ICU复用性呼吸机管道不同清洗消毒方法效果比较

Comparisons of Two Different Ways to Wash and Sterilize Reusable ICU Ventilator Pipes

目的探讨不同清洗消毒方法用于复用性呼吸机管道系统的消毒效果。方法ICU病人连续使用7 d的复用性呼吸机管道和湿化器,分别采用5%有效氯清洗消毒剂浸泡(对照组)、全自动清洗消毒器经济程序(观察组1)和全自动清洗消毒器经济程序加蒸汽灭菌消毒程序(观察组2)方法清洗消毒,每组各30套。分别于消毒前、消毒后放置治疗室后3 d采样,进行细菌培养及细菌菌落计数,比较3组的细菌杀灭率和细菌阳性率。结果(1)消毒前所有样本细菌培养阳性率为100%,呼吸机管道细菌数超过1万cfu/cm2,湿化器中湿化水细菌数为29万～69万cfu/ml。(2)消毒后3组细菌杀灭率均达标。(3)消毒后放置治疗室3 d后,观察组2的细菌阳性率为零,优于其他两种方法(P<0.05);对照组同观察组1存放3 d后细菌阳性率比较,差异无统计学意义(P>0.05)。结论呼吸机管道和湿化器的污染相当严重,3种消毒方法均能达到高水平消毒,但全自动清洗消毒器经济程序加蒸汽灭菌器消毒程序对ICU内复用性呼吸机管道系统的消毒效果最佳。

Objective To explore the sterilization effect of two different ways to wash and sterilize reusable ICU ventilator pipes. Methods 30 complete sets of reusable ventilator pipelines and humidifiers in the control group were sterilized with 5% chlorine disinfectant, another 30 sets with fully automatic washer disinfector at economic program as the first observation group and the last 30 sets as the second observation group with fully automatic washer disinfector plus steam sterilization. The samples from circuits and humidifiers were cultured before and after sterilization and the numbers of bacterium colony forming unit （CFU） were counted. The bacterium-killing rate and positive rate were compared between them. Results （1）Before sterilization, the positive rates of all groups were 100% and the colonies exceeded 10 000 cfu/cm^2 and 290 000-690 000 cfu/ml in number in the pipes and in the humidifiers, respectively. （2）After sterilization, the bacterium-killing rates of all groups met the standard. （3）3 days after sterilization, the positive rate of the second observation group was zero, better than other two groups （P〈0.05）, but there, were no difference between the control group and the first observation group （P〉0.05）. Conclusion The ventilator pipes and humidifiers after continuous use are severely contaminated. The three methods are effective for their sterilization, but the method by fully automatic washer disinfector plus steam sterilization is the best.