Larson E L, Hughes C A, Pyrek J D, Sparks S M, Cagatay E U, Bartkus J M
Georgetown University School of Nursing, Washington, DC, USA.
Am J Infect Control. 1998 Oct;26(5):513-21. doi: 10.1016/s0196-6553(98)70025-2.
In a prospective observational study of 40 nurses (20 with diagnosed hand irritation and 20 without), nurses with damaged hands did not have higher microbial counts (P = .63), but did have a greater number of colonizing species (means: 3.35 and 2.63, P = .03). Although numbers were small, nurses with damaged hands were significantly more likely to be colonized with Staphylococcus hominis (P = .03). Fifty-nine percent of S hominis isolates from nurses with damaged hands were resistant to methicillin compared with 27% of isolates from those with healthy skin (P = .14). Twenty percent of nurses with damaged hands were colonized with Staphylococcus aureus compared with none of the nurses with normal hands (P = .11). Nurses with damaged hands were also twice as likely to have gram-negative bacteria (P = .20), entercocci (P = .13), and Candida (P = .30) present on the hands. Antimicrobial resistance of the coagulase-negative staphylococcal flora (with the exception of S hominis) did not differ between the 2 groups, nor did a trend toward increasing resistance exist when compared with other studies during the past decade. Skin moisturizers and protectant products were used almost universally by nurses at work, primarily products brought from home. Efforts to improve hand condition are warranted because skin damage can change microbial flora. Such efforts should include assessment or monitoring of hand care practices, formal institutional policy adoption and control of use of skin protectant products or lotions, and prudent use of latex gloves or more widespread use of powder-free and nonlatex products.
在一项针对40名护士（20名被诊断有手部刺激症状，20名没有）的前瞻性观察研究中，手部受损的护士微生物计数并不更高（P = 0.63），但定植菌的种类更多（平均值分别为3.35和2.63，P = 0.03）。尽管样本数量较少，但手部受损的护士被人葡萄球菌定植的可能性显著更高（P = 0.03）。手部受损护士分离出的人葡萄球菌菌株中，59%对甲氧西林耐药，而皮肤健康护士分离出的菌株中这一比例为27%（P = 0.14）。手部受损的护士中有20%被金黄色葡萄球菌定植，而手部正常的护士中无人被定植（P = 0.11）。手部受损的护士手上出现革兰氏阴性菌（P = 0.20）、肠球菌（P = 0.13）和念珠菌（P = 0.30）的可能性也高出一倍。两组之间凝固酶阴性葡萄球菌菌群（人葡萄球菌除外）的耐药性没有差异，与过去十年的其他研究相比也不存在耐药性增加的趋势。护士在工作中几乎普遍使用皮肤保湿剂和防护产品，主要是从家里带来的产品。鉴于皮肤损伤会改变微生物菌群，有必要努力改善手部状况。这些努力应包括对手部护理做法进行评估或监测、正式制定机构政策并控制皮肤防护产品或乳液的使用，以及谨慎使用乳胶手套或更广泛地使用无粉和非乳胶产品。
