佳木斯市血液净化中心透析用水及透析液细菌污染情况调查

目的了解佳木斯市透析用水、透析液的细菌污染状况。方法采集佳木斯市8家医院反渗水及透析液标本,对反渗水及透析液标本进行细菌培养和菌落计数,用鲎试剂定性检测内毒素。结果反渗水细菌培养有2家医院阳性,细菌总数均为300 CFU/ml,内毒素检测均〈2 EU/ml;A浓缩透析液内毒素均〈2 EU/ml;B浓缩透析液内毒素均〈2 EU/ml;透析器入口细菌培养3家阳性,内毒素检测有2家〉2 EU/ml。结论目前,佳木斯市部分血液净化中心仍存在反渗水及透析液的细菌污染,应定期检测反渗水、透析液的内毒素水平及进行细菌培养,定期消毒反渗水装置及透析液容器,对减少热源反应至关重要。     

血液透析用水及透析液细菌污染情况监测结果分析

目的探讨血液透析用水及透析液细菌污染的情况,分析其主要污染的菌株。方法采用倾注法对水及透析液中细菌含量进行检测,采用常规方法对细菌进行分离鉴定,采用定性凝胶法对水及透析液中的内毒素含量进行检测。结果透析用水的平均菌落数为132CFU/mL,其内毒素的阳性率为6.1%,透析器的入口处透析液的平均菌落数为263CFU/mL,透析器出口处平均菌落数为651CFU/mL,透析时透析液中平均菌落高于透析用水,两者间差异具有统计学意义(P<0.05),主要的污染细菌为革兰阴性杆菌、革兰阳性杆菌及球菌。不同时间其细菌含量不同,在4～10月份其平均细菌含量较同年其它月份高,差异具有统计学意义(P<0.05)。结论血液透析液在制备、运输等多个环节中均可能引起透析用水及透析液的再次污染,对水路进行合理设计及定期消毒是减少透析用水再次污染的主要措施,同时建立定期开展细菌学监测。     

减少透析液污染易疏忽的环节

目的分析配制透析液过程中的污染因素,寻找控制污染的有效方法。方法分两阶段即装透析液的容器消毒和不消毒,收集各采样点的水标本和透析液标本做细菌培养,根据结果分析污染原因。结果透析用水、透析器入口液细菌培养结果均达到相关标准,即透析用水菌落数≤200CFU/mL,透析液菌落数≤2 000CFU/mL。未消毒容器内透析B液细菌污染严重,分装前检出菌落数为(474.00±292.22)CFU/mL,分装后为(492.22±311.11)CFU/mL;消毒容器内透析B液细菌控制在理想范围,分装前为(9.38±6.19)CFU/mL,分装后为(5.04±4.38)CFU/mL;容器消毒与否,透析B液细菌检出数差异有显著性(P<0.01)。结论保证高质量的透析液,除了应加强水处理系统、送水管道、配液容器、透析机和血路管、透析器等各个环节的严格消毒外,还需严格监控自配透析液的过程。     

医院搬迁前后透析用水及透析液质量的比较分析

目的 比较分析嘉兴市第一医院搬迁前后血透室透析用水及透析液质量状况.方法 回顾分析医院搬迁前后1年血透室透析用水及透析液的内毒素、细菌培养菌落计数、游离氯和硬度定性.结果 医院搬迁前后反渗水输水管路近端的内毒素分别为(0.125±0.073)、(0.020±0.005) EU/ml,反渗水输水管路远端的内毒素为(0.261±0.008)、(0.128±0.083)EU/ml,透析液入透析器口的内毒素为(0.456±0.178)、(0.256±0.071)EU/ml,浓缩B液的内毒素为(0.219±0.113)、(0.096±0.125)EU/ml,差异有统计学意义(P＜0.05);搬迁前后透析用水及透析液内毒素和细菌培养菌落计数超过干预标准率比较差异有统计学意义(P＜0.05);透析液入透析器口内毒素较其他采样部位高;游离氯和硬度定性全部合格.结论 新医院采用双级反渗装置、管路热消毒及更严格的浓缩B液配制制度使透析用水及透析液质量有进一步提高.     

