口腔器械乙肝病毒污染状况调查及牙钻手机二元消毒盒研制
摘要
一 目的
1 了解天津地区医疗单位口腔科使用的诊疗器械病毒污染实际状况(以乙肝病毒为代表)及通过不洁诊疗器械所致病毒、细菌性疾病传播的危险性大小；
2 寻找一种有效、适用、经济的牙钻手机消毒方法。
二 方法
1 选取本市某所三甲医院口腔科使用的牙钻手机、车针、口镜、探针、镊子及弯盘6种常用诊疗器具行涂抹采样；检测指标为HBsAg、HBeAg、HBV-DNA；检测方法为HBsAg和HBeAg采用ELISA法，HBV-DNA为斑点杂交法；
2 充分考虑、利用现有牙钻手机支架插孔，设计牙钻手机二元消毒盒外形及内部构造；选定高效消毒剂戊二醛为消毒盒消毒腔内应用消毒液，其消毒效果及毒性鉴定试验参照卫生部消毒技术规范执行。
三 结果
1 以HBsAg为检测指标，牙钻手机、车针、口镜、探针、镊子及弯盘的阳性率分别为10.3％、8.3％、7.6％、9.0％、6.3％、5.5％，平均阳性率为7.7％，其中以牙钻手机阳性率最高10.3％；以HBeAg为检测指标，上述常用6种口腔诊疗器械阳性率依次为1.7％、1.0％、2.0％、1.0％、0.7％、0，平均
U腔器械乙肝汕毒污染状况调查及牙钻丁机＿joek盒研制2
阳性率为1．1％，其中以口镜阳性率最高2．0％，牙钻手机位居第二1．7为 以
HBV－DNA为检测指标，上述常用 6种口腔诊疗器械阳性率依次为 12．0％、
9．7％、10．3％、11．3％、8．0％、6．3％，平均阳性率为 9．6％，其中仍以牙钻手
机阳性率最高 12．0％。
2一次性使用涡轮牙钻手机二元消毒盒外形及内部构造
二元消毒盒山插柄、密封盖、腔体和置于其中消毒液构成，在密封盖
下还另设有药物存储袋（用于存放另一种消毒剂或增效剂）。二元消毒盒插
柄与现有丁钻手机支架插孔相咬合（连接），利用涡轮牙钻手机支架起到固
定、支撑二元消毒盒之作用。
3消毒腔内消毒液消毒效果鉴定及毒性大小测试
1）二元消毒盒消毒腔内戊二醛含量约为 2．12％，活化前消毒液 PH为
3．79，活化后消毒液PH为6．88。
2） 经稳定性加速试验（54℃恒温箱，放置 14天）证实，戊二醛含量由
2．12％下降为1．94％，下降率S．38％＜10％，属较稳定消毒剂。
3） 二元消毒盒消毒腔内戊二醛对不锈钢、铜、碳钢均无腐蚀，腐蚀速率分
别为：0．0000m／。、0．0015恤／。、O．0016m／。：对铝为轻度腐蚀，腐蚀
速率为0．0552mm乃。在此基础上，我们对气动牙钻轴承用2．12％戊二醛浸
泡120小时后，用扫描电镜扫描，二次电于成像，未见牙钻表面金属之金
属相有改变。
4）二元消毒盒消毒腔内戊二醛（含量2．12％）作用 smin叶破坏 HBsAg的抗
原性。临床PCR试验检测表明，作用1分钟后涂抹采样，无论在牙钻车针
表面还是在牙钻手机内部（气道、水道）均检测不到HBV片断。
5）二元消毒盒消毒腔内戊二醛含量为700mg／L（约30倍稀释）作用Zmin对
金黄色葡萄球菌、大肠杆菌的各次试验杀灭率均达99．90％和99．91％以上。
6）二元消毒盒消毒腔内戊二醛含量为800mg儿（约26倍稀释）作用4min对
白色念珠菌各次试验杀灭率均达99．92％以上。
口腔器械乙肝刑毒污染状况调台及牙钻手机＿in消毒盒讪制3
刀 二元消毒盒消毒腔内戊二醛含量为 2．12％作用 4h对枯草杆菌黑色变种芽
胞各次试验杀灭率均达 100．00％。
8）经LD。；，、蓄积毒性和微核试验表明，二元消毒盒消毒腔内戊二醛消毒液
符合国家对消毒剂毒性安全方面之要求。
四 结论
1天津地区某些医疗单位口腔诊疗器械病毒污染严重，其中牙钻手机由于其
内部结构复杂，消毒处理方法有限，污染情况最为严重。
2一次性使用涡轮牙钻手机工元消毒盒是一种有效、适用、经济的牙钻手
机消毒方法。
I PURPOSE
1 In order to know virus contamination ( hepatitis B virus as representative virus) of the dental diagnosis and treat instruments and its could bring the potential risks of transmission of viral and bacterial infection during the oral diseases treat process in Tianjin area.
