not have the antibodies. Thus, we have not the antibodies and have not suffered from the diseases should be vaccinated in order to prevent hospital infections

Analysis of the incidences of HBs antigen or antibodypositive students of School of Allied Medical Sciences in the past ten year

医療従事者だけでなく看護学生や他医療系学生も針刺し事故によるB型肝炎ウイルス感染の危険がある．私たちは，最近10年間（1990～1999）における長崎大学医療技術短期大学部学生のHBs抗原・抗体保有状況を調査した．　全体のHBs抗原・抗体保有率はそれぞれ0．70％と2．35％で，両者とも最近，減少傾向にあった．HBs抗原・抗体保有率は，看護学科，理学療法学科，作業療法学科間に有意差は無かったが，HBs抗体保有率は，専攻科助産学特別専攻において他学部より有意に高かった．HBウイルスによる感染事故を予防するため，本年度はHBs抗体陰性者に対してHBワクチン接種を施行した．Not only medical staffs but also nursing and other medicine-related students have risks of infection with HB virus by needlestick injuries. We have analyzed the positive rates of HBs antigens or HBs antibodies of all students of the School of Allied Medical Sciences, Nagasaki University, in the past ten years (1990-1999). It was revealed that overall positive rates of serum HBs antigen and HBs antibody were 0.70％ and 2.35％ , respectively, and both of which have been decreasing in recent years. There were no significant differences of the positive rates of HBs antigen and HBs antibody among the students of nursing, physical therapy and occupational therapy courses. However, HBs antibody positive rate of students of midwifery course was significantly higher than those of other three courses. In order to prevent infection with HB virus, the students negative for HBs antibody were vaccinated in 1999