血中ウイルスの医療従事者に対する曝露の危険性は, 針刺し事故や血液飛沫によるものがもっとも高い. 日本における8施設の調査から針刺し事故の実態を解析し, さらに予防対策としての安全器具の評価について考察を加えた.
集計した920件の職務上の事故において, 看護婦と医師の事例が大部分であり, 器材別では内腔のある注射針が81%を占めている. 注射針の中では翼状針において頻度が高く, ペン式注射器, 真空採血針などと続く. 通常の注射針ではリキャップに伴う事故が圧倒的に多いが, リキャップしない方式では専用廃棄容器にかかわる事故が目立つ.
近年, 安全装置付きの注射器が登場しているが, 装置の評価, 使いやすさ, 使用範囲および価格や廃棄処理に対する検討が必要である.

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Mupirocin鼻腔用軟膏の鼻腔内MRSAに対する除菌効果, 安全性および有用性を検討する目的で, 多施設共同のオープン試験を行った.
Mupirocin鼻腔用軟膏を1回60mg (片側の鼻腔に30mg) 1日3回3日間, 両側の鼻腔内に塗布した. 対象は鼻腔内にMRSAを認めた医療従事者および入院患者とし, 以下の成績を得た.
1. 全例で188例が組み入れられ, MRSAに対する解析対象例は最終塗布翌日の除菌効果129例, 最終塗布1週間後の除菌効果125例, 有用度129例, およびMRSAを含むS. aureusに対する安全度については176例であった.
2. 除菌効果は, 最終塗布翌日では86.0%, 最終塗布1週間後では93.6%であった.
3. 副作用の発現はまったく認められず, 安全度は100%であった.
4. 有用度はきわめて有用が86.0%, 有用性あり以上が96.1%であった.
以上の成績より, Mupirocin鼻腔用軟膏は鼻腔内MRSAの除菌に有用な薬剤であると考えられた.

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During the past few years there has been a remarkable increase in organisms that are resistant to several different groups of antimicrobials. These multi-drug resistant (MDR) bacteria cause an increasing number of infections each year, primarily in intensive care units. Increasing numbers of patients with impaired host defenses, use of new instrumentation and procedures, decrease in resources for infection control, and appearance of new organisms that previously were unrecognized are some of the reasons why MDR nosocomial pathogens have become increasigly important. Yet, use of antimicrobial agents is also a major influence on pattern of resistance in hospital organisms causing infection. Thus, measures to optimize use of antimicrobials for these patients have special importance. This requires a coordinated approach by prescriber, pharmacist, nurse, laboratorian, and the patient. The hospital purchasing and pharmacy/therapeutics groups determine the therapeutic agents that are available, and the pharmacy also can provide concurrent monitoring of dose and duration of therapy. The laboratory has an impact on initial empiric choice of drug through periodic summaries of the susceptibility patterns of likely pathogens in the hospital, and can decrease duration of empiric therapy by rapid turnaround of diagnostic testing results. A major impact can result from adoption of critical pathway or clinical guidelines, when these are developed as a cooperative effort. Maximizing benefits of therapy requires further evaluation of several issues. Among these are the value of cycling of antimicrobial therapy and use of combination therapy in delaying emergence of resistance. To assess these strategies, cooperative multi-center studies are needed in which selection and classification biases are addressed prospectively, and in which confounding factors are controlled. The problem will not be solved until the entire healthcare delivery system becomes involved in the campaign.

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