2 look for a better disinfection way for the air turbine dental handpieces which could be effective, economic and applicable.
II METHOD
1 chose one of 3A level hospitals dentistry to carry through sanitation quality investigation of the dental diagnosis and treat instruments. Examined appliance include air turbine dental handpieces, punch-pin, odontoscope, bougie, tweezer, flex-tray that were so common used by dentists and daubed the inside or outside surface of the dental appliance and collected it; Examined targets were HBsAg, HBeAg (detected it with ELISA method ) and HBV-DNA (detected it with molecule spot cross method).
2 make good use of the air turbine dental handpieces bracket jack which was all available in every china hospital dentistry and design outside shape and inside structure of the binary disinfectant-box for the air turbine dental
handpieces. The applicable disinfectant in the cavity of the binary disinfectant-box was high level disinfectant梘lutaraldehyde and according to guideline book of disinfectant evaluation method (ministry of health, P.R.China, 3rd.edition, 1999) germicidal performance and toxicity was tested in the laboratory. Ill RESULT
1 HBsAg as target object, the positive rate of air turbine dental handpieces > punch-pin ^ odontoscope x bougie > tweezer, flex-tray was 10.3%> 8.3%> 7.6%, 9.0%, 6.3% > 5.5% respectively. The average positive rate was 7.7%, the air turbine handpieces was the highest 10.3%; HBeAg as target object, the positive rate in turn of the dental instruments said above was \.7%. \.0%. 2.0%. 1.0%> 0.7%, 0 respectively. The average positive rate was 1.1%, air turbine handpieces was the secend highest 1.7%, just next to odontoscope 2.0%; HBV-DNA as target object, the positive rate in turn of the dental instruments was 12.0%, 9.7%. \O.Z%, II^/CK 8.0%> 6.3% respectively. The average positive rate was 9.6%, the air turbine handpieces was the highest 12.0%.
2 outside shape and inside structure of the binary disinfectant-box
The binary disinfectant-box was composed of insert-hand^ airproof-cove^ cavity and the disinfectant stored in cavity. There was another packet which contain another disinfectant or plus-ingredient which located below the airproof-cover. To make use of dental handpieces bracket jack which was all available in every hospital and support and make fast the binary disinfectant-box.
3 germicidal performance and toxicity
1) The glutaraldehyde content of disinfectant in the cavity of the binary disinfectant-box was about 2.12%, the pH value of glutaraldehyde disinfectant before activation was 3.79, after activation was 6.88;
2) The glutaraldehyde content stability test ( accelerating method, 54癈for 14 day) indicated that the glutaraldehyde content of disinfectant come down from 2.12% to 1.94% after stored it in constant temperature box at 54癈 for 14 day, the decreased rate was 8.38% that was less than 10.0% and this disinfectant belong to more stable disinfectant.
3) The glutaraldehyde disinfectant in the cavity of the binary disinfectant-box did not cause corrosion of stainless steel > copper and carbon steel and essentially did not cause corrosion of aluminum. The corrosion rate of stainless steel > copper carbon steel and aluminum was 0.000 x 0.0015> 0.0016 and 0.0552 mm/a. We dipped in axletree of dental handpieces for 120 hour with 2.12% glutaraldehyde disinfectant, could not find any metal structure change on the surface of axletree by electronic microscope.