一次透析液和透析用水细菌污染的调查与分析

目的了解血透室透析液和透析用水细菌含量超标的原因,找出污染的途径和环节. 方法按卫生部<医院感染管理规范>的要求检测细菌含量,并鉴定细菌种类. 结果透析用水(反渗水)平均细菌数为(97.79±11.64)CFU/ml,透析液平均细菌数为(312.33±8.26)CFU/ml,A液和B液平均细菌数为(0.82±2.32)CFU/ml和(207.11±5.56)CFU/ml,反渗水和B液细菌含量严重超标,且培养出革兰阴性杆菌. 结论血液透析液和透析用水细菌污染与浓缩B液配制过程污染和透析用水管道细菌污染及反渗透装置未及时更换有关.     

甘肃省102家医院血液透析用水和透析液内毒素水平的调查

目的了解甘肃省血液透析用水和透析液的内毒素(ET)污染现状及其相关影响因素。方法以甘肃省102家医院为调查对象,对其5年内送检的透析用水和透析液标本的ET检测结果予以分析。结果 5年间送检透析用水和透析液标本共4859份,总体合格率为96.71%,其中透析用水的合格率94.82%,透析液的合格率为97.57%;二级医院和三级医院的透析液合格率分别为96.44%和98.31%,比较差异有统计学意义(χ~2=11.768,P=0.001);5年间二级、三级医院的透析用水和透析液ET检测合格率均呈逐年上升趋势(P0.05);透析用水和透析液在第一、第四季度合格率均大于第二、第三季度,且透析液的合格率比较差异有统计学意义(χ~2=12.876,P0.001);甘肃省内送检标本距离的远近对透析用水、透析液ET含量无影响。结论甘肃省血液透析中心的透析用水和透析液的内毒素控制情况总体满意。医院等级及季节因素对内毒素水平有一定影响。     

血液透析细菌感染预防与对策

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。     

血液透析室透析液及透析用水的细菌学监测

目的了解血液透析室透析液及透析用水细菌污染的原因及对策. 方法检测血液透析液及透析用水中细菌的含量及细菌种类. 结果透析器入口处透析液的平均菌落数为486 CFU/ml,透析器出口处透析液的平均菌落数为490 CFU/ml,反渗水的平均菌落数为103 CFU/ml,常见细菌为枯草杆菌、类白喉杆菌及某些革兰阴性杆菌. 结论透析液在配制的过程中,有多种环节可能造成污染,应加强透析液的监测工作,并建议修改透析液细菌监测的标准.     

武汉地区医院血液透析用水、透析液和置换液内毒素水平调查分析

目的调查武汉地区部分医院血液透析用水、透析液和置换液内毒素控制状况,为透析用水安全管理提供依据。方法检测武汉地区43家医院血液透析用水、透析液和置换液内毒素含量并分类统计。结果 43家医院2014年9月-2016年12月期间透析用水、透析液和置换液的合格率分别为91.9%、93.4%和99.1%。透析液三甲医院和其他医院(除三甲三乙医院以外级别的医院)的合格率均高于三乙医院,置换液三甲医院合格率高于其它医院,差异有统计学意义(P<0.05)。透析相关治疗用水的检测周期没有一家医院符合要求。结论武汉地区部分医院血液透析相关治疗用水内毒素控制情况良好,但被调查的医院都没达到每三个月至少检测一次内毒素的标准,相关部门应加强对医院透析中心的监管。     

血液透析用水及透析液质量监测结果分析

目的 对血液透析用水、透析液开展质量监测.方法 按《中国药典》方法做微生物限度、细菌内毒素检查、化学污染物等检验.结果 微生物学检验结果符合国家食品药品监督管理局发布的医药行业标准YY0572-2005中规定的要求,但经贮水容器和输水管路出口的透析用水中,细菌内毒素由0.125 Eu/ml增加至0.25 Eu/ml,真菌数由10 CFU/200 ml增加至150CFU/200 ml,硝酸盐浓度增高约5倍.结论 透析用水、透析液应每日现制现用,注意消毒和冲洗各输液管路.     

