动态条件下手术室空气质量及影响因素的研究

目的分析手术室动态空气质量的变化规律及手术室动态条件下空气质量的影响因素,为手术室动态空气质量监测标准的制(修)订提供数据和理论支持。方法选择2017年3月-2017年4月北京大学第三医院的两间洁净度Ⅲ级的手术室,抽取32台妇科腔镜手术进行动态空气质量监测,使用LWC-1型离心式空气微生物采样器采集手术前、手术30min、手术60min、缝皮、出室5个时间点的空气浮游菌,同时统计各时间的手术室内工作人员数量、前后门的开关次数等因素。结果本研究共收集到32份数据,手术前浮游菌数为40.63CFU/m3、手术30min为37.50CFU/m3、手术60min为37.50CFU/m3、缝皮为56.25CFU/m3、出室为137.50CFU/m3,其中手术前-出室、手术30min-缝皮、手术30min-出室、手术60min-出室、缝皮-出室之间的两两比较差异有统计学意义(P0.05);手术前、手术30min、手术60min的空气质量合格率为100.00%,缝皮、出室时的空气浮游菌合格率均为96.88%(P0.05)。结论手术室内人员的数量、前后门的开关次数等对手术室空气质量有影响,手术过程中因为这些因素的改变需要对手术室空气质量进行动态监测。     

两种敷料对层流手术间动态下空气质量的影响

目的研究无纺布手术衣及敷料与棉织布手术衣及敷料对层流手术室动态下空气质量的影响,为提高层流手术间动态空气质量措施提供科学依据。方法选取医院2013年2-10月骨科全髋关节置换手术患者100例,随机分成A、B两组,每组各50例,A组用无纺布手术衣及敷料,B组用棉织布手术衣及敷料;采用沉降法和浮游法对两组手术间动态空气质量进行监测,并将监测结果进行比较。结果沉降法监测中A、B两组手术间平均空气沉降菌菌落数整体比较差异有统计学意义(t=3.12,P<0.01),在不同时点比较中,麻醉前A、B两组手术间空气沉降菌菌落数比较差异无统计学意义,在切皮前、手术中、缝合前及手术结束后各时点两组比较差异均有统计学意义(P<0.05);浮游法监测中A、B两组手术间平均空气浮游菌菌落数整体比较差异有统计学意义(t=3.78,P<0.01),在不同时点比较中,麻醉前A、B两组手术间空气浮游菌菌落数比较差异无统计学意义,在切皮前、手术中、缝合前、手术结束后各时点两组比较差异均有统计学意义(P<0.05)。结论使用无纺布手术衣及敷料的手术其手术间动态空气质量明显优于使用传统棉织布手术衣及敷料。     

洁净手术室手术过程中空气质量动态变化及其影响因素的logistic回归分析

目的掌握洁净手术室空气质量动态变化规律及其影响因素,为制定手术感染防控措施提供科学依据。方法对我院I、Ⅱ、Ⅲ级洁净手术室共214台手术过程,分别于静态、手术切皮时、手术进行30min、手术进行60min以及切口缝合不同时点进行沉降菌、浮游菌和尘埃粒子数监测。同时收集手术过程中医护人员数量、开门次数、系统自净时间等可能相关影响因素情况。建立logistic回归模型,进行多因素分析。采用SAS9.1统计软件包进行数据统计。结果静态条件下,沉降菌监测结果均合格;动态条件下,尘埃粒子数、浮游菌密度总合格率仅70.10%,Ⅲ级洁净手术室合格率不足50%;logistic回归模型分析,室内活动人员数量、台次、术前系统自净时间、开门次数、着装5个因素的偏回归系数有统计学意义。结论动态条件下,空气质量较差。室内活动人员数量、台次、术前系统自净时间、开门次数、着装等是影响手术过程动态空气质量的重要因素。为提高动态空气质量,应加强洁净手术室的规范化管理。     

医院洁净手术室动态条件下空气质量与相关因素分析

目的 探讨动态条件下洁净手术室空气质量的变化规律及其影响因素.方法 采用自然沉降法对20个Ⅲ级洁净手术室空气进行采样检测,其中10个手术室作为对照组;每间手术室按手术区采样60份,周边区80份.结果 Ⅲ级洁净手术室手术区自然菌平均菌落数(8.62±4.53)个,周边区(6.15±3.87)个,手术区空气中自然菌数量显著高于周边区(P＜0.01),且随着手术室人数和手术时间的增加,沉降菌平均数明显增加.结论 Ⅲ级洁净手术室手术过程中空气中细菌数量呈规律变化,手术间人员的活动及人员数量是影响沉降菌数量变化的主要因素之一.     