4) The antigencity of HBsAg could be destroyed after exposure to disinfectant contains 2.12% glutaraldehyde for 8min. The result of clinical PCR test showed that no HBV snippet found on the either outside surface of the disinfected p
1 了解天津地区医疗单位口腔科使用的诊疗器械病毒污染实际状况(以乙肝病毒为代表)及通过不洁诊疗器械所致病毒、细菌性疾病传播的危险性大小；
2 寻找一种有效、适用、经济的牙钻手机消毒方法。
二 方法
1 选取本市某所三甲医院口腔科使用的牙钻手机、车针、口镜、探针、镊子及弯盘6种常用诊疗器具行涂抹采样；检测指标为HBsAg、HBeAg、HBV-DNA；检测方法为HBsAg和HBeAg采用ELISA法，HBV-DNA为斑点杂交法；
2 充分考虑、利用现有牙钻手机支架插孔，设计牙钻手机二元消毒盒外形及内部构造；选定高效消毒剂戊二醛为消毒盒消毒腔内应用消毒液，其消毒效果及毒性鉴定试验参照卫生部消毒技术规范执行。
三 结果
1 以HBsAg为检测指标，牙钻手机、车针、口镜、探针、镊子及弯盘的阳性率分别为10.3％、8.3％、7.6％、9.0％、6.3％、5.5％，平均阳性率为7.7％，其中以牙钻手机阳性率最高10.3％；以HBeAg为检测指标，上述常用6种口腔诊疗器械阳性率依次为1.7％、1.0％、2.0％、1.0％、0.7％、0，平均
U腔器械乙肝汕毒污染状况调查及牙钻丁机＿joek盒研制2
阳性率为1．1％，其中以口镜阳性率最高2．0％，牙钻手机位居第二1．7为 以
HBV－DNA为检测指标，上述常用 6种口腔诊疗器械阳性率依次为 12．0％、
9．7％、10．3％、11．3％、8．0％、6．3％，平均阳性率为 9．6％，其中仍以牙钻手
机阳性率最高 12．0％。
2一次性使用涡轮牙钻手机二元消毒盒外形及内部构造
二元消毒盒山插柄、密封盖、腔体和置于其中消毒液构成，在密封盖
下还另设有药物存储袋（用于存放另一种消毒剂或增效剂）。二元消毒盒插
柄与现有丁钻手机支架插孔相咬合（连接），利用涡轮牙钻手机支架起到固
定、支撑二元消毒盒之作用。
3消毒腔内消毒液消毒效果鉴定及毒性大小测试
1）二元消毒盒消毒腔内戊二醛含量约为 2．12％，活化前消毒液 PH为
3．79，活化后消毒液PH为6．88。
2） 经稳定性加速试验（54℃恒温箱，放置 14天）证实，戊二醛含量由
2．12％下降为1．94％，下降率S．38％＜10％，属较稳定消毒剂。
3） 二元消毒盒消毒腔内戊二醛对不锈钢、铜、碳钢均无腐蚀，腐蚀速率分
别为：0．0000m／。、0．0015恤／。、O．0016m／。：对铝为轻度腐蚀，腐蚀
速率为0．0552mm乃。在此基础上，我们对气动牙钻轴承用2．12％戊二醛浸
泡120小时后，用扫描电镜扫描，二次电于成像，未见牙钻表面金属之金
属相有改变。
4）二元消毒盒消毒腔内戊二醛（含量2．12％）作用 smin叶破坏 HBsAg的抗
原性。临床PCR试验检测表明，作用1分钟后涂抹采样，无论在牙钻车针
表面还是在牙钻手机内部（气道、水道）均检测不到HBV片断。
5）二元消毒盒消毒腔内戊二醛含量为700mg／L（约30倍稀释）作用Zmin对
金黄色葡萄球菌、大肠杆菌的各次试验杀灭率均达99．90％和99．91％以上。
6）二元消毒盒消毒腔内戊二醛含量为800mg儿（约26倍稀释）作用4min对
白色念珠菌各次试验杀灭率均达99．92％以上。
口腔器械乙肝刑毒污染状况调台及牙钻手机＿in消毒盒讪制3
刀 二元消毒盒消毒腔内戊二醛含量为 2．12％作用 4h对枯草杆菌黑色变种芽
胞各次试验杀灭率均达 100．00％。
8）经LD。；，、蓄积毒性和微核试验表明，二元消毒盒消毒腔内戊二醛消毒液
符合国家对消毒剂毒性安全方面之要求。
四 结论
1天津地区某些医疗单位口腔诊疗器械病毒污染严重，其中牙钻手机由于其
内部结构复杂，消毒处理方法有限，污染情况最为严重。
2一次性使用涡轮牙钻手机工元消毒盒是一种有效、适用、经济的牙钻手
机消毒方法。
I PURPOSE
1 In order to know virus contamination ( hepatitis B virus as representative virus) of the dental diagnosis and treat instruments and its could bring the potential risks of transmission of viral and bacterial infection during the oral diseases treat process in Tianjin area.