Microbial contamination of dialysate and its prevention in haemodialysis units

At the haemodialysis centres of nine hospitals in Japan, microbial contamination of treated water (reverse osmosis method), acid and bicarbonate concentrates, and dialysate was investigated. Among these fluids used in haemodialysis, the dialysate was most frequently contaminated and had the highest concentration of bacteria. Of 40 dialysate samples analysed, 42.5% showed a bacterial count of more than 2000cfu/mL, which was above the Association for the Advancement of Medical Instrumentation (AAMI) standard. However, among the 40 samples from 20 dialysis machines, all six dialysate samples from three dialysis machines that used an ultrafiltration membrane in the circuit before the entrance of the dialysate into the dialyser, showed a bacterial count of < or =10 cfu/mL. In addition, when an ultrafiltration membrane was used in the circuit before the entrance of the dialysate into the dialyser for four dialysis machines showing dialysate samples contaminated with 10(4)-10(5)cfu/mL the bacterial count in dialysate samples from these machines became zero. Because dialysis machines are susceptible to microbial contamination, it is necessary to take measures such as placing an ultrafiltration membrane into the circuit before the entrance of dialysate into the dialyser.     

口腔科综合治疗台水路无菌处理效果研究

目的比较不同的供水方式及是否排空水路内水分过夜对口腔综合治疗台水路(DUWLs)细菌数量的影响。方法第一阶段试验将6台综合治疗台随机分成2组,分为外储水罐供水组及市政供水组;第二阶段试验将6台综合治疗台都切换成使用外储水罐,随机分成2组,分别为排空水路过夜组和未排空水路过夜组;分别比较两个阶段两组消毒前及消毒后1周内不同时间的细菌数量。结果第一阶段消毒前DUWLs细菌污染最严重的为机头水,平均菌落数为4 117CFU/mL,合格率为15.38%。消毒前各组细菌数量比较,差异均无统计学意义(均P0.05),各组DUWLs细菌数量严重超标(均3 000CFU/mL)。不同供水途径DUWLs消毒后细菌数量比较,除消毒后第1天差异无统计学意义外(P0.05),第2~7天比较差异均有统计学意义(均P0.05)。消毒后第2天,市政供水组细菌含量开始超标;消毒后第3天,外置储水罐供水组细菌含量开始超标。是否排空水路过夜DUWLs消毒后细菌数量比较,除消毒后第1天差异无统计学意义外(P0.05),第2~7天差异均有统计学意义(均P0.05)。消毒后第4天,未排空水路过夜组细菌含量超标。消毒后第7天,排空水路过夜组细菌含量100CFU/mL。结论使用外置储水罐,每日更换无菌蒸馏水及每日排空水路保持干燥过夜,可有效降低DUWLs细菌数量。     

Bacterial contamination of dialysate in dialysis-associated endotoxaemia

Bacteriological investigations and endotoxin (ET) determinations were performed during a routine haemodialysis session for six patients. The glucose free dialysate was prepared with untreated tap water. All patients were dialysed for 5 h. Pseudomonas aeruginosa was regularly isolated in numbers up to 10(7) cfu ml-1 from samples of the dialysate inflow, the dialysate site and the dialysate outflow. ET levels in the plasma of the patients increased continuously during haemodialysis and were always higher in the blood outflow line of the dialyzer than in the blood inflow. Despite the high bacterial counts in the dialysate and the increasing ET levels in the patients plasma neither bacteraemia nor fever was observed. The former is due to the impermeability of the dialyzer membrane for bacteria, the latter is explained by low pyrogenicity of P. aeruginosa endotoxin. Inspection of the dialyzer machines revealed that air-traps and heater-unit for the incoming (untreated) tap water before mixing with the dialysate concentrate were the only sites where high bacterial release was feasible, as this part of the machine escaped disinfection due to the construction of these devices. We recommend the regular disinfection of all parts of a dialyzer machine, including heating units, air traps and valves.     

