口腔科医院感染危险因素分析

Analysis on risk factors of nosocomial infection in stomatology departments

目的调查口腔科诊疗环境、器械及医护人员手污染状况,以采取有效措施减少口腔诊疗过程中的交叉感染及医护人员职业暴露。方法采用询问、对照检测(医护人员手、诊室空气、诊疗器械细菌量及经血液与体液传播疾病的血清学检测)等方法调查5所医疗机构的口腔科,并进行统计分析。结果诊疗操作后未实施和实施卫生洗手的医护人员手采样细菌数不合格率分别为49.23%、9.23%(χ2=11.79,P<0.01)。口腔周围20cm、40cm、60cm、80cm距离内空气细菌菌落数分别为:(875.37±112.74)CFU/m3、(584.21±97.86)CFU/m3、(436.01±86.54)CFU/m3、(356.69±74.23)CFU/m3,随着口周距离的增大,污染细菌平均菌落数逐渐减少(χ2=15.74,P<0.01)。口腔科与内科诊室医护人员乙型肝炎表面抗原(HBsAg)阳性率分别为10.81%、0.00%,乙型肝炎表面抗体(抗HBs)阳性率分别为56.76%、21.43%;抗HCV阳性率分别为2.70%、0.00%;两两比较,差异均有高度显著性(均P<0.001)。分别对灭菌前、后的手机表面进行HBsAg、HBVDNA检测,阳性率分别为53.21%、22.14%和1.92%、16.79%。结论口腔科诊疗环境(空气)、器械及医护人员手污染严重,应加强标准预防及职业卫生安全防护等相关知识培训,以提高医护人员职业安全防范意识,规范诊疗技术操作。

Objective To investigate the contamination of environment, medical instruments and hands of health care workers （HCWs） in stomatology departments, so as to adopt effective measures for the reduction of cross infection and HCWs occupational exposure. Methods Stomatology departments in 5 hospitals were investigated by inquiring and control detection methods （bacterial counts of hands of HCWs, air in consulting room, medical instruments, and serological test of blood and fluid-transmitted disease）, and statistical analysis was made. Results After performing medical manipulation, the unqualified rate of bacterial counts of hands of HCWs without hygienic hand washing was 49.23%, and the percentage dropped to 9. 23% after hygienic hand-washing（X^2 = 11.79, P〈 0. 01）. The colony counts of air in the distance of 20cm, 40cm, 60cm and 80cm to the mouths were （875.37±112. 74） CFU/m^3 , （584. 21±97. 86） CFU/m^3, （436.01 ± 86. 54） CFU/m^3 and （356. 69±74. 23） CFU/m^3, respectively, the average bacterial counts decreased gradually with the increase of distance to the mouths （X^2 = 15.74, P〈0. 01）. The positive rate of HBsAg in HCWs in department of stomatology and internal medicine was 10. 81% and 0. 00% respectively, the positive rate of anti-HBs was 56. 76% and 21.43G respectively, the positive rate of anti-HCV was 2. 70G and 0. 00% respectively; there was significant difference between the two respectively （All P〈0. 00l ）. The positive rate of HBsAg and HBV DNA in dental handpieces before and after sterilization was 53.21%, 22. 14%, 1.92 % and 16. 79 % respectively. Conclusion The contamination on environment, medical instruments and hands of HCWs in stomatology departments is serious, the training on standard precaution and occu-pational hygienic safety should be strengthened, so as to enhance the awareness of HCWs about occupational safety and standardize medical manipulation.