宁波市某三甲医院消毒与灭菌效果监测分析
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摘要
目的了解宁波市某三甲医院消毒质量现状,为进一步加强医院消毒质量分级监测管理及提高消毒质量提供依据。方法 2013年1月-2016年12月通过现场采样和微生物检测方法对医院室内空气、医务人员手、物体表面、医疗器械、内镜清洗、压力蒸汽灭菌器、血透液和医院污水进行采样监测,并对监测结果进行分析。结果2013-2016年共采样1295份,合格1199份,总体合格率为92.59%,各年合格率分别为93.23%、95.10%、90.72%和91.12%。Ⅰ类环境合格率为98.18%高于Ⅱ~Ⅳ类环境69.23%;共监测134条内镜,其中胃镜86条,肠镜32条,支气管镜13条,膀胱镜3条,内镜清洗消毒效果监测结果均合格;四年中监测医护人员手卫生合格率为85.56%,其中外科手合格率为91.55%(65/71)高于卫生手合格率为80.40%(160/199)(P<0.05);医疗器械清洗效果ATP监测合格率为35.62%,年度波动较大;二氧化氯法监测污水合格率78.43%,2015-2016年低于2013-2014年;四年间医疗器械清洗效果监测采用肉眼裸视合格率为100.00%,放大镜合格率为99.65%。结论医院消毒与灭菌效果总体状况良好,但手卫生、医院污水和医疗器械清洗效果的合格率相对较低,应加强重视,以进一步提高医院消毒灭菌质量。
OBJECTIVE To know the current situation of disinfection quality in a 3 Ahospital in Ningbo,so as to provide evidence for reinforcing disinfection monitoring management and improving the disinfection quality in the hospital.METHODS Field sampling and microbiological detection methods were used to monitor the indoor air in hospital,medical staff hands,object surface,medical instruments,endoscopes cleaning,pressure steam sterilizer,hemodialysis fluid and hospital sewage from Jan.2013 to Dec.2016,and the monitoring results were analyzed.RESULTS A total of 1295 samples were collected during the year 2013 to 2016,and 1199 were eligible with the total qualified rate of 92.59%.The qualified rates during the four years were 93.23%,95.10%,90.71%,and91.12%,respectively.The qualified rate of environment type Ⅰ was 98.18%,which was obviously higher than that of typeⅡ~Ⅳ of 69.23%.A total of 134 endoscopes were monitored,including 86 gastroscopes,32 enteroscopes,13 bronchoscopes and 3 cystoscopes.The results of the endoscopic cleaning and disinfection efficacy were all qualified.The qualified rate of hand hygiene was 85.56%,and that of surgical hand was 91.55%(65/71),which was significantly higher than 80.40%(160/199)of hygienic hand(P<0.05).The ATP bioluminescence assay for evaluating the cleaning effect showed that the qualified rate of medical instrument was 35.62%,and annual variation was great.The chlorine dioxide monitoring results showed that the qualified rate of sewage was 78.43%,and that of 2015-2016 was lower than 2013-2014.The qualified rate of cleaning effect of medical instruments with the naked eye was 100.00%,and with magnifier was 99.65%.CONCLUSIONThe disinfection and sterilization effects of the hospital are good in general,but the qualified rates of hand hygiene,hospital sewage and endoscopes cleaning were relatively low,so more attention should be focus on these items,so as to improve the quality of disinfection and sterilization.
OBJECTIVE To know the current situation of disinfection quality in a 3 Ahospital in Ningbo,so as to provide evidence for reinforcing disinfection monitoring management and improving the disinfection quality in the hospital.METHODS Field sampling and microbiological detection methods were used to monitor the indoor air in hospital,medical staff hands,object surface,medical instruments,endoscopes cleaning,pressure steam sterilizer,hemodialysis fluid and hospital sewage from Jan.2013 to Dec.2016,and the monitoring results were analyzed.RESULTS A total of 1295 samples were collected during the year 2013 to 2016,and 1199 were eligible with the total qualified rate of 92.59%.The qualified rates during the four years were 93.23%,95.10%,90.71%,and91.12%,respectively.The qualified rate of environment type Ⅰ was 98.18%,which was obviously higher than that of typeⅡ~Ⅳ of 69.23%.A total of 134 endoscopes were monitored,including 86 gastroscopes,32 enteroscopes,13 bronchoscopes and 3 cystoscopes.The results of the endoscopic cleaning and disinfection efficacy were all qualified.The qualified rate of hand hygiene was 85.56%,and that of surgical hand was 91.55%(65/71),which was significantly higher than 80.40%(160/199)of hygienic hand(P<0.05).The ATP bioluminescence assay for evaluating the cleaning effect showed that the qualified rate of medical instrument was 35.62%,and annual variation was great.The chlorine dioxide monitoring results showed that the qualified rate of sewage was 78.43%,and that of 2015-2016 was lower than 2013-2014.The qualified rate of cleaning effect of medical instruments with the naked eye was 100.00%,and with magnifier was 99.65%.CONCLUSIONThe disinfection and sterilization effects of the hospital are good in general,but the qualified rates of hand hygiene,hospital sewage and endoscopes cleaning were relatively low,so more attention should be focus on these items,so as to improve the quality of disinfection and sterilization.
