2019-2021年甘肃省某综合三甲医院消毒效果监测及微生物分布特征分析  

Surveillance for disinfection effect and analysis on microorganism distribution in a gradeⅢgeneral hospital in Gansu,2019−2021

作　　者：兰光[1] 李欣颖[1] 张璟[1] 申艳琴[1] 闫静 刘小菊 何婕 孙建云[1] Lan Guang;Li Xinying;Zhang Jing;Shen Yanqin;Yan Jing;Liu Xiaoju;He Jie;Sun Jianyun(Gansu Provincial Center for Disease Control and Prevention,Lazhou 730000,Gansu,China)

机构地区：[1]甘肃省疾病预防控制中心,甘肃兰州730000

出　　处：《疾病监测》2024年第5期553-560,共8页Disease Surveillance

基　　金：甘肃省卫生健康行业科研计划项目(No.GSWSKY2020-24)。

摘　　要：目的了解2019—2021年甘肃省某综合三甲医院环境消毒灭菌工作质量,了解消毒后微生物分布情况及医院感染主要病原菌耐药情况,发现消毒灭菌工作中存在的问题和隐患,有效预防和控制感染性疾病的暴发和流行,为医院感染防控措施的制定提供科学依据。方法根据《消毒技术规范》和《医院消毒卫生标准》对医院空气、物表、医务人员手、内镜、口腔用水、压力蒸汽灭菌器以及医疗污水采样,判定是否符合卫生学标准,并对分离出的病原菌采用微量肉汤稀释法进行药敏试验。结果2019—2021年共采样1054份,合格843份,合格率为79.98%。其中,空气合格率为88.15%,物表合格率为85.34%,外科手合格率为56.16%,卫生手合格率为79.64%,医疗用水(口腔用水)合格率为33.33%,医疗用水(其他用水)合格率为85.42%,内镜合格率为86.42%,压力蒸汽灭菌器合格率为100.00%,污水合格率为83.33%。消毒后环境微生物分布占比居前5位的分别为人葡萄球菌(13.60%)、表皮葡萄球菌(13.05%)、藤黄微球菌(7.68%)、沃氏葡萄球菌(6.03%)和科氏葡萄球菌(5.81%)。检出医院感染主要病原菌鲍曼不动杆菌5株(0.55%)、金黄色葡萄球菌5株(0.55%)、粪肠球菌3株(0.33%)、铜绿假单胞菌2株(0.22%)、大肠埃希菌1株(0.11%)和肺炎克雷伯菌肺炎亚种1株(0.11%)。病原菌鉴定结果以革兰阳性菌为主,主要医院感染病原菌检出于手术室、重症监护室等重点科室,且呈现多重耐药现象。结论该三甲医院总体上消毒质量略低,且消毒效果不稳定,检出常见医院感染病原菌,且耐药情况不容乐观,需加强医院消毒监督管理,制定防治措施,并提高消毒效果。Objective To understand the quality of environmental disinfection and sterilization in a grade III general hospital in Gansu province from 2019 to 2021,understand the distribution of microorganisms after disinfection and the drug resistance of the main pathogens causing nosocomial infections,find the problems and hidden dangers in disinfection and sterilization,and provide evidence for the effective prevention and control of infectious disease outbreak and development of nosocomial infection prevention and control measures.Methods According to the Technical Specification for Disinfection and Hygienic Standard for Disinfection in Hospitals,the hospital air,subject surfaces,hands of medical staff,endoscopes,oral water,pressure steam sterilizers and medical sewage were sampled to evaluate whether they met the hygienic standards,and the isolated pathogens were tested for drug susceptibility by using microbroth dilution method.Results During 2019−2021,a total of 1054 samples were taken,in which 843 met the disinfection requirement(79.98%).The rate was 88.15%for air samples,85.34%for subject surface samples,56.16%for surgical hand swabs,79.64%for hygienic hand swabs,33.33%in medical water(oral water)samples and 85.42%in other medical water samples,and the qualified rate of disinfection was 86.42%for endoscopes,100.00%for pressure steam sterilizer and 83.33%in sewage samples.The top five microorganisms in the post-disinfection environment samples were Staphylococcus hominis(13.60%),Staphylococcus epidermidis(13.05%),Micrococcus luteus(7.68%),Staphylococcus voorhees(6.03%),and Staphylococcus koch(5.81%),respectively.Five strains of Acinetobacter baumannii(0.55%),5 strains of S.aureus(0.55%),3 strains of Enterococcus faecalis(0.33%),2 strains of Pseudomonas aeruginosa(0.22%),1 strain of Escherichia coli(0.11%),and 1 strain of Klebsiella pneumoniae subspecies pneumoniae(0.11%),the main pathogenic bacteria in hospital-acquired infections,were detected.The pathogenic bacteria were mainly gram-positive,which were mainly det

关 键 词：医院感染 消毒效果合格率 主要病原菌 多重耐药 

分 类 号：R211[医药卫生—中医学] R37