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目的:为监测医院空气、环境、物品、医疗器械等细菌污染状况,评价消毒灭菌质量及医院环境物品的洁净度,有效地控制医院感染。方法:对某传染病专科医院的空气、环境、物品、氧气湿化瓶、雾化吸入装置、工作人员手,洗手肥皂及水龙头缠绕的纱布等,随机进行了细菌学监测研究。采样方法详见《消毒技术规范》。空气采样用Cwc-Ⅰ型离心式空气微生物样器。结果:空气细菌学监测合格率为87.7％,无菌区合格率为100％,污染区为78.4％。以季度分,三季度合格率最低,为67.7％。气管切开病人室内环境及用物达标,而空气、陪伴用物和手超标,暖气上放置的湿毛巾细菌量达161.8CFU/cm~2。存放的24件未过期灭菌物品和30件一次性无菌器具均未见细菌生长,而24件过期灭菌物品中7件(29.17％)检出细菌。氧气湿化瓶、雾化吸入装置细菌量为273～4238cfu/cm~2,其优势种有莫拉氏菌、紫色色杆菌、黄杆菌及枯草杆菌。护士、医生、卫生员手细菌数合格率分别为80.3％、70％和63.6％。水龙头缠绕纱布细菌量在650～29800cfu/cm~2之间。干净、干燥放置的2处洗手肥皂细菌数均低于15cfu/cm~2,而放置在潮湿的6处却大大超标,其中一处多达4000cfu/cm~2。结论:氧化湿化瓶、雾化吸人装置细菌污染严重,且多为非发酵菌,故每周一次消毒,多人共用或雾化药液不消毒的做法极需纠正。水龙头缠绕纱布,细菌污染极为严重。盛放于存水肥皂盒中的肥皂,其菌量是干燥、干净处肥皂的500～2000倍。潮湿环境为绿脓杆菌等阴性杆菌生长提供了条件,提示水龙头上不应缠绕纱布,洗手肥皂亦应置于干净、干燥处。空气监测结果表明,自二季度开始,合格率下降(88％),三季度最低(67.7％),在炎热潮湿的夏季,尤以注意消毒灭菌和管理。陪伴用物的菌量是病人的7倍多,手和湿毛巾中更多,警示对气管切开等院内感染的高危人群,应重视陪伴用物的消毒处理和手的正确洗涤,否则即成为细菌携带、贮存的传染源,彻底有效的洗手可使医院感染的发生率下降30～50％。
Objective: To monitor the bacterial contamination status of air, environment, objects and medical devices in hospitals, evaluate the quality of disinfection and sterilization and the cleanliness of hospital environmental items, and effectively control nosocomial infections. Methods: A bacteriological monitoring study was carried out on air, environment, articles, oxygen humidification bottle, atomizing inhalation device, staff hand, hand soap and gauze wrapped with faucet in an infectious disease hospital. Sampling methods see “disinfection technical specifications.” Air sampling with Cwc-I centrifugal air sampler. Results: The qualified rate of air bacteriology monitoring was 87.7%, the pass rate of aseptic area was 100%, and the pollution area was 78.4%. Quarter quarter, the lowest rate of third quarter, 67.7%. Tracheotomy patients with indoor environment and objects compliance, and air, companion and hand exceeded, wet towels placed on the heating of bacteria amounted to 161.8CFU / cm ~ 2. No bacterial growth was observed in 24 non-expired sterilized items and 30 disposable sterile devices, while 7 out of 24 sterilized items (29.17%) detected bacteria. Oxygen humidification bottles, aerosol inhalation device bacterial amount of 273 ~ 4238cfu / cm ~ 2, the dominant species of Moraxella, Pseudomonas, Flavobacterium and Bacillus subtilis. Nurses, doctors, health staff bacteria pass rates were 80.3%, 70% and 63.6%. Taps entangled gauze bacteria in 650 ~ 29800cfu / cm ~ 2 between. The number of bacteriocides in both clean and dry hand-washing soap was less than 15cfu / cm ~ 2, while it was greatly exceeded in humid 6, with one of them reaching as high as 4000cfu / cm ~ 2. Conclusion: Oxidation and humidification bottles, aerosol inhalation device bacterial contamination is serious, and mostly non-fermenting bacteria, it is disinfected once a week, multi-person sharing or aerosol liquid non-sterilized practice very much needed to be corrected. Taps wrapped gauze, bacterial contamination is extremely serious. In full bloom soap in the soap box, the amount of bacteria is dry, clean place soap 500 ~ 2000 times. Wet environment for the growth of negative bacteria such as Pseudomonas aeruginosa provided the conditions, suggesting that the faucet should not be wrapped gauze, hand soap should also be placed in a clean, dry place. The air monitoring results show that since the second quarter, the passing rate has dropped (88%) and the lowest in the third quarter (67.7%). In hot and humid summers, special attention has been paid to disinfection and sterilization. Accompanied by bacteria more than 7 times the volume of patients, hand and wet towels more warning of tracheotomy and other high-risk nosocomial infections should be accompanied by disinfection of disinfectants and hands properly wash, or become Bacterial carriers, sources of infection stored, thorough and effective hand washing can reduce the incidence of nosocomial infections by 30 to 50%.