二氧化氯对ICU医疗环境多重耐药菌的消毒效果

Effect of chlorine dioxide on disinfection of multidrug-resistant bacteria in ICU

目的探究重症监护病房(ICU)多重耐药菌感染患者周围致病菌环境污染情况及二氧化氯在ICU医疗环境中清洁消毒效果。方法采用实验流行病学的方法,以厦门大学附属第一医院ICU一区为实验组,ICU二区为对照组,同时以ICU一区进行前后对照分析二氧化氯消毒较常规含氯消毒剂效果,并通过ICU二区前后对照排除时间因素及研究的霍桑效应。实验组采用现制现用的二氧化氯消毒液进行环境清洁消毒,对照组采用常规含氯消毒剂进行环境清洁消毒,对ICU一区和ICU二区进行环境卫生学采样,对比分析二氧化氯消毒剂在ICU隔离病房环境多重耐药菌清洁消毒效果。结果ICU耐碳青霉烯类多重耐药菌感染患者隔离病房环境物表共检出耐碳青霉烯类多重耐药菌17株,多重耐药菌检出率为6.05%(17/281),其中以呼吸机表面检出率最高为16.67%(3/18),其次为隔离病房洗手池、地面均为13.79%(4/29);环境中耐碳青霉烯类多重耐药菌检出以鲍氏不动杆菌为主(8/17,47.06%),其次为耐碳青霉烯肺炎克雷伯菌(CRKP),(4/17,23.53%);ICU一区使用二氧化氯消毒剂后环境多重耐药菌检出率较常规含氯消毒剂降低(χ^(2)=3.944,P=0.047)。ICU二区前后两阶段环境多重耐药菌检出率差异无统计学意义。结论多重耐药菌感染患者隔离病房内环境物表存在一定的多重耐药菌污染,其中以呼吸机表面最严重,其次为洗手池和地面,二氧化氯对病房环境多重耐药菌清洁消毒效果优于常规含氯消毒剂。

OBJECTIVE To explore the status of contamination of environment by pathogens in intensive care unit(ICU) patients with multidrug-resistant bacteria infection and observe the effect of chlorine dioxide on cleaning and disinfection of environment of ICU. METHODS By means of experimental epidemiology method, the first area of ICU of the First Affiliated Hospital of Xiamen University was assigned as the experimental group, the second area of ICU was assigned as the control group, and the disinfection effects of chlorine dioxide and conventional chlorine-containing disinfectants in the first area of ICU were observed and compared, the time factor and Hawthorne effect of the study were excluded by contrasting the second area of ICU.The experimental group was treated with freshly made chlorine dioxide for environmental cleaning and disinfection, the control group was treated with conventional chlorine-containing disinfectants for environmental cleaning and disinfection.Environmental hygiene sampling was carried out for the first and second area of ICU, and the effect of chlorine dioxide disinfectant on cleaning and disinfection of multidrug-resistant bacteria in ICU was observed and compared. RESULTS A total of 17 strains of carbapenem-resistant bacteria were isolated from the object surfaces of the wards, the isolation rate of multidrug-resistant bacteria was 6.05%(17/281),the isolation rate was the highest in the surface of ventilator 16.67%(3/18), followed by the hand washing sink and the ground 13.79%(4/29).Among the carbapenem-resistant multidrug-resistant bacteria that were isolated from the environment, Acinetobacter baumannii(8/17,47.06%) was dominant, followed by carbapenem-resistant Klebsiella pneumoniae(CRKP)(4/17,23.53%).The isolation rate of multidrug-resistant bacteria in the environment of the first area of ICU was significantly lower after the disinfection with chlorine dioxide than after the disinfection with conventional chlorine-containing disinfectants(χ2=3.944,P=0.047).There was no significant difference in the isolation rate of multidrug-resistant bacteria in the environment of the second area of ICU between the two stages. CONCLUSION There is certain contamination wit multidrug-resistant bacteria in the environmental object surfaces of isolation wards of the patients with multidrug-resistant bacteria infection, the surfaces of ventilators are most severe, followed by the hand washing sink and the ground, and the effect of chlorine dioxide is better than that of the conventional chlorine-containing disinfectants on the cleaning and disinfection of multidrug-resistant bacteria.