创新样本采样器在透析用水水质监测中的应用

An innovative water sampling method for quality monitoring of dialysis water

目的 分析探讨创新的水质样本采样器在透析用水细菌及内毒素监测中的应用效果。方法选取第三军医大学附属大坪医院肾内科血液净化中心2015年11月1日~2016年2月1日的36台血液透析机进行,按三种不同的样本采集方法采集水质标本。3组样本抽取方法分别为：（1）常规组：用碘伏等方式消毒旁路端口后无菌空针抽取采集;（2）创新组：采用水质监测采样器进行采样,在透析液填充旁路端后,用碘伏消毒采样口,用无菌空针插入采样口采集样本;（3）标准组：透析液能填充旁路端后,在透析器的旁路出水端采集。每周不重复采集3台透析机的水质样本,进行内毒素和细菌菌落数的检查,连续监测3个月,并统计采集样本所消耗时间。以标准组为样本检测准确度的金标准,将另外2组的检查结果分别与标准组进行差异性比较分析。结果 将3组组间采用单因素方差分析,进一步的两两比较采用Dunnett-t检验得出：与标准组相比,常规组水质监测内毒素含量上升29.7%具有统计学意义（P=0.006）,细菌菌落数增多32.2%;而创新组水质监测内毒素含量上升4.5%,无统计学意义（P=0.976）,细菌菌落数增多7.6%。同时,与常规组相比,创新组水质采集样本所消耗时间减少1.88%。结论 采用创新的水质样本采样器与标准法的采样结果无差异性,但创新组采集样本所消耗的时间最短,在提高检查准确度的同时有效的提高了工作效率,避免因人为因素导致的假阳性或假阴性结果,更有力的保障了治疗安全,同时提高了工作人员的满意度。

Objective To explore the application of the innovative water sampling method for endotoxin and bacterial colony count assays in the quality monitoring of dialysis water. Method The investigation was carried out on 36 units of blood dialysis machine during Nov. 1, 2015 to Feb. 1, 2016. Three water sampling methods for water quality monitoring were used： （1） Conventional method taking water sample from the bypass port. After sterilization of the bypass port with iodine volts, water sample was taken by a sterilized syringe from the sterilized bypass port. （2）The innovative method taking water sample from water quality monitoring sampler. The bypass port end was filled with dialysate, sterilized with iodine volts and then with ethanol after 2 minutes to take off iodine. A 5ml sterilized syringe was inserted into the sampler end to get water sample. （3） Standard method for water sampling. After the bypass port end filled with dialysate, water sample was taken from the dialyser bypass water outlet end, taking care of the needle not touching the outlet wall. No more than 3 water samples in a week were taken from a dialysis machine. Endotoxin and bacterial colonies in water samples were examined continuously for 3 months. The time used for water sampling was statistically analyzed. The examination accuracy of the samples taken by standard method was recognized as the golden standard to compare with that taken by conventional method and that taken by the innovative method. Results Analysis of variance for single factor and Dunnett t test for further comparison of two variables found that endotoxin increased by 29.7% （n=36, P=0.006） and bacterial colonies increase by 32.2% in water samples by conventional method as compared with those by standard method; endotoxin increased by 4.5% （n=36, P= 0.976） and bacterial colonies increased by 7.6% in water samples by the innovative method as compared with those by standard method. The time used for water sampling reduced by 1.88% by using the innovative method as compared with that by using conventional method. Conclusion Water samples taken by the innovative method and those taken by standard method had no differences in water quality monitoring results. However, the time for water sampling using the innovative method was the shortest among the three water sampling methods. Therefore, the innovative method increased the working efficiency and preserved the same examina- tion accuracy. This method also reduced the working strength and working procedures for the technicians and other professionals in the infection-control department, reduced the false negative and false positive results due to cumbersome procedures, improved the treatment safety for the patients, and also increased the satisfaction of the medical professionals.