Microbiological assessment of house and imported bottled water by comparison of bacterial endotoxin concentration, heterotrophic plate count, and fecal coliform count

Consumers increasingly use bottled water and home water treatment systems to avoid direct tap water. According to the International Bottled Water Association (IBWA), an industry trade group, 5 billion gallons of bottled water were consumed by North Americans in 2001. The principal aim of this study was to assess the microbial quality of in-house and imported bottled water for human consumption, by measurement and comparison of the concentration of bacterial endotoxin and standard cultivable methods of indicator microorganisms, specifically, heterotrophic and fecal coliform plate counts. A total of 21 brands of commercial bottled water, consisting of 10 imported and 11 in-house brands, selected at random from 96 brands that are consumed in Puerto Rico, were tested at three different time intervals. The Standard Limulus Amebocyte Lysate test, gel clot method, was used to measure the endotoxin concentrations. The minimum endotoxin concentration in 63 water samples was less than 0.0625 EU/mL, while the maximum was 32 EU/mL. The minimum bacterial count showed no growth, while the maximum was 7,500 CFU/mL. Bacterial isolates like P. fluorescens, Corynebacterium sp. J-K, S. paucimobilis, P. versicularis, A. baumannii, P. chlororaphis, F. indologenes, A. faecalis and P. cepacia were identified. Repeated measures analysis of variance demonstrated that endotoxin concentration did not change over time, while there was a statistically significant (p < 0.05) decrease in bacterial count over time. In addition, multiple linear regression analysis demonstrated that a unit change in the concentration of endotoxin across time was associated with a significant (p < 0.05) reduction in the bacteriological cell count. This analysis evidenced a significant time effect in the average log bacteriological cell count. Although bacterial growth was not detected in some water samples, endotoxin was present. Measurement of Gram-negative bacterial endotoxins is one of the methods that have been suggested as a rapid way of determining bacteriological water quality.     

膜法血液透析水处理设备的研制

目的:研制一种与血液透析机配套使用的水处理设备,为血液透析系统提供安全用水。方法:采用超滤、反渗透、荷电微孔膜集成膜分离工艺,通过机电一体化设计,研制主要由动力系统、净化系统、检测指示系统和电路控制系统等组成的血液透析水处理设备。结果:水处理设备产水中细菌总数小于1.0 CFU/mL,细菌内毒素含量小于0.1 EU/mL,21种化学污染物指标均符合血液透析用水标准规定。结论:膜法血液透析水处理设备产水安全有效。     

75例供精者精液细菌学分析

目的:建立精液标本采集、菌落计数、分类培养、鉴定和杂菌污染判断等相对较为完整的精液细菌培养方法,了解供精者精液中细菌菌落数及其分布情况。方法:对61例精液进行细菌菌落计数,75例精液进行需氧菌及厌氧菌的分类培养。结果:7例精液被杂菌污染,占11.2%;在未被杂菌污染的精液中,90.7%的精液有细菌生长,其中7.4%的精液菌落数>104CFU/ml。细菌分类培养发现精液中以棒状杆菌、草绿色链球菌、表皮葡萄球菌、肠球菌、溶血葡萄球菌、微球菌为主,分别为68.0%、29.3%、20.0%、10.7%、9.3%、8.0%;另外,还培养出缓症链球菌、大肠埃希氏菌、消化链球菌、肺炎克伯雷氏菌、松鼠葡萄球菌、铜绿假单胞菌等精液中稀有细菌或致病菌。结论:精液中细菌常规培养的阳性率高,细菌种类多。     

