救护车内污染调查、消毒现状分析及干预措施的探索

Exploration of Contamination Investigation,Disinfection Status Analy-sis and Intervention Measures in the Ambulance

目的 充分掌握当前救护车内污染程度和消毒感控管理现状,为预防、控制干预救护车规范清洁、消毒提供依据.方法 通过对随机抽检的院外医疗急救一线使用救护车、从业人员手部的菌落采样,并对车内空气、车载医疗设备及院外医疗急救从业人员手部细菌菌落定量及定性分析,全面评估当前院外医疗急救消毒、隔离、防护工作的现状及工作质量.结果 菌落采样检测抢救型救护车采样检测29项,转运型救护车采样检测14项.其中,菌落计数前6位的分别为负压吸引器4162 cfu/cm^2、气动力呼吸机1238 cfu/cm^2、氧气湿化瓶405 cfu/cm^2、升降担架车393 cfu/cm^2、软担架374 cfu/cm^2、心电监护除颤仪358 cfu/cm^2;从业人员中担架员手部菌落数远远大于急救医生和驾驶员.结论 当前清洁消毒方法单一,消毒流程不规范,救护车内污染程度严重,可能成为院内感染的重要来源之一.为此,迫切需要探索更为规范的清洁、消毒方案,建立科学的院外医疗急救消毒隔离监测评价的方法和标准,为新一轮的120院外医疗急救消毒感控管理提供科学依据.

objective To fully recognize the current situation of the contamination degree and disinfection control management in ambulances,so as to provide a basis for the prevention and control of intervention in ambulance car cleaning and disinfection.Methods By sampling the bacterial colonies of ambulances in the first line of pre-hospital medical emergency,the quantitative and qualitative analysis of the bacterial colonies in the air inside the vehicle,the onboard medical equipment and the hands of 120 pre-hospital medical first aid practitioners were carried out to comprehensively evaluate the current situation and work quality of pre-hospital medical emergency disinfection,isolation and protection.Results Colony sampling was used in 29 rescue ambulances and 14 transfer ambulances.Among them,colony counting the top 6 are negative pressure aspirator 4162 cfu/cm^2,aerodynamic ventilator 1238 cfu/cm^2,oxygen humidifier 405 cfu/cm^2,lift stretcher 393 cfu/cm^2,soft stretcher 374 cfu/cm^2,and ecg monitoring defibrillator 358 cfu/cm^2.The number of bacterial colonies in the hands of stretcher bearers was much higher than that of emergency doctors and drivers.Conclusion Current cleaning and disinfection method is single,disinfection process is not standard.The severity of contamination in ambulances,which may be one of the important sources of nosocomial infection.Therefore,it is urgent to explore more standardized cleaning and disinfection solutions,establish scientific methods and standards for pre-hospital medical emergency disinfection isolation monitoring and evaluation,and provide scientific basis for a new round of 120 pre-hospital medical emergency disinfection control management.