人乳库捐赠人乳病原学谱分析及关键风险控制

Pathogen spectrum analysis and key risk control of donated human milk in human milk bank

目的对人乳库捐赠人乳(donor human milk,DHM)进行病原学谱分析,探讨人乳库运行环节中的风险控制。方法采用液体增菌培养方法,对我院人乳库DHM样本进行微生物学检测。选取2015年12月至2021年12月在我院人乳库的DHM样本共1601例,按照区组随机化分为巴氏消毒前组(n=866)和巴氏消毒后组(n=735),对2组样本微生物学检测结果进行病原学谱对比分析。选取2015-2021年人乳库环境卫生学检测结果,采用趋势分析法,分析人乳库环境感染控制效果。结果巴氏消毒前DHM样本培养出病原体占比74.36%,无病原体生长占比25.64%。巴氏消毒后培养出病原体占比12.52%,无病原体生长占比87.48%。巴氏消毒后的病原体检出率显著低于消毒前,差异有统计学意义(P<0.05);消毒后致病菌检出率降低,差异有统计学意义(P<0.05)。对DHM进行厌氧和需氧培养,在DHM中共检出两种厌氧菌:产气荚膜梭菌和第三梭菌;人乳库环境卫生学监测合格率逐年递增,差异有统计学意义(P<0.05)。结论DHM无法通过巴氏消毒完全杀灭病原体,采用液体增菌培养对DHM进行微生物学检测提高病原体检出率;规范环境清洁消毒提高人乳库环境卫生检测合格率,是确保人乳库运行安全的关键风险控制点。

Objective To make pathogen spectrum analysis of donor human milk(DHM)in human milk bank and investigate the risk control in the operation of human milk bank.Methods Liquid hyperplasia culture was used for microbiological detection of DHM samples in the human milk bank of our hospital.A total of 1601 DHM samples in the human milk bank of our hospital from December 2015 to December 2021 were selected.The samples were randomly divided into pre-pasteurization group(n=866)and post-pasteurization group(n=735).The results of microbiological detection of the 2 groups of samples were further analyzed with pathogen spectrum analysis.The results of environmental hygiene test for the human milk bank from 2015 to 2021 were selected and trend analysis was applied to analyze the effectiveness of environmental infection control.Results Before pasteurization,74.36%of the DHM samples cultured with pathogens,and 25.64%of them were without pathogens.After pasteurization,12.52%of the DHM samples had pathogens and 87.48%did not.The pathogen detection rate was significantly lower after pasteurization than before disinfection(P<0.05);After disinfection,the detection rate of pathogenic bacteria was decreased with statistical significance(P<0.05).Two kinds of anaerobic bacteria were detected in the DHM samples after anaerobic and aerobic culture:Clostridium perfringens and Clostridium tertiary.The qualified rate of environmental hygiene monitoring was increased year by year in the human milk bank(P<0.05).Conclusion Pasteurization can not completely kill the pathogen in the DHM samples.The microbiological detection of the DHM by liquid enrichment culture can improve the pathogen detection rate,and the standardized environmental cleaning and disinfection can improve the qualified rate of environmental health detection in the human milk bank.It is the key risk control point to guarantee the safe operation of the human milk bank.