不同化学指示卡对压力蒸汽消毒效果评价准确度的比较

Accuracy comparison of different chemical indicators in evaluation of pressure steam disinfection effect

目的比较不同类型化学指示卡对医疗废物包装袋内的压力蒸汽消毒效果评价的准确度。方法以生物监测法为金标准,验证不同类型的6种化学指示卡在单层和双层医疗废物包装袋内消毒效果评价结果的一致性。结果本研究共开展模拟试验92袋次,单层与双层医疗废物包装袋模拟试验分别为51袋次与41袋次。单层医疗废物包装袋内,产品3-6的一致性较高,Kappa值均>0.6(P值均<0.001);灵敏度分别为84.2%、94.7%、86.8%,78.9%,特异度分别为92.3%、76.9%、100.0%和100.0%。双层医疗废物包装袋内,产品4的一致性最高,Kappa值为0.788(P<0.001),灵敏度为97.4%,特异度为100.0%,其余化学指示卡的Kappa值均<0.4。结论纸质不覆膜化学指示卡易受冷凝水影响,在监测过程中容易发生指示卡变色异常、不均匀,甚至断裂的情况,对医疗废物包装袋内消毒效果的验证能力不太理想。在开展高致病性医疗废物压力蒸汽消毒工作前,根据不同的监测环境选择适合的化学指示卡对于消毒效果评价准确度判断有重要意义。

Objective This paper aims to compare the accuracy of different types of chemical indicators in evaluation of pres-sure steam disinfection effect in medical waste packaging bags.Methods The biological monitoring method was used as the gold standard,and the consistency of evaluation results of six different types of chemical indicators was verified both in single-layer and double-layer medical waste packaging bags.Results A total of 92 bags were simulated in this study,and 51 bags and 41 bags were simulated in single-layer and double-layer medical waste packaging bags,respectively.In single-layer medical waste packaging bags,the consistency of products 3-6 was high,with the Kappa value higher than 0.6(P<0.001).The sensitivity was 84.2%,94.7%,86.8%and 78.9%,respectively,and the specificity was 92.3%,76.9%,100.0%and 100.0%,respectively.In double-layer medical waste packaging bags,product 4 showed the highest consistency with the Kappa value of 0.788(P<0.001),and the sensitivity and specificity were 97.4%and 100.0%,respectively.The Kappa values of other chemical indicators were all lower than O.4.Conclusion Non-waterproof chemical indicators are susceptible to condensation water,and abnormal discoloration,uneven discoloration,and even breakage of the indicator card are easy to occur in the monitoring process,so their verification ability of the disinfection effect in the medical waste packaging bag is poor.Before carrying out pressure steam disinfection on highly pathogenic medical waste,it is of great significance to select suitable chemical indicators according to different monitoring environments for the accuracy of disinfection effect evaluation.