某市血液透析现状及透析用水和透析液质量合格情况调查

Status of hemodialysis and qualified status of dialysis water and dialysate in a city

目的了解某市血液透析现状及透析用水和透析液合格情况。方法对该市36所开展血液净化项目的医疗机构血液透析现状进行调查,并同时采集透析用水及透析液分别进行微生物检验(包括常规和低温培养方法)及现场ATP水样检测。结果 13.89%的水处理设备使用时间在1年内,5.56%的设备使用超过10年。砂滤等净化设备超过1年未更换的机构占77.78%,72.22%的滤芯式过滤器更换时间<3个月,反渗水供水管道使用时间超过10年的占2.78%。77.78%的医疗机构使用成品A液,72.22%使用成品B液,集中提供A液的医疗机构占22.22%,集中提供B液的医疗机构占19.44%,自配桶装B液的医疗机构达8.34%。36所医疗机构微生物日常检测均合格,但有80.56%检测结果长期为"0"值;现场采集的透析用水及透析液ATP检测均合格;常温微生物检验1份超标,2份达干预值;低温培养法4份超标,6份达干预值;不同级别医疗机构之间3种检测方法合格率比较,差异均无统计学意义(均P>0.05)。结论该市透析用水及透析液的质量总体较好,大部分医疗机构重视水处理设备的日常维护,定期检测透析用水和透析液的质量,但是微生物检测技术有待提高,日常检测结果异常或达到干预值需要分析原因和不断改进。

Objective To investigate current status of hemodialysis,and qualified status of dialysis water and dialysate in a city.Methods Status of hemodialysis in 36 medical institutions in a city which conducted blood purification programme was surveyed,dialysis water and dialysate were collected to perform microbial detection(including conventional and low temperature culture methods)and on-site ATP detection.Results 13.89%of equipments for water treatment were used less than 1 year,5.56%were used for more than 10 years.77.78%of medical institutions didn’t replace sand filtration which had been used for more than 1 year,the replacement time of 72.22%of filter core was less than 3 months,2.78%of reverse water supply pipeline was used for more than 10 years.77.78%of medical institutions used finished A solution,72.22%used finished B solution,22.22%used centrally provided A solution,19.44%used centrally provided B solution,and 8.34%used self-made B solution.Routine microbial detection in 36 medical institutions were qualified,but 80.56%of detection results were"0"value for long period;ATP detection of on-site collected dialysis water and dialysate were all qualified.One specimen for microbial detection under normal temperature exceeded the standard,2 reached the intervention value;4 specimens for microbial detection under low temperature exceeded the standard,6 reached the intervention value;qualified rates of 3 kinds of detection methods among different levels of medical institutions weren’t significantly different(all P>0.05).Conclusion The overall quality of hemodialysis water and dialysate in this city is good,the majority of medical institutions pay attention to the routine maintenance of water treatment equipment,detect the quality of hemodialysis water and dialysate regularly,but microbial detection technique needs to be improved,causes for abnormal results or intervention value of routine detection needs to be analyzed and improved continuously.