湖南省医院血液透析用水卫生质量及影响因素

Sanitary Quality of the Blood Dialysate in Hospitals and Its Infuential Factors in Hu'nan

目的了解湖南省医院血液透析用水的卫生质量及影响因素。方法选择湖南省14个市(州)99家医院的血液透析室采集血液透析用水,按照《生活饮用水卫生规范》和《消毒技术规范》检测钙、氯化物、氟化物、锌、钠等22个理化指标及致热原和细菌总数,按照美国人工脏器协会(ASAIO)和美国医疗促进协会(AAMI)制定的透析用水标准进行评价。另外对血液透析用水的水处理设施的运行和维护进行了问卷调查。结果99家医院中血液透析用水卫生质量完全合格的有31家,占32%。透析用水中致热原、细菌总数、钙、氯化物、氟化物、锌离子、钠离子合格率分别为44.4%、71.7%、90.9%、97.0%、99.0%、99.0%、99.0%。2000-2003年安装并投入使用的透析用水处理设施的透析用水合格率(45.1%)显著高于1995-2000年投入使用的设施合格率(16.7%),χ2=9.293,P<0.05。三级甲等医院的透析用水合格率(46.2%)显著高于二级甲等医院(23.3%),χ2=4.48,P<0.05。结论血液透析用水的卫生质量与水处理系统的使用时间、水处理量、水处理系统的滤砂、活性碳、离子交换树脂、反渗透膜的及时更换及消毒和储水罐防护措施等有关。

Objective To understand the sanitary quality of the blood dialysate in hospitals in Hu'nan and its influential factors. Methods Pyrogen,total count of bacteria,22 physical and chemical indexes including calcium,chloride,fluoride,zinc,sodium and other indexes in the blood dialysate samples collected from blood dialysis rooms in 99 hospitals distributed among 14 cities and states in Hu'nan were measured according to the Sanitary Standards of Drinking Water and the Sanitary Standards for Disinfection Technology. The data of analysis were evaluated based on the standards for the blood dialysate ruled by ASAIO and AAMI. The questionnaire on the status operation and maintenance of the water purification system for blood dialysate was performed simultaneously. Results The sanitary quality of the blood dialysate samples from 31 hospitals were completely accorded with the related standards with a qualified rate of 32%. The qualified rates were 44.4%,71.7%,90.9%,97.0%,99.0%,99.0%,99.0% for pyrogen,total count of bacteria,calcium,chloride,fluoride,zinc,sodium in the blood dialysate samples respectively. The blood dialysate from the water treatment system established and put into production during 2000-2003 showed higher qualified rate(45.1%)compared with that during 1995-1999(16.7%),χ2=9.293,P<0.05. The blood dialysate samples respectively from 3A grade hospitals showed significantly higher qualified rate(45.1%)compared with that from 2A grade hospitals(23.3%),χ2=4.48,P<0.05. Conclusion The sanitary quality of the dialysate in hospitals was associated with the operating time and the discharge volume of treated water of the system,the timely exchange and disinfection of the filtering sand,active carbon,ion-exchange resin and reverse osmosis membrane,the prevention measures on water storage tank.