过氧化氢等离子灭菌循环方式及效果评价方法研究

Cycle mode and effect evaluation method of hydrogen peroxide plasma sterilization

目的探讨过氧化氢等离子灭菌过程中不同循环方式的灭菌效果及特殊情形下对器械进行过氧化氢等离子灭菌循环方式的选择,最大限度消除影响手术器械灭菌质量的隐患,保障患者诊疗安全。方法按照循环方式不同分为实验组(长循环)和对照组(短循环),实验组为2016年4-6月120锅次;对照组为2016年1-3月120锅次,标本共计3 840个。根据不同灭菌情形分为(ABCD)组,A为两锅之间间隔时间>4h;B为器械装载量≥80%时;C为放入非兼容器械时;D为灭菌剂在保质期内由于运输引起的暴晒、高温、剧烈晃动等因素造成浓度下降时,待灭菌包均依据医院消毒供应中心操作规范进行清洗、消毒、干燥、包装,监测评价灭菌效果,并进行分析。结果实验组和对照组生物PCD监测合格率分别为83.33%和6.67%,差异有统计学意义(P<0.001);两组化学PCD监测合格率分别为80%和6.67%,差异有统计学意义(P<0.001);同组生物测试剂和生物PCD监测合格率分别为86.67%和6.67%,差异有统计学意义(P<0.001);同组化学指示卡和化学PCD监测合格率分别为96.67%和6.67%,差异有统计学意义(P<0.001)。结论在过氧化氢等离子灭菌过程中,使用长循环对器械进行灭菌可显著提高管腔及复杂器械的灭菌质量;特殊情形下更应选择长循环进行灭菌;灭菌过程挑战装置PCD的监测结果更精确。

OBJECTIVE To discuss the sterilization effects of different cycle modes with hydrogen peroxide plasma sterilization and the selection of cycle under special circumstances,so as to minimize the hidden dangers of health risks caused by unqualified sterilization to ensure patients′safety.METHODS STERRAD 100Slow-temperature hydrogen peroxide plasma sterilizers were divided into experimental group（long cycles,from Apr.to Jun.2016）and control group（short cycles,from Jan.to Mar.2016）according to different cycle modes.Under 4different situations（Group A,B,C,D）that caused unqualified sterilization effect and were challenging to monitor with current methods,120 loads of instruments were sterilized with different lengths of cycles respectively.The time interval between two loads in group A was 4hours,sterilization load in group B was ≥80%,instruments not compatible with the process were loaded in group C,and sterilization agent diluted due to factors like excessive sun exposure,high temperature or violent shaking during transportation belonged to group D.Sterilized bags were cleaned,disinfected,dried,and packaged according to hospital disinfection supply center operation standards,and the sterilization effects were monitored,evaluated,and analyzed.RESULTS Comparison between experimental group and control group,the qualified rates of Nordonbio 628 biological PCD were 83.33%and 6.67%respectively with a significant difference（P〈0.001）,qualified rates of Nordonbio 728（PCD）were 80% and 6.67% respectively with a significant difference（P〈0.001）;qualified rates of CycleSureTMbiological test agent and Nordonbio628biological PCD in the same group were 86.67% and 6.67% respectively with a significant difference（P〈0.001）;and qualified rates of STERRAD chemical indicators and Nordonbio 728（PCD）in the same group were 96.67% and 6.67% respectively with a significant difference（P〈0.001）.CONCLUSIONIn the process of hydrogen peroxide plasma sterilization,using long cycle for sterilization can significantly improve sterilization quality of the lumens and complex instruments.Long cycle sterilization should be chosen under special circumstances,and PCD monitoring results are more accurate during the sterilization process.