深圳市宝安区医疗机构消毒监测情况及其菌种特征分析

Surveillance and analysis of disinfection in medical institutions and bacterial distribution and drug resistance in Bao’an district,Shenzhen

目的 了解深圳市宝安区医疗机构常规消毒效果,分析诊疗环境中消毒不合格样本的细菌分布和耐药特征,为制定医院感染防控策略提供指导依据。方法 按照GB 15982-2012《医院消毒卫生标准》对深圳市宝安区医疗机构常规消毒效果进行监测,分析2014—2020年辖区医疗机构常规消毒效果,并对2019—2020年诊疗环境中消毒不合格样本应用VITEK 2全自动微生物鉴定仪鉴定细菌种属和耐药性。结果 2014—2020年采集辖区医疗机构消毒效果监测样本13 358份,包括消毒后的空气、医护人员手表面、物体表面、压力灭菌器、内镜以及使用中的消毒剂。细菌总数合格12 507份,总合格率为93.6%,其中,压力灭菌效果和使用中消毒剂这两项监测指标合格率均达95%以上;医院空气、医护人员手表面和消毒后内镜这3项监测指标的合格率均在85%以下。菌种鉴定结果表明,45份消毒监测细菌总数不合格样本中分离的菌株以革兰阳性葡萄球菌为主,占86.7%。耐药性检测结果表明,23份细菌总数不合格样本中分离的菌株耐药性高达86.96%,其中10株出现对3种及以上抗生素同时耐药的多重耐药现象。结论 尽管宝安区医疗机构消毒质量整体状况较好,但医护人员、医院空气和消毒内镜的消毒质量不稳定,消毒后的空气、医护人员手表面、物体表面和内镜等诊疗环境中仍然存在多种条件致病性葡萄球菌,并具有较高的耐药性,各医疗机构应引起高度重视。

Objective To investigate the effect of routine disinfection in medical agencies in Bao’an district,Shenzhen,and analyze the microbial composition and drug resistance characteristics of improperly disinfected samples that were collected in the environment of diagnosis and treatment areas,thereby provide evidence to optimize the procedure for the infection control in hospitals. Methods According to GB 15982-2012 "Hygienic Standard for Hospital Disinfection",the effect of routine disinfection in medical agencies of Bao ’an district was regularly surveillanced. The surveillance results from 2014 to 2020 were analyzed,the bacterial composition and characteristics of drug resistance were further measured for the unqualified samples that were collected in the area of diagnosis and treatment by VITEK2 system.Results From 2014 to 2020,a total of 13 358 samples were collected from the air,surfaces of medical staff hands,instruments(such as steam sterilizer and endoscope) and in-use disinfectants. The result show that a total of 12 507samples(93.6%) were qualified. The qualified rates of samples collected from steam sterilizer and disinfectants in use were greater than 95%. The qualified rates for samples collected from the air,medical staff hands and the disinfected endoscope were less than 85%. Gram-positive Staphylococcus was the dominant genus(86.7%) identified across a total number of 45 unqualified samples,of which,Staphylococcus warneri,Staphylococcus epidermidis and Micrococcus luteus/lylae were the top three strains. The drug resistance test revealed that 87.0% of the isolates obtained from 23 unqualified samples were resistant to at least one antibiotic,with 10 strains resistant to three or more drugs simultaneously. Conclusion The general condition of disinfection quality in Bao’an district’s medical agencies is good,but the disinfection quality for medical staff hands,hospital air and disinfected endoscopes was unstable. Some species of opportunistic pathogenic Staphylococcus were detected in some samples collected from the cleaned hospital air,medical staff hands,item surfaces,and endoscopes,most of which showed resistance to at least one antibiotic. All medical agencies should be alerted and pay attention to this issue.