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耐性菌の伝播防止に向けた感染対策のエビデンス構築 : 適切な個人防護具着脱の重要性についての検討

岡本, 耕 東京大学 DOI:10.15083/0002008345

2023.12.27

概要

審査の結果の要旨
氏名 岡本 耕
本研究は、耐性菌の伝播と医療関連感染症が大きな問題となる集中治療室において、
個人防護具着脱時のエラーが耐性菌伝播においてどのような役割を果たしているかを明ら
かにするため、耐性菌保菌によって接触予防策を行っている患者にケアを提供する医療従
事者を対象に、①医療従事者の属性・認識と個人防護具着脱時のエラーの関連、②個人防
護具着脱時のエラーと患者ケア後の耐性菌による汚染の関連、③患者・病室内環境の汚染
および患者ケアと患者ケア後の耐性菌による汚染の関連について明らかにすることを試み
たものであり、下記の結果を得ている。
1.

125 名の医療従事者のうち、105 名(84.8%)はガウンの装着時、16 名(12.9%)

は手袋の装着時、47 名(37.6%)は個人防護具を外す時に複数のエラーがあった。勤
務歴 6 年以上であることは、手袋・ガウンを外すときに複数のエラーを起こすことと統
計学的に有意に関連していた。
2.

複数のエラーがある割合は、手袋・ガウン同時に脱着する方法で 17.4%、ガウン

を先に外す方法で 51.7%、手袋を先に外す方法で 72.0%と統計学的に有意に異なって
いた。個人防護具を外す際に複数のエラーがあった医療従事者では複数のエラーがなか
った医療従事者に比べ、患者ケア後に衣類が汚染している可能性が約 6 倍統計学的に
有意に高かった。また、患者ケア後に手指衛生を行う前の手が汚染する可能性は、手袋
を先に外すやり方のほうが約 13 倍統計学的に有意に高かった。
3.

医療従事者が患者ケアを行った後の手袋・ガウンの汚染は、患者や病室内環境の汚

染の割合が高いほど多く、特に患者が下痢をしている場合や、患者近くの病室内環境の
汚染が高度である場合にその傾向が強かった。同様に医療従事者が患者ケアを行った後
の手袋・ガウン以外の部位(衣類、機器)の汚染の程度も患者および病室内環境の汚染
の程度と関連していた。
以上、本論文は、耐性菌の保菌や感染症の既往のために接触予防策を行っている患者
に対して医療従事者がケアを行った後の耐性菌による汚染のリスクは、個人防護具の外し
方、外す際のエラーの程度によって異なっていたことを明らかにした。本研究の結果は、
臨床現場における耐性菌伝播における個人防護具の適切な着脱の重要性を確認するととも
に、個人防護具を外す順番を統一するといったシンプルな介入で医療従事者の耐性菌によ
る汚染を減らせる可能性を示唆するものであり、臨床現場における耐性菌伝播を減らす方
策の解明に重要な貢献をなすと考えられる。
よって本論文は博士(医学)の学位請求論文として合格と認められる。

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65

謝辞

本研究の実施、本論文の作成にあたって、ご指導ご鞭撻を賜りました森屋恭爾

東京大学大学院医学系研究科感染症・生体防御学教授、ラッシュ大学メディカル

センター感染症科 Robert Weinstein 教授、Mary Hayden 教授、Kyle Popovich 准教

授に心より感謝を申し上げます。また、ラッシュ大学感染症科の Yoona Rhee 先

生、Jennifer Cheng 先生、Shivani Reddy 先生、ラッシュ大学統計学教室の Michael

Schoeny 先生、ラッシュ大学メディカルセンター微生物検査室の Karen Lolans 先

生、Melanie Carr 氏、Patricia Mangan 氏、Grace McIlroy 氏、ラッシュ大学 Efrain

Salazar 氏、George P. Warpinski 氏にご協力とご助言を賜りましたことを厚くお礼

申し上げます。

66

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