抗生素锁与肌注给药在治疗家兔中心静脉导管相关感染模型中的效果差异

目的比较抗生素锁(ALT)与全身用药在治疗中心静脉导管相关感染中的效果差异。方法体外制作内含细菌生物膜的导管,并植入家兔中心静脉,将其随机分为两组:一组为导管组,向导管内注入抗生素与肝素混合液;一组为全身组,肌内注射抗生素,导管内注入肝素液。连续用药10 d,每日在更换药液前留取导管血和外周静脉血,检测菌落数。第11天停用全部抗生素,留置导管观察5 d再拔管。拔管前采导管血和外周血做细菌计数和药敏试验。并将拔出的导管做导管尖端细菌培养和生物膜观察。结果用药期间血培养细菌计数:不同用药时间导管组导管血细菌平均计数均低于全身组,差异具有统计学意义(均P0.05);导管组外周血培养阳性标本从第4天开始逐渐出现,共有阳性标本6例;全身组阳性标本第2天即出现,共有阳性标本31例。停药期间血培养细菌计数:两组在拔管当日的导管血细菌计数均高于停药当日,差异均有统计学意义(均P0.05)。停药当日导管组2例外周血标本检出细菌,全身组8例阳性;拔管当日导管组无新增阳性标本,而全身组有1例新增阳性标本。全身组的导管尖端细菌计数[(8.02±0.05)log10CFU/mL]高于导管组[(3.12±0.14)log10CFU/mL],差异有统计学意义(t=26.82,P0.05)。导管组33.33%的标本可见散在生物膜,全身组全部标本被菌膜覆盖。拔管前导管血和外周血细菌培养及药敏试验:导管组的抑菌环直径在19~20 mm之间,全身组为15~16 mm,两组细菌对常见抗菌药物均为敏感。结论在治疗中心静脉导管相关感染中ALT局部清除细菌的效果优于全身用药,可降低全身感染。但是倘若导管内细菌生物膜未完全清除,停药后仍可复发,因此精准的用药量和用药时间值得进一步量化研究。     

Recreational water quality control in Mississippi, USA: bacteriological assessment in the Pearl River and Ross Barnett reservoir

We assessed the bacteriological water quality in the Pearl River and Ross Barnett reservoir, a major source of public raw water for the city of Jackson, Mississippi, USA and an important site for recreational activities for local residents and visitors. Infectious diseases caused by pathogenic bacteria are the most common and widespread health risks associated with such water contact activities as bathing, canoeing, and swimming in recreational waters. Water samples collected twice monthly from April 2004 to April 2005 from five different sites of the Pearl river/Ross Barnett reservoir were tested for heterotrophic bacteria, total coliforms, fecal coliforms, and enterococci using membrane filtration technique. Physicochemical parameters (temperature, pH, turbidity, dissolved oxygen, conductivity) were also analyzed using standard methods. The respective mean concentrations of bacteria in water samples were 8.9 x 10(4) +/- 7.4 x 10(4) colony forming units (CFU) 100 mL(-1), 3.0 x 10(3) +/- 4.1 x 10(3) CFU 100 mL(-1), 2.3 x 10(2) +/- 5.4 x 10(2) CFU 100 mL(-1), and 2.3 x 10(2) +/- 4.8 x 10(2) CFU 100 mL(-1) for heterotrophic bacteria, total coliforms, enterococci, and fecal coliforms. The mean values of the physical and chemical parameters were at acceptable levels. Bacterial densities, however, significantly exceeded federal/state guidelines, raising public health concerns. Hence, control strategies should be developed and implemented to prevent further bacterial contamination of Pearl River-Ross Barnett reservoir water resource system.     

High level of recovery of fungi from water and dialysate in haemodialysis units

The counts of yeasts and filamentous fungi were investigated in the municipal water supplies of haemodialysis centres, in the treated water and the dialysate from all 85 haemodialysis units in Greece, in order to estimate their occurrence, their correlation with contamination indicator bacteria and other influencing factors. Filamentous fungi and yeasts were isolated from 69 (81.2%) and from three (3.5%) feed water samples, from 74 (87.1%) and seven (8.2%) treated water samples and from 66 (77.7%) and 11 (12.9%) dialysate samples respectively. Aspergillus spp and Penicillium spp were the most frequent moulds, while Candida spp were the prevailing yeasts. The occurrence of yeasts was significantly higher in dialysate than in tap water samples. Counts of filamentous fungi in all 255 samples were significantly correlated with the counts of total heterotrophic bacteria and enterococci, whereas the counts of yeasts were correlated with faecal coliforms, total heterotrophic bacteria, as well as enterococci, Pseudomonas spp and total coliforms, while no correlation was detected with the age of either haemodialysis units, the age of water treatment system, the number of artificial kidney machines or the components of the water purification system. High recovery of fungi from haemodialysis aqueous environments implies a potential risk for haemodialysis patients and indicates the need for continuous maintenance and monitoring.