安装速干手消剂装置对减少医院电梯按钮污染的效果

目的 了解安装速干手消毒剂装置后对减少医院电梯按钮污染的效果。方法 对某三级甲等医院的门诊部、外科楼和内科楼楼层中的公用电梯按钮进行调查。以安装速干手消毒剂装置和张贴手卫生宣传报后1周、1个月、1季度、半年和1年为试验期，随机抽样调查速干手消毒剂装置完整性及使用率；比较安装前后电梯按钮微生物污染情况。结果 试验期共抽取100个速干手消毒剂装置安装点（门诊部15个、外科楼75个和内科楼10个）进行调查，随着时间延长，其手消毒剂装置完整率和可用率均逐渐降低。试验期内共随机跟踪观察电梯按钮按键人员1 613人次，按键人员在安装速干手消毒剂装置后1个月内，按键前后均消毒率逐渐增加，未消毒率逐渐减少；一个月后，随着时间延长，按键前后均消毒率逐渐下降，未消毒率逐渐上升至85.89%。不同时期按键人员的手消毒剂使用率构成比较，差异有统计学意义（P<0.05）。安装前和试验期采集的600份按钮标本中仅7份标本未检出微生物，微生物污染率为98.83%。安装速干手消毒剂装置一周后，微生物污染率及菌落总数平均值、中位数、最大值和超标率均最低，之后逐渐上升；菌落总数合格率均较低，最高为32.00%。593份电梯按钮标本共检出微生物1 411株，其中革兰阳性菌1 178株，占83.49%；革兰阴性菌222株，占15.73%；真菌11株，占0.78%，主要是霉菌。电梯按钮表面污染的微生物主要为鲍曼不动杆菌（30株）、金黄色葡萄球菌（18株）、阴沟肠杆菌（14株）、肺炎克雷伯菌（9株）等常见病原微生物。不同时期电梯按钮微生物构成比较，差异无统计学意义（P>0.05）。结论 该院安装速干手消毒剂装置前期效果好，后期管理未落实到位，预防效果差；需从硬件、管理及宣传等多方面多部门联合，以提高医院电梯人性化服务水平。

Effect of installing alcohol-based handrub devices on reducing the contamination of hospital elevator buttons

Objective To understand the effect of installing alcohol-based handrub (ABH) devices on reducing the contamination of elevator buttons in hospital. Methods The public elevator buttons in outpatient department, surgical building and internal medicine building of a tertiary first-class hospital were investigated. One week, one month, one quarter, half a year and one year after installing ABH devices and putting up the hand hygiene bulletin were taken as test period, the integrity and utilization rate of ABH devices were investigated by random sampling, microbial contamination on elevator buttons before and after installation was compared. Results A total of 100 installation points (15 at outpatient department, 75 at surgical building and 10 at internal medicine building) of ABH devices were selected for investigation during the test period, with the extension of time, the integrity rate and availability rate of ABH devices gradually decreased. During the test period, 1 613 person-times of elevator button operators were randomly observed, within one month after the installation of ABH devices, disinfection rate of button operators before and after pressing the buttons both gradually increased, and non-disinfection rate gradually decreased; after one month, with the extension of time, disinfection rate before and after pressing the buttons both gradually decreased, and the non-disinfection rate gradually increased to 85.89%. There was significant difference in constituent of utilization rate of hand disinfectant among different periods (P<0.05). Among the 600 button specimens before installation and during the test period, only 7 specimens did not isolate microbes, microbial contamination rate was 98.83%. One week after the installation of ABH devices, microbial contamination rate and the average, median, maximum and over standard rate of total bacterial count were the lowest, and then gradually increased; the qualified rate of total bacterial counts were all low, the highest was 32.00%. A total of 1 411 strains of microbes were detected from 593 elevator button specimens, 1 178(83.49%) of which were Gram-positive bacteria, 222 (15.73%) were Gram-negative bacteria, and 11 (0.78%) were fungi, mainly mold. The main microbes on the surface of elevator buttons were Acinetobacter baumannii (30 strains), Staphylococcus aureus (18 strains), Ente-robacter cloacae (14 strains), and Klebsiella pneumoniae (9 strains). There was no significant difference in consti-tuent of microbes of elevator buttons in different periods (P>0.05). Conclusion The effect of installed ABH devices in this hospital is good during early period, but the management is not implemented in place in the later period, prevention effect is poor, it is necessary to combine the hardware, management and publicity to improve the humanized service level of hospital elevators.