2种不同消毒方式对CDDS系统消毒效果的对比研究

Comparative study on disinfection effect of the two different disinfection methods for CDDS system

目的对比分别使用高浓度次氯酸钠与过氧乙酸消毒、每日夜间无消毒液浸泡,与低浓度次氯酸钠与过氧乙酸夜间浸泡消毒,2种不同消毒方式的有效性与安全性,分析夜间低浓度消毒液浸泡法用于中央透析液供应系统(central dialysis fluid delivery system,CDDS)消毒的优势。方法2017年11月~2019年11月,中国人民解放军总医院第一医学中心CDDS系统分别使用2种不同消毒方式各12个月。对比2种消毒方式下,中央透析液供应系统不同采样点细菌、内毒素水平以及消毒液夜间浸泡中浓度变化情况,评价有效性。检测2种低浓度消毒剂冲洗至安全残留浓度的时间,评价该消毒方式的安全性。结果与高浓度冲洗消毒相比,夜间低浓度浸泡消毒后透析液供给装置出口细菌菌落数(Z=-2.041,P=0.041)、内毒素(t=4.761,P=0.032)、系统管道末端细菌菌落数(Z=-2.178,P=0.029)、内毒素(t=5.405,P=0.027)均明显降低。2种消毒方式下透析机出口细菌水平(Z=-1.069,P=0.285)、内毒素水平(t=2.621,P=0.086)无统计学差异。经过夜间管道滞留,次氯酸酸钠有效浓度下降15.78%,过氧乙酸下降5.88%,浓度保持43mg/L,160mg/L;2种消毒液分别冲洗14min、16min后,残留浓度达安全水平。结论夜间低浓度消毒液浸泡法用于中央透析液供应系统消毒安全、有效,可应用于临床。

Objective To compare the effectiveness and safety of the two different disinfection methods,high concentrations of sodium hypochlorite and peracetic acid with no solution immersion every night,and low concentrations of sodium hypochlorite and peracetic acid with solution immersion every night,and to analyze the advantages of low concentration disinfectant immersion method at night in the disinfection of central dialysis fluid delivery system(CDDS).Methods During the period from November 2017 to November 2019 in the First Medical Center of the General Hospital of the Chinese People's Liberation Army,the CDDS used two disinfection methods,each for 12 months.The levels of bacteria and endotoxin at different sampling points in CDDS and the changes of disinfectant concentration during night immersion were compared between the two disinfection methods to evaluate the effectiveness.The washing time required to the safe residual concentration of the two low disinfectants was measured to evaluate the safety of the disinfection method.Results Compared with the high concentration washing disinfection,the low concentration immersion disinfection at night resulted in the decreases of bacterial colonies(Z=-2.041,P=0.041)and endotoxin(t=4.761,P=0.032)at the outlet of dialysate supply device,and the decreases of bacterial colonies(Z=-2.178,P=0.029)and endotoxin(t=5.405,P=0.027)at the end of system pipeline.There were no significant differences in the levels of bacteria colonies(Z=-1.069,P=0.285)and endotoxin(t=2.621,P=0.086)at the outlet of dialysis machine between the two disinfection methods.After the disinfectant dwelled in pipeline ever night,the effective concentration of sodium hypochlorite decreased by 15.78%to the concentration of 43mg/L,and peracetic acid decreased by 5.88%to the concentration of 160mg/L.The residual concentrations of the two disinfectants reached safe levels after washing for 14 min and 16 min respectively.Conclusion Night low concentration disinfectant immersion method is safe and effective for CDDS disinfection and can be used clinically.