氧气通路中连接口及湿化液细菌污染的监测与分析

Nonitoring and analysis of oxygen passage connecting port and the wet fluid bacterial contamination

目的:调查氧气通路中连接口及湿化液细菌污染情况,探讨科学的防范措施,减少院内感染的发生。方法:分别以有效氯含量为500 g/L的消毒液及0.5%聚维酮碘消毒液对我院呼吸、消化科使用中的壁式供氧装置连接口进行消毒,2 min内无菌生理盐水棉拭子涂擦送检细菌培养;另对普通及一次性吸氧装置中湿化液在使用前、使用6,12,24 h及使用2,3,4,5,6,7,8,9,10 d进行微生物学监测。结果:两消毒法涂擦连接口后仅检出个别非致病菌,而无致病菌检出。使用前普通及一次性吸氧装置中湿化液合格率分别为96%及100%,普通吸氧装置组不同使用时段,均有细菌检出,至使用后24 h合格率(60%)明显降低。一次性吸氧装置组,使用至第7天,每个时段合格率均为100%,使用第8天合格率(84%)开始下降。进一步菌谱分析显示被污染湿化液中致病菌以铜绿假单胞菌为主。结论:连接口消毒以500 g/L有效氯消毒液及0.5%聚维酮碘消毒液处置均可,建议使用前者;一次性吸氧装置优于普通吸氧装置,建议前者使用时限不超过7 d,最好每日更换氧气湿化瓶及湿化液。

Objective ： To survey the bacteria pollution situation of the oxygen pathway connectors and wetting liquid, and to explore the scientific precaution- ary measures for reducing the occurrence of nosocomial infections. Methods ： Disinfecting the wall oxygen supply instrument connectors in the respiratory and digestive departments by 500 g/L active chlorine and 0.5% povidone iodine respectively, and bacteria culture was taken by cotton swab inunction within 2 minutes. Meanwhile, microbiological monitoring of wetting liquid in common and disposable oxygen devices was performed before and 6 h, 12 h,24 h,2 - 10 d after used. Results ： Only individual nonpathogenic bacteria but no pathogenic bacteria were detected on the tube connectors disinfected by two disinfection methods. The detection rates had no obvious difference between two methods. Before using, the qualification rate was 96.0% and 100%, respectively for wet- ting liquid in ordinary and disposable oxygen device. Bacteria were positive for the ordinary oxygen device at each point. And the qualification rate was only 60% by the time of 24 h after used. For the disposable oxygen device,qualification rate was 100% at each point till day 7. And the rate （84%） began to drop at day 8. Further bacteria spectrum analysis showed that pathogenic bacteria contaminating the wetting liquid is given priority to pseudomonas aerugino- sa. Conclusion：Both 500 g/L available chlorine and 0.5% povidone iodine were effective disinfectants for the tubes connectors,while the former was more recommended. Disposable oxygen device is superior to the ordinary oxygen device. The use time limited within 7 days was suggested for the former. And daily changing the oxygen bottle and wet process of wetting liquid was strongly recommended for the latter.