血液透析细菌感染预防与对策  

Prevention and Countermeasure for Bacterial Infection Caused by Hemodialysis

作　　者：邵卫东[1] 章莉[2] 商学钗[3] 计仁华[4] 

机构地区：[1]浙江省中西医结合医院医院感染管理科,浙江杭州310004 [2]浙江省中西医结合医院血液透析中心,浙江杭州310004 [3]浙江省中西医结合医院肾病实验室,浙江杭州310004 [4]浙江省中西医结合医院检验科,浙江杭州310004

出　　处：《中华医院感染学杂志》2011年第4期714-716,共3页Chinese Journal of Nosocomiology

摘　　要：目的了解医院血液透析中心透析液、透析用水水质状况,分析细菌内毒素及菌落数超标的原因及相关性,实现规范化管理的同时督促持续质量改进。方法收集分析自2006年1月-2010年7月透析用水和透析液的监测数据,分别比较A、B两种方法,水处理管路更换前后监测结果,对透析用水、透析液现场采样并对照监测细菌菌落数及内毒素,为采取防治对策提供依据。结果使用不同的内毒素检测方法对透析液、透析用水内毒素检测合格率差异有统计学意义,A方法为69.23%,B方法为100.00%;对照透析液、透析用水细菌菌落数与内毒素含量,两者差异无统计学意义,细菌菌落数合格率为81.58%,内毒素合格率为90.79%。结论探索一种科学可行的内毒素含量检测方法;透析用水、透析液含菌量与内毒素含量不成正比;透析用水、透析液的水质状况与水处理系统管路长短、有无死腔、使用年限、有无生物膜形成,配制过程是否被污染有关,重在预防。OBJECTIVE To understand the quality status of dialyzate and water used for dialysis, to analyze the bacterial endotoxin, the cause of the exceeding bacterial clump number and their relativity, so as to realize the standardization of management, at the same time to supervise to the continuous quality improvement. METHODS The monitoring data of the water used for dialysis and the dialyzate from Jan 2006 to Jul 2010 was collected, A and B methods were separately adopted to compare the monitoring results before and after the changing the pipelines. The dialyzate and the water used for dialysis were sampled and the bacterial clump number and the endotoxin were compared to provide basis for making the preventive countermeasures. RESULTS The differences of thel clump qualified rates between dialysis and the water used for dialysis examined by different endotoxin detection methods were statistically significant, A method was 69.23% and B method was 100.00%. There was no statistically significant difference between the bacteria number of the dialyzate and the water used for dialysis and endotoxin, the qualified rate of bacterial clump number was 81. 58%, while the qualified rate of endotoxin was 90. 79%. CONCLUSION A scientific and feasible detection method for endotoxin content is explored. The bacterial content in water used for dialysis or the dialyzate is not directly proportional to the content of the endotoxin. The quality of the water used for dialysis and dialyzate is related to the length of water disposal system pipeline, dead cavity, service life , biomembrane formation and the pollution of configuration process, so the prevention is important.

关 键 词：透析用水 透析液 生物膜 细菌 内毒素 

分 类 号：R181.32[医药卫生—流行病学]