枯草杆菌干预金属器械经不同灭菌方式的时效性研究

Chronergy Study of Bacillus subtilis interfering metal instruments by different sterilization methods

目的采用低温过氧化氢等离子灭菌和脉动预真空压力蒸汽灭菌技术探索枯草杆菌黑色变种芽孢干预金属器械后灭菌的时效性。方法将我科消毒灭菌的4 000件金属器械随机分为2组,人工清洗组采用传统手工清洗,机器清洗组使用酶清洗剂超声清洗。取枯草杆菌菌悬液分别在1、2、3、4h后滴染清洗合格的金属器械各100件,采用不同灭菌方式进行消毒,比较清洁器械不同时间点的灭菌效果;根据灭菌结果选择合格的金属器械分别在3、6、8、10、12月随机抽样各100件,进行枯草杆菌黑色变种芽孢的培养及三磷酸腺苷(ATP)检测,同时设立阴、阳性对照试验,比较不同灭菌方式的灭菌效果及灭菌物品的有效期限。结果无论是目测法、蛋白棒法测定法还是隐血试纸法,机械清洗组的清洗合格率均明显高于人工清洗组,差异有统计学意义(P<0.05)。洁净金属器械在2h内及时灭菌可达到100%合格的标准,3h后压力蒸汽灭菌器灭菌效果达到94%,高于等离子灭菌器的91%,但差异无统计学意义(P>0.05),而4h后压力蒸汽灭菌器的灭菌效果(88%)显著高于等离子灭菌器(75%),差异有统计学意义(P<0.05)。经等离子灭菌的金属器械放置6个月后枯草杆菌未检出,经压力蒸汽灭菌的金属器械放置8个月后枯草杆菌未检出。经2种方式灭菌的金属器械放置6个月后,ATP荧光检测均未见RLU值超标,但8个月后,压力蒸汽灭菌的金属器械ATP荧光检测的合格率为97%。结论相比传统人工清洗法,机械清洗法对金属器械的清洗效果更好。采用不同的灭菌方式2h内均可达到灭菌的效果,灭菌合格后6个月为2种灭菌方式有效期。

Objective To explore the sterilization chronergy of metal instruments contaminated with Bacillus subtilis,which were then sterilized by low temperature hydrogen peroxide plasma sterilization and pulsating vacuum pressure steam sterilization.Methods A total of 4 000 pieces of surgical instruments were divided into two groups randomly.The artificial cleaning group underwent traditional handwashing combined with hypothermia sterilization,while the mechanical cleaning group underwent enzymatic ultrasonic cleaning.After cleaning for 1,2,3 and 4 hours,100 pieces of qualified metal instruments were contaminated with Bacillus subtilis,and sterilized by different sterilization methods and comparing the sterilization effect at different time points of clean instruments.Selecting qualified metal instruments according to the results of sterilization,100 random samples were sampled in third,sixth,eighth,ten,and twelve month.Detection of Bacillus subtilis and detection of bacteriology and detection of adenosine triphosphate were carried out.Setting up a negative and positive control test,the negative control was sterile saline,the positive control was Bacillus subtilis suspension.Explore the effect and expiration date of different sterilization methods.Results Whether visual method,protein stick method or occult blood test paper method,the cleaning rate of mechanical cleaning group was significantly higher than that of artificial cleaning group,the difference was statistically significant（P 0.05）.The clean metal apparatus can be sterilized in time to reach 100% standard in 2 h,and the sterilization effect of pressure steam sterilizer after 3 his94%,higher than 91% of plasma sterilizer,but the difference is not statistically significant（P 0.05）,and the sterilization effect of pressure steam sterilizer after 4 h（88%）is significantly higher than that of plasma sterilizer（75%）.There were statistical significance（P 0.05）.Bacillus subtilis was not detected after 6 months of plasma sterilization and 8 months of pressure steam sterilization.After 6 months of two methods of sterilization of metal instruments,ATP fluorescence detected no RLU value,but 8 months later,the qualified rate of ATP fluorescence detection by pressure steam sterilization was 97%.ConclusionThe sterilization effect can be achieved within 2 hours with different sterilization methods,and the 6 months after sterilization is the effective period of two sterilization methods.