外界环境对静脉用药调配中不溶微粒产生的影响调查

Investigation on influence of external environment on insoluble particulates in intravenous drug dispensing

目的了解静脉用药操作环境对药液中不溶微粒的影响因素。方法通过对Ⅰ类和Ⅳ类环境的物表、医护人员手、空气中的细菌菌落数及尘埃粒子数的检测,对比不同环境静脉用药药液中不溶微粒的情况。结果工作台面、医护人员手、空气中的细菌菌落总数随着操作时间的延长不断增加。Ⅰ类环境护士手的细菌总数远高于Ⅳ类环境护士手操作后30min、60min,不同环境医护人员手细菌菌落总数差异有统计学意义(P<0.05)。不同环境空气中浮游菌细菌菌落总数与尘埃粒子数的差异有统计学意义(P<0.05)。不同环境配置药液中直径大小为3μm、5μm、25μm的不溶微粒数量差别有统计学意义(P<0.05)。结论在药物、溶药器自身无法有效改进的前提下,外界环境和操作规范化是药液中不溶微粒产生的主要途径。静配中心空气净化系统能够大大减少静脉药物在配置过程中不溶微粒的产生和微生物的污染。改善静配中心环境卫生条件,规范医务人员操作,控制配置环境的空气洁净度,尽量避免不溶微粒的产生,为患者提供高效安全的静脉输液。

Objective To study the influence factors of the operation environment on the insoluble particles in the intravenous drug solution.Methods Different environment of the table,medical personnel hand,the number of the bacterial colonies in the air,and the number of dust particles in the air inⅠclasses and classⅣwere tested,different environmental intravenous drug use the insoluble particles in solution were compared.Results The total number of bacterial colonies on the working table,the hands of the medical staffs and the air increased with the extension of operation time.The number of bacteria on nurse hands in classⅠenvironment was much more than in classⅣenvironment,both 30 mins and 60 mins after operation,the number of bacterial colonies on medical personnel hands in different environmental had differences statistically significant(χ~2=4.73,P<0.05).The static distribution center air purification system could effectively control the number of phytoplankton and dust particles in the air,and the difference between the total number of bacterial colonies of phytoplankton and the number of dust particles in air in different environments was statistically significant(P<0.05).Ⅰclass environment configuration of the liquid in the diameter size of 3μm,5μm,10μm,25μm of insoluble particles were less thanⅣclass environment configuration of insoluble particles in liquid.Conclusion The external environment control and operation standardization are the main ways for the improvement of insoluble particles in the medicine solution,under the premise that the medicine and the dispenser can’t be improved effectively.The air purification system of the PIVAS can greatly reduce the number of insoluble particles and microbial pollution during the preparation process of intravenous drugs.Sanitation conditions of the static distribution center should be improved,the medical personnel operation should be standardized,the clean air of configuration environment should be controlled to avoid the generation of insoluble particles and provide patients with effective safety of intravenous fluids.