术中人员流动对手术室空气细菌动态变化及切口感染的影响

目的探讨手术室中人员流动对于空气质量及切口感染的影响,并提出相应的措施。方法随机选择医院8间手术室在2014年9月-2015年3月60台手术,分别监测手术过程中人员流动、人员数量及空气中细菌动态变化,同时记录人员流动的原因,进行分析。结果术中人员流动对于空气中细菌变化有着显著的影响,人员流动量的增加使手术野空气含菌量明显升高;在手术开始后0.5h及2h人员流动出现高峰,流动次数分别为(26.4±4.09)次和(40.4±4.54)次,空气含菌量也出现了对应的高峰值(168.88±31.2)CFU/m~3和(179.12±20.9)CFU/m~3。结论通过减少术中人员流动可改善手术过程中空气质量,从而降低切口感染率,临床工作中可以采取相应的措施控制人流、物流。     

动态监测与管理洁净手术部

目的：探讨洁净手术部在动态下（即手术过程中）空气中的微生物变化规律，以及怎样进行有效的全程卫生质量控制。方法：在手术过程中医护人员正常工作的情况下进行沉降（浮游）菌测试和尘埃粒子数测定。结果：实测值（动态）均明显高于《规范》中的标准值（静态）。结论：动态监测能反映手术过程中微生物的变化，根据具体监测结果和现代手术控制感染的思路，必须强化手术中全过程控制的理念。     

采用不同方法清洁消毒数字减影血管造影机对导管室手术间空气质量的影响

目的 探讨应用不同方法清洁消毒数字减影血管造影(DSA)机对导管室手术间空气质量的影响.方法 在手术间净化空调层流系统正常运行状态下,同一人员分别应用清水及250 mg/L含氯消毒液对DSA机进行擦拭清洁消毒,应用清水和消毒液均清洁消毒两次,在无人和术中两种情况下,分别在擦拭前、擦拭后30、60、120 min进行空气采样和细菌计数.结果 采用清水及含氯消毒液擦拭消毒DSA机器后,导管室手术间空气质量均能达到Ⅲ类一般洁净手术室标准,≥0.5 μm尘粒含尘浓度≤350粒/L、浮游菌≤75 CFU/m3、沉降菌≤2 CFU/(30min·Φ90 mm皿),差异无统计学意义.结论 采用清水擦拭清洁和含氯消毒液擦拭消毒DSA机,对导管室手术间空气质量无明显影响,两者能够达到等同效果.     

微生物实验室空气紫外线消毒效果监测

目的了解微生物实验室经紫外线消毒后,空气中沉降菌和浮游菌的消亡率。方法用GB/T 16294-2010《医药工业洁净室（区）沉降菌的测试法》和GB/T 16293-2010《医药工业洁净室（区）悬浮粒子测试法》,对空气中沉降菌和浮游菌进行监测。结果紫外线灯消毒30min后,空气中的浮游菌随着时间延长而回升,沉降菌基本保持稳定。结论微生物实验室经紫外线消毒后,须在3h内进行试验,否则浮游菌会出现光复活而影响实验室空气质量。     

两次更鞋对洁净手术部空气质量影响分析与探讨

目的了解洁净手术部两次更鞋方式对空气质量的影响。方法于1次更鞋和两次更鞋方式下,分别监测洁净手术间及洁净走廊空气尘埃粒子数及细菌污染浓度,细菌污染浓度监测采取沉降法和浮游菌法两种方法,对监测结果进行分析。结果洁净手术部空气质量在不同更鞋方式时差异无统计学意义(P0.05)。结论进入洁净手术部无须进行两次更鞋,但需加强一次更鞋流程及手术室人员的管理。     

妇科接台手术空气质量影响因素的研究

目的探讨妇科接台手术空气质量的动态变化及其影响因素,为加强手术室的管理提供数据支持。方法2013年9月-2014年3月对北京市某三级甲等医院40个妇科接台手术万级手术间空气的相关指标进行监测,采用沉降法采集手术结束时、结束10、20、30min 4个时间点的菌落数,并根据监测结果分析影响妇科接台手术空气质量的因素。结果手术结束时、结束10、20min及30min 4个时间点相应沉降菌平均浓度均符合洁净手术部污染控制规范,合格率分别为97.5%、100.0%、100.0%、100.0%;撤腹腔镜、缝皮、拔管、移床、出室、保洁等一系列操作及室内人员数量、开门次数均对接台手术空气质量造成影响。结论妇科接台手术空气质量受多种因素的影响,手术结束后的不同时间段空气质量不同,Ⅲ级洁净手术间手术结束30min内空气质量即可达到合格。     

两种手术室空气质量的对比分析

目的 了解影响手术室空气质量的相关因素,探讨提高手术室洁净度的措施.方法 对长春市某三甲医院的普通手术间和层流手术间进行空气静态和动态细菌学监测.结果 普通手术间和层流手术间静态采样合格率分别为98.97%、99.02%,两组比较差异无统计学意义;普通手术间和层流手术间在择期手术开始时(T_0)采样合格率分别为93.51%、94.67%,两组比较差异无统计学意义(P>0.05);普通手术室和层流手术室在急诊手术开始时(T_0)采样合格率分别为78.95%、93.88%,两组比较差异有统计学意义(P<0.05);普通手术室随着手术时间的延长细菌总数逐渐增加,层流手术室在手术开始的T_2内,细菌总数呈波动性上升,T_3后显著下降.结论 急诊手术、手术时间是影响手术室空气质量的危险因素.手术室采用净化空调系统可以提高空气洁净度.     

