摘要
医院空气污染是引起院内感染的重要因素之一,医院环境空气质量的检测和控制正在日益引起人们的重视。传统的空气消毒方法,如紫外线灯照射、臭氧消毒、甲醛熏蒸等,只能对空气进行静态消毒消毒后由于医护人员入内的活动致使室内空气中细菌的菌落数回升,造成空气的再次污染,故仅有暂时的消毒效果。另外,传统的空气消毒方法不具有除尘作用,而小粒径微生物粒子(即微生物气溶胶)在因空气传播引起的医院内感染上起着非常重要的作用,应该是医院空气消毒的重点。随着医学科学技术的发展和医疗水平的不断提高,要求医院能在室内有人员活动的情况下保持空气的持续洁净,传统的消毒方法已不能满足现代的要求。如何对医院的空气进行有效安全的消毒净化,一直是医学界和消毒界所共同关注的问题。
动态空气净化消毒是近年来提倡的空气净化消毒方法,主要包括空气净化机和层流空气净化系统的应用等,但是层流洁净技术因价格昂贵,维护较难,建造投入成本大,在我国现有的经济基础下,不能实现在基层医院的广泛应用。空气净化机可以对空气进行循环消毒净化,已成为众多研究者所关注的热点。新型空气净化系统是采用高压静电和过滤双重净化原理对空气进行消毒净化的一种新设备,克服了传统消毒方法的不足,应用前景较为广阔。但是,目前对其在医院环境中对应的作用效果、影响因素、动态作用的鉴定和评价方法等都缺乏深入研究。
为了进一步了解新型空气净化系统的作用特点和规律,探讨其在医院环境对空气进行动态净化消毒的效果,进行了本项研究,主要内容包括以下三个方面:
(1)医院环境空气质量检测
筛选5家三级甲等医院的监护室病房,在设定时间下,采用手持式激光尘埃粒子计数器对空气中可吸入颗粒物和微生物的水平进行现场测定和分析,并对颗粒物采样进行扫描电镜的观察。
(2)新型空气净化系统的净化效率检测
选取3间20m2模拟现场空气实验室,随机分为A试验间(运行TA100空气净化机2h)、B试验间(运行TA1000空气净化机2h)和对照间(无空气净化机)进行测试,采用3511型压电天平式粉尘测定仪测量可吸入颗粒物降解率,FA-1式多级空气撞击式采样器测量白葡萄球菌杀灭率,应用4160型甲醛现场分析仪分析甲醛降解率。
(3)新型空气净化系统应用于监护室的净化效果检测
在某三级甲等医院,随机选取两间面积大小相同的监护室病房,其中一间安装有新型空气净化系统作为实验组,对空气进行动态循环净化,另外一间未安装空气净化系统的监护室作为空白对照组,采用手持式激光尘埃粒子计数器对空气中可吸入颗粒物的动态变化进行现场测定和分析。
结果:
(1)医院空气质量现状
5家三级甲等医院空气中PM2.5的浓度值为(260096.7-33097.39)个/m3,PM10的浓度值为(260980.5±33214.69315)个/m3,PM2.5是PM10的主要组成部分;随着粒径增大,颗粒物数量减少。所调查的医院监护室内空气消毒监测总体合格率为70.42%。
(2)新型空气净化系统的现场净化效果
①TA100空气净化机开机1和2h可吸入颗粒物降解率分别为47%和73.6%,TA1000空气净化机则分别为56%和77.8%,均显著高于对照组的O和3.4%(P<0.01),TA1000颗粒物降解率优于TA100(P<0.05)'
②TA100和TA1000空气净化机开机2h白葡萄球菌杀灭率分别为94.47%和99.97%,而对照组仅为55.83%,净化机组均优于对照组(P<0.01),但TA100和TA1000差异无显著性(P>0.05);
③TA100和TA1000空气净化机开机2h甲醛降解率分别为74%和83%,显著高于对照组的7.5%(P<0.01),TA1000降解率优于TA100(P<0.05)。
(3)新型空气净化系统应用于监护室的净化效果
应用TA2000空气净化机的监护室内空气中可吸入颗粒物PM1。的浓度均值为197951个/m3,PM2.。的浓度均值为197440个/m3,均显著低于对照组(P<0.05),在监测的任一时刻,实验组可吸入颗粒物浓度水平较对照组低。
本研究结果提示,医院环境空气质量存在一定问题,传统的空气净化消毒方法已不能满足现代医学的要求,此新型空气净化系统具有较高的净化效率,对医院监护室内空气中可吸入颗粒物具有较高的动态清除作用,同时对多种粒径范围的尘埃粒子均有除尘作用,除尘粒子谱广。
本研究结果为进一步研究医院环境室内空气中微生物气溶胶的分布规律提供了翔实的基础资料,对于有效控制医院感染、规范和促进动态空气净化消毒器的发展具有重要的意义,为政府开展医院感染和消毒管理工作提供了科学的依据。
Recent studies have suggested a link between exposure to ambient particulate matter <2.5μM in diameter and the hospital acquired infection. The conventional ways only temporarily reduced or inactivate the bacteria, parasites, viruses and microorganisms. However, this approach could not provide a continuously work in the environment with people. Due to exposion to fine particulate, especially to microorganism aerosol, air pollution consider as a major cause of in-hospital infections and the conventional way have nothing to do with air particulate matter <2.5μM, the dynamic air disinfection has obvious adventage and distinctions. A dynamic air disinfecting equipment contains a high strength built-in ultraviolet irradiation function, a laminar filter system, an oxygen anion generator and a starting device to survey the source of pollution automatically. Each part of the equipment is expensive and hard to maintain. Compared with conventional air disinfection way, dynamic air disinfection equipment could provide constantly purified ambient and control the germ and bacteria's concentration under specific level which would facilitate to the recover of patients. Purpose of our study is to eveluate the effect of dynamic air disinfecting equipment and to estimate its feasibility in hospital.
