常规进行医院环境卫生学监测的辨证与思考
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摘要
医院环境卫生学监测是否需常规进行,存在两种不同的观点。支持者认为环境卫生学监测能及时发现医院感染隐患,制定防控措施,而且能准确评估医院环境清洁质量,应按照国家规范标准要求定期开展环境卫生学监测;反对者认为发达国家已取消了常规环境微生物监测,常规监测投入成本大,但与医院感染率无相关性,且存在无法真实体现医院环境污染情况,因此应更多关注环境的清洁消毒工作,而不是常规进行环境卫生学监测。辨证分析环境卫生学常规监测的必要性与存在的问题,通过完善采样方法、时间、监测内容等,寻找更多的循证依据来发挥环境卫生学监测在医院感染控制中应有的作用。
There are two different viewpoints on whether hospital environmental hygiene monitoring needs to be carried out routinely. Supporters believe that environmental hygiene monitoring can detect hidden dangers of nosocomial infection, formulate preventive and control measures, and accurately assess the quality of hospital environmental cleanliness. So routine environmental hygiene monitoring should be carried out in accordance with national standards. Opponents argue that developed countries have abolished routine environmental microbial surveillance, the cost of routine surveillance is high, it has no correlation with nosocomial infection rate, and there is no true embodiment of hospital environmental pollution, so more attention should be paid to environmental cleaning and disinfection, rather than routine environmental hygiene monitoring. The necessity and existing problems of environmental hygienic routine monitoring were dialectically analyzed. By improving sampling time, method, monitoring content and so on, more evidence-based evidence was found to play the role of environmental hygiene monitoring in nosocomial infection control.
There are two different viewpoints on whether hospital environmental hygiene monitoring needs to be carried out routinely. Supporters believe that environmental hygiene monitoring can detect hidden dangers of nosocomial infection, formulate preventive and control measures, and accurately assess the quality of hospital environmental cleanliness. So routine environmental hygiene monitoring should be carried out in accordance with national standards. Opponents argue that developed countries have abolished routine environmental microbial surveillance, the cost of routine surveillance is high, it has no correlation with nosocomial infection rate, and there is no true embodiment of hospital environmental pollution, so more attention should be paid to environmental cleaning and disinfection, rather than routine environmental hygiene monitoring. The necessity and existing problems of environmental hygienic routine monitoring were dialectically analyzed. By improving sampling time, method, monitoring content and so on, more evidence-based evidence was found to play the role of environmental hygiene monitoring in nosocomial infection control.
引文
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[12] Getachew H,Derbie A,Mekonnen D.Surfaces and air bacteriology of selected wards at a referral hospital,northwest Ethiopia:a cross-sectional study[J].Int J Med Microbiol,2018,3:6413179.
[13] Lai YY,Li Y,Lang J,et al.Metagenomic human repiratory air in a hospital environment[J].PLoS One,2015,10(10):e0139044.
[14] 陈炜,陈雪娥,金浩龙,等.重症监护病区物体表面细菌污染情况调查[J].中华医院感染学杂志,2016,26(24):5740-5741.
[15] Anderson DJ,Chen LF,Weber DJ,et al.Enhanced terminal room disinfection and acquisition and infection caused by multidrug-resistant organisms and Clostridium difficile (the Benefits of Enhanced Terminal Room Disinfection study):a cluster-randomized,multicentre,crossover study[J].Lancet,2017,389(10071):805-814.
[16] Pirincci E,Altun B.An analysis of hospital cleaning staff's attitudes and conduct regarding hand hygiene and cleaning[J].Int J Occup Saf Ergon,2016,22(2):241-245.
[17] 倪晓平.《医疗机构环境表面清洁与消毒管理规范》重点诠释[J].中华医院感染学杂志,2017,27(15):3370-3376.
[18] 阮晶晶,陶秀彬,彭辉,等.医院环境物体表面清洁方法与效果评价研究进展[J].中华医院感染学杂志,2016,26(20):4788-4791.
[19] Carling PC,Huang SS.Improving healthcare environmental cleaning and disinfection:current and evolving issues[J].Infect Control Hosp Epidemiol,2013,34(5):507-513.
[20] Sehulster L,Chinn RY,CDC,et al.Guidelines for environmental infection control in health-care facilities:recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC)[J].MMWR Recomm Rep,2003,52(RR-10):1-42.
[21] 张晓莺,林妙芬.血液净化中心环境卫生学监测及管理策略[J].实用医学杂志,2015,31(16):2763-2765.
[22] 肖书萍,李小芳.介入手术室环境卫生学监测及持续质量改进[J].护理学杂志,2017,32(1):89-90,106.
[23] 鲁飞,崔树玉.层流洁净手术室环境医院感染控制措施[J].中国消毒学杂志,2016,33(5):478-481.
[24] 张晓玲,雷毅,董小峰,等.某三甲医院洁净手术室空气监测结果分析[J].中国消毒学杂志,2019,36(01):50-51.
[25] 胡小燕,胡艳芬.门诊口腔科消毒灭菌质量监测及管理措施[J].中华医院感染学杂志,2013,23(2):427.
[26] 中华人民共和国国家卫生和计划生育委员会.WS/T510-2016病区医院感染管理规范[EB/OL].(2016-12-27)[2019-01-25]http://www.nhfpc.gov.cn/zhuz/s9496/201701/d98872b367644755a5be80a69f5faf36.shtml.
[27] Provincial Infectious Diseases Advisory Committee.Best practices for environmental cleaning for prevention and control of infections[R].Toronto:PIDAC,2009:91-92.
[28] Chemaly RF,Simmons S,Dale C Jr ,et al.The role of the healthcare environment in the spread of multidrug-resistant organisms:update on current best practices for containment[J].Ther Adv Infect Dis,2014,2(3-4):79-90.
[29] Mehta Y,Gupta A,Todi S,et al.Guidelines for prevention of hospital-acquired infections[J].Indian J Crit Care Med,2014,18(3):149-163.
[30] 吕天婵,张玉侠,刘林霞,等.NICU环境卫生监测及医院感染的多中心现况调查[J].护理学杂志,2016,31(13):92-94.
[31] 倪晓平,胡必杰.中国医院环境感染控制实践与进展[J].中华医院感染学杂志,2012,22(12):2708-2710.
[32] 耿庆玲,邹艳艳.医院环境卫生监测与医院感染关系[J].现代预防医学,2013,40(15):2780-2781.
[33] Fekadu S,Getachewu B.Microbiological assessment of indoor air of teaching hospital wards:a case of Jimma University Specialized Hospital[J].Ethiop J Health Sci,2015,25(2):117-122.
[34] 金慧,王慧敏,孔庆鑫,等.医院感染调查环境表面微生物采样技术应用现状与研究进展[J].中华医院感染学杂志,2018,28(16):2555-2560.
[35] 钱子煜,张越文,严冰清,等.2008-2017年上海市徐汇区12起医疗机构内诺如病毒急性胃肠炎暴发流行病学特征[J].中华医院感染学杂志,2018,28(11):1633-1636,1653.
[36] 中华人民共和国卫生部.消毒技术规范[EB/OL].(2002-11-15)[2018-12-01].http://www.moh.gov.cn/zhjcj/s9139/200804/86d017920ad84e64a90806717719624f.shtml.
[37] 任南,文细毛,付陈超,等.中国医院感染监测工作的发展及变化趋势[J].中国感染控制杂志,2016,15(9):642-647.
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