儿童医院医疗废物处置路径的病原微生物监测及溯源探索

Pathogenic microorganism monitoring and traceability exploration of medical waste disposal routes in children’s hospital

目的通过模型科室医疗废物处置路径的微生物分析,探究路径的微环境、防控难点及管理意见。方法依标准流程完成模型科室医疗废物处置路径消毒前后不同时段的采样及分析,重要病原菌耐药性及分子分型溯源分析,并评估模型科室医疗废物处置全路径应用消毒方案的动态效果。通过消毒前后的环境监测,评估相关场所及手套消毒实施的高效频率及应用效果。结果多数分离菌株为环境微生物,也分离到鲍氏不动杆菌、铜绿假单胞菌、肺炎链球菌、粪肠球菌和屎肠球菌等,并发现一株多重耐药性的鲍氏不动杆菌株。通过分型溯源,发现多株鲍氏不动杆菌是不同遗传来源且两株来自同一克隆系。应用原创检测技术未检出路径中存在沙门菌、志贺菌污染。新冠病毒及诺如病毒未被检出,但轮状病毒的环境污染明显。结论现用手消试剂无法彻底解决轮状病毒随机传播风险,及时甚至频繁更换手套是工作流程中的简便方案。消毒过的医疗废物转运车经过一定路径后易成为轮状病毒的污染源,医疗废物处置人员要及时更换车才可入其他病区。针对保洁人员卫生专业能力弱,给予简便易行的流程指南是当前最有效的方案。

OBJECTIVE Due to the lack of effective monitoring of microbial spectrum of medical waste collection, transport, storage and transfer path, as well as the evaluation of disinfection effects in medical institutions, this study aimed to explore the microenvironment, prevention and control difficulties and management opinions of medical waste disposal path through the microbial analysis of the medical waste disposal path in model departments. METHODS According to the standard process, the environmental samples at different time periods before and after the disinfection of the medical waste disposal path in the model department were collected and analyzed. The drug resistance and molecular typing traceability of important pathogens were analyzed. And the dynamic effect of the whole path application of the disinfection scheme for medical waste disposal in the model department were evaluated. Efficient frequency and application effect of disinfection of and hygiene of relevant places and gloves were evaluated through environmental monitoring before and after disinfection. RESULTS Most of the isolated strains were environmental microorganisms, Acinetobacter baumannii, Pseudomonas aeruginosa, Streptococcus pneumoniae, Enterococcus faecalis and Enterococcus faecium were also isolated, and a multidrug-resistant A. baumannii strain was identified. Through typing and tracing the source, the multiple strains of A. Baumannii were found to be of different genetic origins and the two strains were from the same clonal line. Using original detection technology, no contamination of Salmonella and Shigella was found in the path. The new coronavirus and norovirus were not detected. However, the environmental pollution of rotavirus was obvious. CONCLUSION The risk of random transmission of rotavirus cannot completely solved by existing hand-sterilized regents. Timely or even frequent replacement of gloves is a simple solution in the workflow. The sterilized medical waste transfer vehicles are likely to become the pollution source of rotavirus after passing through a certain medical waste path. The medical waste disposal personnel should replace the rotating vehicle in time before entering other wards. In addition, due to the weak professional ability of cleaners, simple and easy process guidelines is the most effective solution at present.