2 look for a better disinfection way for the air turbine dental handpieces which could be effective, economic and applicable.
II METHOD
1 chose one of 3A level hospitals dentistry to carry through sanitation quality investigation of the dental diagnosis and treat instruments. Examined appliance include air turbine dental handpieces, punch-pin, odontoscope, bougie, tweezer, flex-tray that were so common used by dentists and daubed the inside or outside surface of the dental appliance and collected it; Examined targets were HBsAg, HBeAg (detected it with ELISA method ) and HBV-DNA (detected it with molecule spot cross method).
2 make good use of the air turbine dental handpieces bracket jack which was all available in every china hospital dentistry and design outside shape and inside structure of the binary disinfectant-box for the air turbine dental
handpieces. The applicable disinfectant in the cavity of the binary disinfectant-box was high level disinfectant梘lutaraldehyde and according to guideline book of disinfectant evaluation method (ministry of health, P.R.China, 3rd.edition, 1999) germicidal performance and toxicity was tested in the laboratory. Ill RESULT
1 HBsAg as target object, the positive rate of air turbine dental handpieces > punch-pin ^ odontoscope x bougie > tweezer, flex-tray was 10.3%> 8.3%> 7.6%, 9.0%, 6.3% > 5.5% respectively. The average positive rate was 7.7%, the air turbine handpieces was the highest 10.3%; HBeAg as target object, the positive rate in turn of the dental instruments said above was \.7%. \.0%. 2.0%. 1.0%> 0.7%, 0 respectively. The average positive rate was 1.1%, air turbine handpieces was the secend highest 1.7%, just next to odontoscope 2.0%; HBV-DNA as target object, the positive rate in turn of the dental instruments was 12.0%, 9.7%. \O.Z%, II^/CK 8.0%> 6.3% respectively. The average positive rate was 9.6%, the air turbine handpieces was the highest 12.0%.
2 outside shape and inside structure of the binary disinfectant-box
The binary disinfectant-box was composed of insert-hand^ airproof-cove^ cavity and the disinfectant stored in cavity. There was another packet which contain another disinfectant or plus-ingredient which located below the airproof-cover. To make use of dental handpieces bracket jack which was all available in every hospital and support and make fast the binary disinfectant-box.
3 germicidal performance and toxicity
1) The glutaraldehyde content of disinfectant in the cavity of the binary disinfectant-box was about 2.12%, the pH value of glutaraldehyde disinfectant before activation was 3.79, after activation was 6.88;
2) The glutaraldehyde content stability test ( accelerating method, 54癈for 14 day) indicated that the glutaraldehyde content of disinfectant come down from 2.12% to 1.94% after stored it in constant temperature box at 54癈 for 14 day, the decreased rate was 8.38% that was less than 10.0% and this disinfectant belong to more stable disinfectant.
3) The glutaraldehyde disinfectant in the cavity of the binary disinfectant-box did not cause corrosion of stainless steel > copper and carbon steel and essentially did not cause corrosion of aluminum. The corrosion rate of stainless steel > copper carbon steel and aluminum was 0.000 x 0.0015> 0.0016 and 0.0552 mm/a. We dipped in axletree of dental handpieces for 120 hour with 2.12% glutaraldehyde disinfectant, could not find any metal structure change on the surface of axletree by electronic microscope.