大规模洁净手术室空气洁净度标准化管理的实践

目的确保大规模洁净手术室空气洁净度。方法用质性研究方法梳理规范洁净手术室空气洁净度管理过程,建立洁净手术室空气洁净度管理系统。结果大规模洁净手术室空气细菌浓度与洁净度均保持恒定。结论建立四位一体的科学管理系统是管理组织架构保障;对关键环节实施标准化管理是空气洁净度控制的核心;探索降低运行成本是洁净手术室管理的重要课题。     

百级层流手术室动态条件下空气细菌数量的调查

目的探讨医院百级层流手术室在进行手术状态下,空气中沉降细菌数量监测结果,了解影响其因素和探讨改进层流手术室洁净度的措施。方法测定百级层流手术室在进行手术状态下(即动态条件下)不同时段空气中沉降细菌菌落数。结果静态条件下不同手术室之间比较,差异无统计学意义,动态条件下不同手术室之间亦差异无统计学意义;同一手术室动态条件下第一台手术开始时与结束前比较,1、3室沉降菌数量随手术时间延长而增加,差异有统计学意义(P<0.01),2室差异无统计学意义;在手术室内5～10人时,空气沉降菌数量为(10.978±7.275)CFU/平板,11～16人时,沉降菌数量为(23.399±17.334)CFU/平板,两组比较差异有统计学意义(P<0.01),即手术室动态条件下空气沉降菌数量与手术室人数呈正相关。结论人员是层流手术室空气污染的主要因素,应严格限制手术室内人数,是保障手术中空气洁净度的一项关键措施。     

Physician communication in the operating room: expanding application of face-negotiation theory to the health communication context

Communication variables that are associated with face-negotiation theory were examined in a sample of operating-room physicians. A survey was administered to anesthesiologists and surgeons at a teaching hospital in the southwestern United States to measure three variables commonly associated with face-negotiation theory: conflict-management style, face concern, and self-construal. The survey instrument that was administered to physicians includes items that measured these three variables in previous face-negotiation research with slight modification of item wording for relevance in the medical setting. The physician data were analyzed using confirmatory factor analysis, Pearson's correlations, and t-tests. Results of this initial investigation showed that variables associated with face-negotiation theory were evident in the sample physician population. In addition, the correlations were similar among variables in the medical sample as those found in previous face-negotiation research. Finally, t-tests suggest variance between anesthesiologists and surgeons on specific communication variables. These findings suggest three implications that warrant further investigation with expanded sample size: (1) An intercultural communication theory and instrument can be utilized for health communication research; (2) as applied in a medical context, face-negotiation theory can be expanded beyond traditional intercultural communication boundaries; and (3) theoretically based communication structures applied in a medical context could help explain physician miscommunication in the operating room to assist future design of communication training programs for operating-room physicians.     

基层医院洁净手术室建设的思考

目的:分析评估基层医院洁净手术室建设管理现状,提高设备使用效率,制定感染控制措施。方法:用沉降法和浮游法对手术室空气样本进行细菌含量检测。结果:沉降法采集洁净手术室空气样本206份,其中手术区合格率为44.7%,周边区合格率为71.8%;普通手术间空气样本168份,合格率为97.6%。浮游法采集洁净手术室空气样本189份,其中手术区合格率52.9%,周边区合格率70.9%;普通手术间空气样本32份,合格率71.8%。结论:基层医院空气样本平均合格率低,建议相关部门制定洁净手术室建设应用管理制度,提高洁净设备使用人员的管理水平。     

连台手术室两种空气消毒方法的比较

目的比较三氧消毒机和YKX/G100型医用空气消毒净化机,两种消毒方法对连台手术室空气的消毒效果,探讨连台手术空气消毒方法。方法用自然沉降法于消毒前、后和连台手术开始后的不同时段采样监测,观察两种方法对连台手术室空气中自然菌的杀灭效果。结果两种方法均能使空气中自然菌的杀灭率〉85%;三氧机消毒的A手术间,连台手术开始后空气中的菌落数明显上升;空气净化机消毒的B手术间,连台手术开始后空气中的菌落数逐渐下降。结论空气消毒净化机可以缩短手术间隔时间,是解决连台手术有人条件下持续空气消毒的较好方法。     

