喉镜柄所致院内感染：对现行指南的置疑  

作　　者：Tyler R. Call, MD Frederic J. Auerbach,MD dScott W. Riddell, PhD Deanna L. Kiska, PhD Sumena C. Thongrod, DO See Wan Tham, MD Nancy A Nussmeier, MD 徐然(译) 岳云(校) 

机构地区：[1]College of Medicine, Departments of Syracuse, New York [2]College of Medicine, Departments of Pathology, and ＊Anesthesiology, Syracuse, New York [3]Anesthesiology, State Universityof NY(SUNY) Upstate Medical University, Syracuse, New York [4]不详

出　　处：《麻醉与镇痛》2010年第5期89-93,共5页Anesthesia & Analgesia

摘　　要：背景按照现有规定，不同病例之间喉镜片是进行清洁的。然而，尽管有证据显示喉镜柄可能导致院内感染，但各个机构以及美国麻醉医师协会却都没有任何针对喉镜柄消毒的指导意见。我们假设，喉镜柄极易被细菌和病毒污染，并对新型的清洁喉镜柄方法的应用加以证实。方法从成人手术间取60个喉镜柄，用无菌拭子取样。采样在两个手术之间进行，手术间是用于多专科手术的，房间和设备已为下一个手术常规清洁后再收集样本。其中40支喉镜柄要去做需氧菌培养，分离的菌株同时做抗生素耐药检测。另外20支喉镜柄要通过聚合酶链式反应检测17种呼吸道病毒。结果4JD支送检细菌培养的喉镜柄样本显示，30（75％）支喉镜柄的细菌污染检测呈阳性，在阳性结果中，25（62．5％）支喉镜柄是被产生凝固酶阴性葡萄球菌污染，7（17．5％）支喉镜柄是被非炭疽的芽孢杆菌属的细菌污染，3（7．5％）支喉镜柄是被α-溶血性链球菌属的细菌污染，1（2．5％）支喉镜柄是被肠球菌、金黄色葡萄球菌（金葡菌）和棒状杆菌属所污染。这其中没有发现耐万古霉素的肠球菌、耐甲氧西林的金葡菌以及格兰阴性杆菌。所有病毒的检测都是阴性的。结论我们发现，喉镜柄经低标准消毒后仍有较高的细菌污染发生率。然而这其中没有发现耐万古霉素的肠球菌、耐甲氧西林的金葡菌、格兰阴性杆菌或是呼吸道病毒。因此，我们的结果支持采纳如下的指导意见：在每一例患者使用后，对喉镜柄应强制性的进行至少低标准的消毒处理。BACKGROUND： Laryngoscope blades are often cleaned between cases according to well-defined protocols. However, despite evidence that laryngoscope handles could be a source of nosocomial infection, neither our institution nor the American Society of Anesthesiologists has any specific guidelines for handle disinfection. We hypothesized that laryngoscope handles may be sufficiently contaminated with bacteria and viruses to justify the implementation of new handle-cleaning protocols. METHODS： Sixty laryngoscope handles from the adult operating rooms were sampled with premoistened sterile swabs. Collection was performed between cases, in operating rooms hosting a broad variety of subspecialty procedures, after the room and equipment had been thoroughly cleaned for the subsequent case. Samples from 40 handles were sent for aero- bic bacterial culture, and antimicrobial susceptibility testing was performed for significant isolates. Samples from 20 handles were examined for viral contamination using a polymerase chain reaction assay that detects 17 respiratory viruses. RESULTS： Of the 40 samples sent for culture, 30 （75%） were positive for bacterial contamination. Of these positive cultures, 25 （62.5%） yielded coagulase-negative staphylococci, seven （17.5%） Bacillus spp. not anthracis, three （7.5%） α-hemolytic Streptococcus spp., and one each （2.5%） of Enterococcus spp., Staphylococcus aureus （S. aureus）, and Corynebacterium spp. No vancomycin-resistant enterococci, methicillin-resistant S. aureus, or Gram-negative rods were detected. All viral tests were negative. CONCLUSION： We found a high incidence of bacterial contamination of laryngoscope handles despite low-level disinfection. However, no vancomycin-resistant enterococci, methicillin-resistant S. aureus, Gram-negative rods, or respiratory viruses were detected. Our results support adoption of guidelines that include, at a minimum, mandatory low-level disinfection of laryngoscope handles after each patient use.

关 键 词：喉镜片 院内感染 耐万古霉素的肠球菌 细菌污染检测 美国麻醉医师协会 聚合酶链式反应 金黄色葡萄球菌 呼吸道病毒 

分 类 号：R720.597[医药卫生—急诊医学]