4) The antigencity of HBsAg could be destroyed after exposure to disinfectant contains 2.12% glutaraldehyde for 8min. The result of clinical PCR test showed that no HBV snippet found on the either outside surface of the disinfected p
引文
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28．吴一福．牙科手机快速消毒器研制成功．消毒与灭菌，1987；4(1)：14
29．丁兰英，蒋莉，扬华明，等．WBY-1型微波牙科手机消毒器的研究．中国消毒学杂志，1995；12(2)：65
30．王斌、刘国防、张悦，等。无偿献血人群病毒感染流行病学调查分析．中华医院感染学杂志，2002，12(1)：40～41．
31. Scheid RC, Rosen S, Beck FM. Reduction of CFUs in high-speed handpieces water lines over time. Clin Prev Dent, 1990:12(2):9
32. Checchi L, Montebubnoli L, Samaritanni S. Contamination of the turbine air chamber: a risk of cross infection. J Clin Periodontol, 1998:25(8):607
33. Talamini G, Vomo G, Pezzilli-R, et al. Serum creatinine and chest radiographys in the early assessment of acute pancreatitis [J].Am J Surg,1999,17(1):7
34. Beger HG, Rau B, Lsenmann R, et al. Surgical treatment of acute pancreatitis [J]. Ann Chirurg Gynaecol, 1998,87(3):183
35. Ohsuka S, Ohta M, Masuda K, et al. Microbiological evaluation of a newly designed dental air-turbine handpieces for anti-cross contaminations. Int J Presthodont, 1994:7(3):201
36. Matsuyama M, Usami T, Masuda K, et al. Prevention of infection in dental procedures. J Hosp Infect, 1997:35(1):17
37. Deskins-Knebel D, Rosen S. Comparision of handpieces asepsis among Ohio dentists:1991&1992. Focus Ohio Dent, 1993:67(2):8
38．周学东，等．防回吸手机防止交叉感染的细菌学研究．中华医院感染学杂志，2001；11(5)：370-1
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41. Feldman RE, Schiff ER.Hepatitis in dental professional. J AM Med Assoc, 1975,232:1288
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26. Lloyd L, Burke FJ, Cheung SW. Handpieces asepsis: a survey of the attitudes of dental practitioners. Br Dent J, 1995;178(1):23
27. Gerevich I, Dubin R, Cunha B. Dental instrument and device sterilization and disinfection practices. J Hosp Infect, 1996;32:295
28．吴一福．牙科手机快速消毒器研制成功．消毒与灭菌，1987；4(1)：14
29．丁兰英，蒋莉，扬华明，等．WBY-1型微波牙科手机消毒器的研究．中国消毒学杂志，1995；12(2)：65
30．王斌、刘国防、张悦，等。无偿献血人群病毒感染流行病学调查分析．中华医院感染学杂志，2002，12(1)：40～41．
31. Scheid RC, Rosen S, Beck FM. Reduction of CFUs in high-speed handpieces water lines over time. Clin Prev Dent, 1990:12(2):9
32. Checchi L, Montebubnoli L, Samaritanni S. Contamination of the turbine air chamber: a risk of cross infection. J Clin Periodontol, 1998:25(8):607
33. Talamini G, Vomo G, Pezzilli-R, et al. Serum creatinine and chest radiographys in the early assessment of acute pancreatitis [J].Am J Surg,1999,17(1):7
34. Beger HG, Rau B, Lsenmann R, et al. Surgical treatment of acute pancreatitis [J]. Ann Chirurg Gynaecol, 1998,87(3):183
35. Ohsuka S, Ohta M, Masuda K, et al. Microbiological evaluation of a newly designed dental air-turbine handpieces for anti-cross contaminations. Int J Presthodont, 1994:7(3):201
36. Matsuyama M, Usami T, Masuda K, et al. Prevention of infection in dental procedures. J Hosp Infect, 1997:35(1):17
37. Deskins-Knebel D, Rosen S. Comparision of handpieces asepsis among Ohio dentists:1991&1992. Focus Ohio Dent, 1993:67(2):8
38．周学东，等．防回吸手机防止交叉感染的细菌学研究．中华医院感染学杂志，2001；11(5)：370-1
39．卫生部消毒技术规范(第三版)第三分册 疫源地消毒技术规范 第9页．
40．杨聚才，安银东，黄萍，等．戊二醛浸泡口腔医疗器械对HbsAg破坏效果的检测．中国消毒学杂志，1998；15(4)：235-6
41. Feldman RE, Schiff ER.Hepatitis in dental professional. J AM Med Assoc, 1975,232:1288
42．赵皿．口腔科的交叉污染及交叉感染．国外医学口腔分册，1984，11(2)：65
43．许斌，韩光宇，程梅．血液HBsAg、抗HCV复检中应采用不同试剂和设置低限灰区．临床检验杂志，1998；16(6)：342