比较三种检测方法在检测医院高频接触物体表面清洁消毒效果的作用和成本效果

Comparison among 3 methods used to test the cleaning and disinfection effectiveness of high frequent contacted surfaces in hospital

目的比较ATP生物荧光检测法、菌落计数法和荧光标记法在检测医院高频接触物体表面清洁消毒效果中的作用及成本效果。方法将某三级医院重症监护室(ICU)的120个高频接触物体表面随机分为三个检测组,每组共40个采样点,在同一时段分别检测其清洁消毒前后的相对光单位(RLU)值、细菌总数和清洁消毒后的荧光标记清除情况,比较三种方法检出率的差异,并计算检测成本,比较成本效果比值。结果清洁消毒后,高频接触物表的菌落总数中位数由9.07 cfu/cm^2降至2.47 cfu/cm^2,差异有统计学意义(t=5.844,P<0.016 7);RLU值中位数由378降至211,差异有统计学意义(t=4.353,P<0.016 7);菌落计数法检测合格率最高(80%),其次是ATP生物荧光检测法(72.5%),荧光标记法最低(42.5%),三者间差异有统计学意义(χ~2=13.846,P<0.016 7);三种方法检测合格率两两比较,菌落计数法和ATP生物荧光检测法差异无统计学意义(χ~2=0.621,P>0.016 7),荧光标记法检测合格率低于菌落计数法和ATP生物荧光检测法,差异有统计学意义(χ~2=11.85、7.366,P<0.016 7);三种方法成本效果比值由高到低依次为:ATP生物荧光检测法41.45元,菌落计数法35.50元,荧光标记法2.35元。结论三种方法均可用于评价医院高频接触物表清洁消毒效果,但荧光标记法更具有成本效果,值得普遍推广。

Objective To compare the effect and the cost-effectiveness among ATP bioluminescence assay,flat colony counting method and fluorescence labeling method on evaluating the cleaning and disinfection effectiveness of high frequent contacted surfaces in hospital. Methods 120 high frequent contacted surfaces in an ICU of a tertiary hospital were randomly divided into 3 test groups,each group contained 40 testing points. Three groups＇ relative light units（RLUs）,colony forming units（CFU）and elimination rate of fluorescence labeling were all detected at the same time before and after cleaning and disinfection. The eligible rates of 3 methods were compared,their costs were calculated and the cost-effectiveness was compared. Results After cleaning and disinfection,the median of the total bacterial count on the high frequent contacted surfaces decreased from 9.07 cfu/cm^2 to 2.47 cfu/cm^2;the differences were statistically significant（t=5.844,P〈0.05/3）.The median of the RLUs on the high frequent contacted surfaces decreased from 378 to 211;thedifferences were statistically significant（t=4.353,P〈0.05/3）. The eligible rate of flat colony counting method,was the highest,80%;ATP bioluminescence assay was 72.5%,and fluorescence labeling method was the lowest,42.5%,and the difference among them were statistically significant（χ~2=13.846,P〈0.05/3）. As compared the eligible rate among three methods,flat colony counting method and ATP bioluminescence assay had no significant difference（χ~2=0.621,P〉0.05/3）,while differences between fluorescence labeling method and flat colony counting method（χ~2=11.85,P〈0.05/3）,and between fluorescence labeling method and ATP Bioluminescence assay（χ~2=7.366,P〈0.05/3）were statistically significant.The cost-effectiveness ratio of ATP Bioluminescence assay,flat colony counting method and fluorescence labeling method were 41.45 Yuan,35.50 Yuan and 2.35 Yuan,respectively. Conclusion These three methods were adapted to evaluate the cleaning and disinfection effectiveness of high frequent contacted surfaces in hospital,but the fluorescence labeling method was the most cost-effectiveness.