引文
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[16]陈小英,马晓,朱光锋,等.宁波市市属医疗机构消毒效果监测[J].中国消毒学杂志,2016,33(2):119-121.
[17]王淑香,翟德翠,李秀丽.传染科医务人员手卫生与医院感染的相关性研究[J].中华医院感染学杂志,2013,23(13):3217-3218.
[18]申桂娟,吴利和,陆军.高频接触物体表面消毒质量管理在多重耐药菌控制中的作用研究[J].中华医院感染学杂志,2016,26(4):950-950.
[19]王艳,高佳芹,周晶,等.消毒供应中心对手术器械清洗方法的效果观察[J].医疗装备,2011,24(3):28-29.
[2]Avery L,Bennett R,Brinsleyrainisch K,et al.National and state healthcare-associated infections progress report[J].Am J Clin Nutr,2015,101(101):3.
[3]郁旷明,王双英,陈浩,等.一起诺如病毒医院感染事件调查与控制[J].中国消毒学杂志,2015,32(12):1220-1222.
[4]Carling PC,Bartley JM.Evaluating hygienic cleaning in health care settings:what you do not know can harm your patients[J].Am J Infect Control,2010,38(5Suppl 1):S41-50.
[5]Julian D,Tanaka A,Mattingly P,et al.A comparative analysis and guide to virtual reality robotic surgical simulators[J].Int J Med Robot,2017,10.
[6]Nandy P,Lucas AD,Gonzalez EA,et al.Efficacy of commercially available wipes for disinfection of pulse oximeter sensors[J].Am J Infect Control,2016,44(3):304-310.
[7]金波娜,冯乐玲,孙雪芬,等.环境清洁消毒监测对SICU鲍氏不动杆菌切口感染的影响[J].中华医院感染学杂志,2013,23(15):3602-3603.
[8]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-randomised,multicentre,crossover study[J].Lancet,2017,389(10071):805-814.
[9]Visrodia K,Haseeb A,Hanada Y,et al.Reprocessing of single-use endoscopic variceal band ligation devices:apilot study[J].Endoscopy,2017,49(12):1202-1208.
[10]Cook BW,Cutts TA,Nikiforuk AM,et al.The disinfection characteristics of Ebola virus outbreak variants[J].Sci Rep,2016,6:38293.
[11]Veiga-Malta I.Preventing healthcare-associated infections by monitoring the cleanliness of medical devices and other critical points in a sterilization service[J].Biomed Instrum Technol,2016,Suppl 3:45-52.
[12]中华人民共和国国家质量监督检验检疫总局.GB 15982-2012医院消毒卫生标准[S].北京:中国标准出版社,2012.
[13]中华人民共和国住房和城乡建设部,中华人民共和国国家质量监督检验检疫总局.医院洁净手术部建筑技术规范[S].北京:中国建筑工业出版社,2013.
[14]Obee PC,Griffith CJ,Cooper RA,et al.Real-time monitoring in managing the decontamination of flexible gastrointestinal endoscopes[J].Am J Infect Control,2005,33(4):202-206.
[15]中华人民共和国国家环境保护总局.GB18466-2005医疗机构水污染物排放标准[S].北京:中国环境科学出版社,2005.
[16]陈小英,马晓,朱光锋,等.宁波市市属医疗机构消毒效果监测[J].中国消毒学杂志,2016,33(2):119-121.
[17]王淑香,翟德翠,李秀丽.传染科医务人员手卫生与医院感染的相关性研究[J].中华医院感染学杂志,2013,23(13):3217-3218.
[18]申桂娟,吴利和,陆军.高频接触物体表面消毒质量管理在多重耐药菌控制中的作用研究[J].中华医院感染学杂志,2016,26(4):950-950.
[19]王艳,高佳芹,周晶,等.消毒供应中心对手术器械清洗方法的效果观察[J].医疗装备,2011,24(3):28-29.