感染手术对共用净化系统手术环境影响的研究

Effect of contaminated surgery on surgical environment of common purification system

目的探讨在同一净化系统中感染手术与常规手术能否同时进行,是否会造成医院感染,为临床手术开展提供参考。方法将试验对象分为预试验组和试验阶段组,预试验组设计:A手术间进行感染手术12例、B手术间为空置状态,试验阶段组设计:A手术间进行感染手术16例、B手术间进行Ⅱ类手术16例;对两组A、B手术间的空气监测采用沉降法,同时对患者感染创面进行采样。结果感染创面病原菌培养:A手术间预试验阶段主要为阴沟肠杆菌32.4%、鲍氏不动杆菌21.6%,试验阶段主要为金黄色葡萄球菌20.7%、铜绿假单胞菌18.9%,B手术间患者术区取样培养以人体皮肤正常菌群为主,其中表皮葡萄球菌占56.8%;洁净手术间空气监测:A手术间沉降密度均高于B手术间(P<0.05),手术间术区及周边区空气沉降菌密度变化不明显,各时间段差异无统计学意义,空气细菌分类结果表明两组A、B手术间空气细菌基本相同。结论手术室设计合理,感染控制措施执行严格的状态下,感染手术对共用净化系统手术环境影响很小;因此在同一净化系统中感染手术能够与常规手术同时进行,不会造成医院感染的发生。

OBJECTIVE To explore the simultaneous process of contaminated surgery and clean surgery in the same purification system and observe the status of nosocomial infections.METHODS The study objects were divided into the pre-test group and the test group,the design of the pre-test group： twelve contaminated surgery were performed in room A,while room B was vacant.The design of the test group： 16 contaminated surgeries were performed in room A,and 16 type Ⅱ surgeries were performed in room B,the air in the A and B room of the two groups were monitored by sedimentation method,and the infected wounds of the patients were sampled.RESULTS The pathogen culture for the infected wound： Enterobacter cloacae（32.4%） and Acinetobacter baumannii（21.6%） were the predominant species in the room A of the pre-test group,Staphylococcus aureus 20.7%） and Pseudomonas aeruginosa（18.9%） were dominant in the test group;the bacterial flora of human skin were the main species cultured from the patients in room B,among which Staphylococcus epidermidis accounted for 56.8%;the monitoring of the air in the operating room： the sedimentation density was significantly higher in the room A than in room B（P0.05）,the change of air sedimentation density in the operating room and its surrounding area was not significant,the difference between various stages was not statistically significant,the classification of the airborne bacterial bacteria indicated that the species of the airborne bacteria in the room A were basically the same as in the room B.CONCLUSION With the reasonable design of the operating room and the strict infection control,the contaminated surgery has little impact on the surgical environment of common purification system,thus the simultaneous operation of the contaminate surgery and the routine surgery in the common purification system can not cause the nosocomial infections.