洁净手术室术中器械和空气的细菌学动态监测

Dynamic Bacteriological Monitoring of Apparatus and Air in Disinfected Operation Rooms

目的了解洁净手术室无菌手术中不同时间段器械及空气污染情况,为医院感染的预防和控制提供依据。方法选择手术持续时间7 h或以上的无菌手术,动态采集Ⅰ～Ⅳ级洁净手术间术前和术中5 h、6 h、7 h器械表面及手术间空气标本进行细菌学监测。结果Ⅰ～Ⅳ级洁净手术间于术中5 h、6 h、7 h采集的200个空气样本中除有6个超标外其余的空气样本都能达到国家标准;术中5 h、6 h、7 h采集的共600件器械样本中共45例阳性,术中使用过且暴露于空气中的器械阳性率最高,用无菌治疗巾覆盖使用过的器械阳性率最低。结论同一台无菌手术的无菌器械使用的安全时段可延至7 h,影响无菌器械使用的不安全因素与器械表面残留的血迹和是否直接暴露于空气中有关,器械护士术中应及时清洁附着在器械表面的血迹或用无菌治疗巾覆盖使用过的器械。加强洁净手术室日常管理,切实做好参观人员的控制及人员的流动管理,是确保手术安全、预防感染的关键因素。

Objective To learn about the infection in the disinfected operation rooms at different stages of operations, and thus to provide a basis for prevention and control of infections in the operation room. Methods Operations lasting 7 hours or more were selected, and dynamic bacteriological monitorings were made of the the surface of the apparatus and sample air within the Grade Ⅰ～Ⅳ disinfected operation rooms before the the surgery and at the 5th, 6th, and 7th hours in the operation. Results Of the 200 air samples collected, all but six were up to the national standard; of the 600 pieces of surgical tools collected, 45 were positive, with those used in the operation and exposed in the air showing the highest rate of positivity, while those covered with aseptic dressing towels demonstrating the lowest positivity rate. Conclusion Within an operation, the safety time for use of the various tools can last 7 hours; the factors affecting the safety of the disinfected tools include blood stains left on the tools and exposure to the air. Nurses should cleanse the tools of blood stains left and cover them with aseptic dressing towels. Also, daily management of the operation room should be strengthened, and visitors and other mobile population to the operation room should be well controlled.