| 特集名 | 透析室の環境整備 -- 院内感染を含めて | |
|---|---|---|
| 題名 | ［各論］血液透析スタッフの作業動線から考える透析室とは | |
| 発刊年月 | 2004年 07月 | |
| 著者 | 芝本 隆 | 東京医科歯科大学血液浄化療法部・臨床工学技士 |
| 著者 | 阿部 薫 | 清湘会菊川橋クリニック・臨床工学技士 |
| 【 要旨 】 | 透析室のスタッフ動線から感染対策を考慮した施設設備を解説する．血液透析療法の特殊性は，体外循環を用いる観血的医療行為を外来診療で行い，一般の診療所に比べ電気・上下水道の容量が多く，緊急時や災害時のバックアップ対策などである．また，使用済み医療材料の廃棄保管や医療器材の洗浄・消毒を目的とする設備が付帯する．動線は27床の透析クリニックを対象に調査した．看護師の7割，臨床工学技士の6割は臨床業務での作業場所はベッドサイドである．その間の移動場所としては手洗いとステーションが多い．ベッド間隔調査から一般透析室では80 cm以上の間隔が必要である．手洗いはスタッフの使いやすい位置で5床/1カ所，シンクは手洗い水がシンク外へ飛散しない形状とする．現状では，既存のテナントビルを透析施設とする場合が多く，感染対策やスタッフ動線を優先に設計することは難しい．感染対策を考えるとベッド間隔を十分にとることが近道かもしれない． | |
| Theme | Environmental Arrangements of Hemodialysis Room -- including In-hospital Infection | |
|---|---|---|
| Title | Conditions for infection control in dialysis facilities with staff movement | |
| Author | Takashi Shibamoto | Department of Blood Purification, Tokyo Medical and Dental University Hospital |
| Author | Kaoru Abe | The Foundation of Seishoukai, Kikukawabashi Clinic |
| [ Summary ] | An evaluation of optimal conditions for hemodialysis facilities was carried out. Facility layout, movement of dialysis unit staff members, distance between treatment beds, as well as the movement of patients from different parts of the hospital/clinic to the dialysis unit were analyzed at the Department of Blood Purification, Tokyo Medical and Dental University Hospital and at private dialysis clinics. The movement of staff members was analyzed by observing their passage in and out of the utility sterilization room and the isolation room. Traffic to and from the utility sterilization room was frequent during the initiation of treatment and during the observation of treatment. Traffic to and from the isolation room was observed for twenty seven minutes at the beginning and end of each treatment. During the observation period, there were five visits to the isolation room that lasted seven minutes each. A minimum distance of 80 cm is required for standard dialysis beds and 120 cm for infection beds, considering the potential for blood spillage. A screen between the standard dialysis beds secured the privacy of patients visually, however, conversation and various sounds could be overheard. It was not considered possible to immediately comply with the results of this report on design and facilities. However, considering the fact that outpatient dialysis for infectious patients is being performed, infection protection facility design in critically important. Standards for dialysis facility design, with provisions for the prevention of nosocomial infection, medico-economic considerations must be considered. |
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