日本未熟児新生児学会雑誌　第26巻第2号　69～73頁（2014年）

日本未熟児新生児学会雑誌　26(2)：299-303；2014　

受付日：平成25．07．11

受理日：平成26．01．09

NICUにおける末梢穿刺中心静脈カテーテルの管理方法と血流感染率の関連

Management Practice on Peripherally Inserted Central Venous Catheter in Relation to the Incidence of Bloodstream Infection in NICU

日本未熟児新生児学会感染対策・予防接種推進室
＊1群馬大学医学部附属病院　周産母子センター　NICU，＊2大阪府立母子保健総合医療センター　新生児科
＊3名古屋第一赤十字病院　小児科

Division of Infection Prevention and Vaccine Promotion of Japan Society for Premature and Neonatal Medicine
＊1Neonatal Intensive Care Unit, Perinatal Care Center, Gunma University Hospital
＊2Department of Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health
＊3Department of Pediatrics, Japanese Red Cross Nagoya Daiichi Hospital

大木康史＊1・北島博之＊2・大城　誠＊3・荒川浩一＊1

Yasushi OHKI＊1，Hiroyuki KITAJIMA＊2，Makoto OOSHIRO＊3，Hirokazu ARAKAWA＊1

Key Words：catheter-related bloodstream infection，peripherally inserted central venous catheter，maximal barrier precautions，sterile drape

　日本未熟児新生児学会感染対策・予防接種推進室の「極低出生体重児（VLBW）の感染症」，「末梢穿刺中心静脈カテーテル（peripherally inserted central venous catheter：PICC）管理法」の2 調査資料を用い，PICC管理方法とVLBWの血流感染症頻度の関連を検討した。両者に回答し，VLBW入院数21名以上の67施設につき解析した。血流感染症頻度（％）で4 群（A：0 ～2.6，B：2.7 ～ 4.8，C：4.9 ～ 9.1，D：9.2 ～25.0）に分け，群間でVLBWの入院数，PICC 管理（清潔手技，滅菌手袋・滅菌覆い布・マスク・帽子・滅菌ガウンの有無，定期的な入れ替え，クリーンベンチでの輸液調剤，消毒薬の種類）を比較した。滅菌覆い布使用とマスク着用はA，B群でC，D群より多かった。その他の項目に有意差はなかった。VLBWへのPICCで留置時の清潔手技が血流感染の発生頻度に何らかの影響を与える可能性が示唆された。

　We retrospectively analyzed the relationship between the management practice of peripherally inserted central venous catheter（PICC）and the incidence of bloodstream infection among very low birth weight infants in NICU. Data from two studies conducted by division of infection prevention and vaccine promotion of Japan society for premature and neonatal medicine, was utilized. We analyzed data from 67 NICUs with more than 21 VLBW admissions per year. NICUs were classified into four groups（A to D）according to the incidence of bloodstream infection. Background factors were compared among groups. Number of admission of infants less than 1kg did not significantly differ among groups. Usage of sterilized large drape, mask, were significantly higher in groups with lower infection rate groups. Other items including the degree of barrier precautions, usage of sterilized gloves, cap, sterile gown, routine change of catheter, aseptic preparation of intravenous solutions, and details of skin antiseptics, did not show certain trend. Our data indicated that some of aseptic procedure during insertion might affect the incidence of bloodstream infection in VLBW infants admitted to NICUs in Japan. Large-scaled prospective study should be conducted to elucidate this issue in future.