Bacterial contamination of the air in different operating rooms

Bacteria air samples were taken in the operating rooms, with no people present, to specify the level of air contamination and suggest bacteriological standards for different operating rooms. In the first step of this study, for 5 months the air contamination mean value of operating rooms, ventilated at 15 changes/hour was 18.5 Cfu/m3 +/- 1.9. In the second part of the study, during two years, 1 381 air samples were taken in 8 different operating rooms. The mean values of air contamination range from 1.4 Cfu/m3 in a Charnley isolator system to 121 Cfu/m3 in an operating room ventilated at 7.5 changes per hour. As a general rule, the airborne contamination is more significant in the oldest operating rooms than in the new one with filtrated air. The variations observed between 1981 and 1982 are explained by technical modifications of the system or progress in control of operating room conditions. Measurements of the bacterial contamination of the air give useful informations, but it is however better to ensure that the specifications for volume air supply and positive air pressure in the operating theatres are being fulfilled. The airborne bacterial concentration in a modern ventilated operating room should not exceed 30 Cfu/m3.     

基层医院洁净手术室实效性的探讨

目的探讨基层医院洁净手术室使用的最大实效性。方法启用洁净手术室后(A组)与同期普通手术室(B组)的无菌手术切口感染率、手术间空气细菌监测、手术间的使用率结果相比较。结果A组洁净手术间无菌切口感染率为0,B组普通手术间无菌切口感染率为0.19%;空气监测结果:A组为(9.77±29.13)CFU/m3,B组为(132.37±81.40)CFU/m3;洁净手术间使用率明显增高。结论正确理解洁净手术室的概念、严格操作流程和科学管理,最大程度上发挥基层医院洁净手术室的实效性。     

Infection and sepsis after operations for total hip or knee-joint replacement: influence of ultraclean air, prophylactic antibiotics and other factors.

Operating in ultraclean air and the prophylactic use of antibiotics have been found to reduce the incidence of joint sepsis confirmed at re-operation, after total hip or knee-joint replacement. The reduction was about 2-fold when operations were done in ultraclean air, 4.5-fold when body-exhaust suits also were worn, and about 3- to 4-fold when antibiotics had been given prophylactically. The effects of ultraclean air and antibiotics were additive. Wound sepsis recognized during post-operative hospital stay was, however, reduced by these measures only when it had been classed as major wound sepsis. This was reported after 2.3% of operations done without antibiotic cover in conventionally ventilated operating rooms. Joint sepsis was much more frequent after wound infection and especially after major wound sepsis, although most cases of joint sepsis were not preceded by recognized wound sepsis. This was particularly noticeable after major wound sepsis associated with Staphylococcus aureus; after 37 such infections the same species was subsequently found in the septic joint of 11 patients. The sources of wound colonization with Staph. aureus, when this was not followed by joint sepsis, appeared to differ widely from those where joint sepsis occurred later. Operating-room sources could be found for most of the latter and the risk of infection appeared to be similar with respect to any carrier in the operating room whether a member of the operating team or the patient. For wound colonization that was not followed by joint sepsis, operating-room sources could only be inferred for fewer than half and of these more than one half appeared to be related to strains carried by the patient at the time of operation. During the follow-up period, which averaged about 2 1/4 years with a maximum of four years, there were, in addition to the 86 instances of deep joint sepsis confirmed at re-operation, 85 instances in which sepsis in the joint was suspected during this period but was not confirmed, because re-operation on the joint was not done. The incidence of suspected joint sepsis was, like that of confirmed joint sepsis, less after operations done in ultraclean air: 1/2.5, or with prophylactic antibiotics, 1/2.3 Although re-operation was more frequent on the knee-joint than on the hip, and pain after the initial operation was more frequent after knee operations, there was no evidence that this was the result of any increased risk of infection.(ABSTRACT TRUNCATED AT 400 WORDS)     

手术室医院感染危险因素的logistic回归分析

目的：研究手术室医院感染的危险因素，并探讨其相应的护理措施。方法对2011年1月至2013年6月期间接受外科手术治疗的1985例患者的临床资料进行回顾性分析，发现63例医院感染患者。收集上述患者的临床资料，包括性别、年龄、是否合并全身慢性疾病、手术是否为侵入性操作方式、麻醉方式、术后是否使用抗菌药物、手术室空气菌落数、手术无菌操作情况、手术室消毒情况、手术器械消毒情况等，并对上述资料进行logistic回归分析。结果年龄、基础疾病、侵入性操作、麻醉方式、手术室空气洁净度等是导致医院感染发生的影响因素。结论手术时应注意尽量减少导尿管置留时间，缩短手术麻醉插管时间和术后留置的时间，加强手术室及手术器械的消毒灭菌等环节，减少医院感染的发生。