5家医院67例消毒负效应案例分析

Analysis of negative effects of disinfection on 67 cases in 5 hospitals

目的了解医疗机构消毒负效应发生情况,为医院合理使用消毒产品提供建议,减少消毒负效应的发生。方法选择北京、上海、湖南、黑龙江4个省市的5家三级医院,开展了为期1年的消毒产品负效应的监测,监测对象为接触消毒剂、消毒灭菌器械及可能消毒灭菌因子残留的所有医务工作者、患者、环境物品及医疗器械,对获得的消毒负效应案例按产品主要成分、接触途径和损害特征等进行统计分析。结果经过1年的监测,共发现67例消毒负效应案例,其中人员消毒负效应54例,年龄主要集中于20~50岁,男女比例为1∶2.4,主要损害表现为皮肤黏膜的刺激及过敏反应,发生率前3位主要成分为葡萄糖酸洗必泰+乙醇、三氯异氰尿酸和醋酸氯已定。共发现物品消毒负效应13例,主要损害表现为结构腐蚀,其中含氯消毒剂所占比例最高。结论医院应增强对消毒负效应的重视程度,了解不同种类消毒产品对人员、器械及环境物品的损害特征,加强个人防护,严格按照产品操作规程开展消毒灭菌工作。

Objective To understand the status of adverse effects of disinfection in hospitals,so as to offer advices for rational use of disinfection products and to reduce the occurrence of adverse effects of disinfection. Methods Five tertiary hospitals in Beijing,Shanghai,Hunan and Heilongjiang provinces were chosen to monitor the negative effects of disinfection products for one year. The monitoring objects were the person or medical instruments or environmental materials that might contact with disinfectants or might contain residual disinfectants. The adverse effects of disinfection were analyzed statistically according to the main components,contact routes and damage characteristics,etc. Results After one year of monitoring,67 cases of adverse effects of disinfection were found,including 54 cases of human adverse effects,and the age was mainly between 20 ~ 50 years old,and the ratio of male to female was 1 ∶ 2. 4. The main damages to human were manifested by irritation and hypersensitivity of the skin and mucous membrane. The main components of top three products were chlorhexidine gluconate ＋ ethanol,trichloroisocyanuric acid and chlorhexidine acetate. 13 cases of environmental materials/instruments adverse effects were found. The main damages were structural corrosion,of which chlorine disinfectant occupied the highest proportion. Conclusion Hospitals should pay more attention to the adverse effects of disinfection,and to understand the different types of damage to the personnel,medical instruments and environmental materials. Hospitals should strengthen personal protection,and carry out disinfection and sterilization work in accordance with the product specifications.