输液器瓶塞穿刺针下移暴露空气后微生物污染的实验研究

The experimental study of the microbial contamination after the puncture needle downward and ex-posed in the air of infusion bottle stopper

目的：探讨临床静脉输液过程中输液器瓶塞穿刺针下移后暴露时间与微生物污染的关系。方法选择2014年11月1日至2015年1月31日600例临床静脉输液的病例，更换输液药瓶（袋）时，慢慢下移输液器瓶塞穿刺针，使针头斜面至输液瓶（袋）橡皮塞内口，轻轻挤压茂菲管至药液不滴为止，记录下移穿刺针头至药液滴完时穿刺针头在空气中的暴露时间。用采样棉签蘸取下移局部，将采样棉签置于营养肉汤培养基培养，同时换下一瓶药液，取下一瓶剩余药液2 ml注入肉汤培养基培养，48 h后均转种血平板培养，观察有无细菌生长及生长情况。结果600例临床输液病例，采样棉签微生物培养24例阳性，阳性率为4.0%，其中革兰阳性球菌15例，革兰阴性杆菌3例，革兰阳性杆菌3例，真菌3例；药液肉汤培养3例阳性，阳性率0.5%，为革兰阳性球菌。暴露时间与采样棉签微生物培养结果差异有统计学意义，暴露时间与药液肉汤微生物培养结果差异无统计学意义。结论通过下移输液器瓶塞穿刺针可以减少输液瓶（袋）内药液残留，但下移穿刺针暴露在空气中的时间越长，造成微生物污染的概率会越高。

Objective To study the relationship between the exposure time of puncture needle of infusion bottle stopper and microbial contamination during clinical intravenous transfusion. Methods A total of 600 cases from November 1, 2014 to January 31, 2015 who have received the clinical intravenous transfusion for investigation were selected.When replacing the infusion bottle (bag), inserting the puncture needle slowly across the bottle stopper and making the needle tip be canted to the transfusion bottle mouth (bag) of the rubber plug, gently squeezing the Murphy's tube until solution was not dripping, recording down the exposure time in the air of the needle tip from medicine droplet to the end. To dip the lower part with sterile swabs and culture the swabs in nutrient broth medium. Meanwhile, to replace the next bottle of medicine and get the remaining 2 ml of liquids into the culture broth medium, after 48 h, both of which medium were switched to blood plate culture cultivation for observing the general situation of the bacteria growth. Results Among the 600 cases of clinical transfusion, 24 cases were positive for sterile swabs microorganisms culture, positive rate was 4.0%, among which microorganisms, 15 cases were gram-positive coccus, 3 cases were gram-negative bacillus, 3 cases were gram-positive bacillus and 3 cases were fungi. Correspondingly, 3 cases were positive for liquid broth culture, positive rate was 0.5%as the gram-positive coccus. The exposure time and broth microbial culture result was statistically significant, while the exposure time and medicinal broth microorganisms culture result possesses had no statistical significance. Conclusions Inserting the puncture needle across the bottle stopper could successfully reduce the liquid drug residues in the infusion bottle (bag), however, which might also cause time-dependent microbial contamination during the exposure process in the air.