Our study conducted as three part as follows:
(1) Detection of air quality in hospital environment
5intensive care unit was selected as the study objects and then the degradation rates of inhalable particles and Staphylococcus were detected and analyzed by laser-dust counter. then observe on particles with Scaning Electron Microscope.
(2) Detection of efficacy of new type air purification system
3air simulated cabins was selected as the study objects and were randomly divided into3groups, group A (TA100air purifier), group B(TA1000air purifier), and blank control group C (no air purifier). And then the degradation rates of inhalable particles was measured with laser aerosol particle counter, Staphylococcus was measured with Anderson sampler, and formaldehyde of each group was measured with spectrophotometer.
(3) Detection of efficacy of new type air purification system in intensive care unit
2intensive care unit with the same area were selected as the study objects and were randomly divided into2groups, study group (air purifier is on), and blank control group (no air purifier). And then the dynamic degradation rates of inhalable particles was measured and analyzed with laser aerosol particle counter.
RESULT:
(1) Present situation of air quality in hospital
The concentration of PM2.5and PM10in5hospital is (260096.7±33097.39)/m3,(260980.5±33214.69315)/m3respectively. PM2.5is important part of PM10,the amount of particles decrease with the increase of its grain size.
(2) Efficacy of new type of air purification system in purification of indoor air
①The1h degradation rates of inhalable particles of group A and B is47%,56%respectively, The2h degradation rates of group A and B is73.6%,77.8%respectively. Both groups were significantly higher than the blank control group C (P<0.01).
②The2h degradation rates of Staphylococcus of group A and B is94.47%and99.99%respectively. Both groups were significantly higher than that of blank control group C (P<0.01)
③The2h degradation rates of formaldehyde of group A and B is74%and83%respectively. Both groups were significantly higher than that of blank control group C (P<0.01)
(2) Efficacy of new type of air purification system in purification of intensive care unit
The concentration of PM10and PM2.5in5study group(TA2000air purifer was on) hospital is197951/m3and197440/m3respectively. Both of them are lower than blank control group (P<0.05). The concentration of inhalable particles of study group is lower than blank control group.
This study revealed that qualiy of ambient air in selected hospital was disturbing. Traditional methods could not provide a satisfactory quality of air to meet the requirement in high-ranking hospital. The dynamic air disinfecting system domenstrated a high efficacy in air purificatiion and in processing ambient particulate matters.
This study has provided basicmaterials for the further study of the distribution rules of the microbial aerosols of the air inside the hospital rooms and has offered scientific grounds for the administration.
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