铜绿假单胞菌消毒剂-磺胺耐药基因检测及对消毒剂的抗性研究

目的了解铜绿假单胞菌Ⅰ类整合子消毒剂-磺胺耐药基因(qacE△1-sull)的携带情况以及阳性菌株对碘伏、戊二醛、氯己定、"84"消毒液的抗性。方法对某院2007年12月-2008年1月连续分离的20株铜绿假单胞菌以聚合酶链反应(PCR)法检测qacE△l-sull基因,测定其阳性菌株对上述4种消毒剂的最低抑菌浓度(MIC)。结果 20株铜绿假单胞菌中检出qacE△1-sull阳性株10株(50.00%)。碘伏、戊二醛、氯己定、"84"消毒液对qacE△1-sull阳性菌株的MIC范围分别为:8.0～128.0μg/mL、16.0～256.0μg/mL、1.0～16.0μg/mL、4.0～64.0μg/mL。结论 qacE△1-sul1基因普遍存在于临床分离的铜绿假单胞菌中,阳性菌株对碘伏、戊二醛、氯己定、"84"消毒液存在抗性差异,应合理使用消毒剂并增加作用时间,以有效控制铜绿假单胞菌的播散。     

Bacterial contamination of keyboards: efficacy and functional impact of disinfectants.

BACKGROUND: Computers are ubiquitous in the healthcare setting and have been shown to be contaminated with potentially pathogenic microorganisms. This study was performed to determine the degree of microbial contamination, the efficacy of different disinfectants, and the cosmetic and functional effects of the disinfectants on the computer keyboards. METHODS: We assessed the effectiveness of 6 different disinfectants (1 each containing chlorine, alcohol, or phenol and 3 containing quaternary ammonium) against 3 test organisms (oxacillin-resistant Staphylococcus aureus [ORSA], Pseudomonas aeruginosa, and vancomycin-resistant Enterococcus species) inoculated onto study computer keyboards. We also assessed the computer keyboards for functional and cosmetic damage after disinfectant use. RESULTS: Potential pathogens cultured from more than 50% of the computers included coagulase-negative staphylococci (100% of keyboards), diphtheroids (80%), Micrococcus species (72%), and Bacillus species (64%). Other pathogens cultured included ORSA (4% of keyboards), OSSA (4%), vancomycin-susceptible Enterococcus species (12%), and nonfermentative gram-negative rods (36%). All disinfectants, as well as the sterile water control, were effective at removing or inactivating more than 95% of the test bacteria. No functional or cosmetic damage to the computer keyboards was observed after 300 disinfection cycles. CONCLUSIONS: Our data suggest that microbial contamination of keyboards is prevalent and that keyboards may be successfully decontaminated with disinfectants. Keyboards should be disinfected daily or when visibly soiled or if they become contaminated with blood.     

医院常见致病菌的消毒剂药敏试验及质粒分析

[目的]对医院常见致病菌进行消毒剂药敏试验,对耐药菌株进行质粒特征分析,为消毒剂规范合理使用提供参考。[方法]在泰州地区5所医院的各类环境、高危科室、使用中消毒剂进行采样,在样品中分离和鉴定4种常见致病菌（金黄色葡萄球菌,表皮葡萄球菌,大肠杆菌,绿脓杆菌）。选择分离得到的菌株,在常用高中低效消毒剂内分别选取1种（84、碘伏、醋酸氯已定）,测定消毒剂对菌株的最低抑菌浓度（MIC）、最低杀菌浓度（MBC）,确定耐药菌株。对消毒剂耐药菌株提取质粒,采用琼脂糖凝胶电泳法进行质粒特征分析,并以相应的标准菌株作比较。[结果]分离4种致病菌共90株,金黄色葡萄球菌、表皮葡萄球菌、大肠杆菌、绿脓杆菌对碘伏、醋酸氯已定未发现抗药性产生;表皮葡萄球菌、大肠杆菌、绿脓杆菌对84未发现抗药性产生;分离出6株金黄色葡萄球菌对84已经产生抗药性。金黄色葡萄球菌84抗性株与敏感株质粒特征比较显示两者有统计学差异。[结论]医院消毒剂使用不合理,尤其是高效消毒剂滥用,可致使医院菌株对常用消毒剂产生抗药性,抗药机理与细菌耐药质粒产生有关。     

Effect of disinfectants on microbial ecology in model distribution systems

This research was conducted to assess the impact of various disinfectants on bacterial water quality within model distribution systems (i.e. annular reactors). After colonization with non-disinfected water, annular reactors were treated with relatively low doses of chlorine (0.4 mg/l), chlorine dioxide (0.15 mg/l), or chloramines (0.9 mg/l). Under the tested conditions, bacterial inactivation varied as a function of disinfectant type (ranking by efficiency per mg of oxidant: ClO2 > Cl2 > ClNH2) and sample type (bulk water vs. biofilm). Depending on the disinfectant, the log inactivation of suspended and attached bacteria were 0.7-1.2 and 0.5-1.0, respectively. The characterization of microbial communities in drinking water can be performed using biochemical and/or molecular methods. In this study, biochemical tests were used, showing that pseudomonad and pseudomonad-like bacteria, as in other studies, were the most predominant micro-organisms (e.g. Pseudomonas fluorescens, Brevundimonas vescularis). The ratio Gram-positive to Gram-negative organisms was 1 to 3. No drastic differences were observed between the non-treated and disinfected pipes. Based on the bacteriological data presented in these experiments, chlorine dioxide represents an alternative to chlorine for certain distribution systems.     

A 17-month evaluation of a chlorine dioxide water treatment system to control Legionella species in a hospital water supply.

OBJECTIVE: To assess the safety and efficacy of a chlorine dioxide water treatment system in controlling Legionella in a hospital water supply. DESIGN: For 17 months following installation of the system, we performed regular water cultures throughout the building, assessed chlorine dioxide and chlorite levels, and monitored metal corrosion. RESULTS: Sites that grew Legionella species decreased from 41% at baseline to 4% (P = .001). L. anisa was the only species recovered and it was found in samples of both hot and cold water. Levels of chlorine dioxide and chlorite were below Environmental Protection Agency (EPA) limits for these chemicals in potable water. Further, enhanced carbon filtration effectively removed the chemicals, even at chlorine dioxide levels of more than twice what was used to treat the water. After 9 months, corrosion of copper test strips exposed to the chlorine dioxide was not higher than that of control strips. During the evaluation period, there were no cases of nosocomial Legionella in the building with the system, whereas there was one case in another building. CONCLUSIONS: Our results indicate that operation of a chlorine dioxide system effectively removed Legionella species from a hospital water supply. Furthermore, we found that the system was safe, as levels of chlorine dioxide and chlorite were below EPA limits. The system did not appear to cause increased corrosion of copper pipes. Our results indicate that chlorine dioxide may hold promise as a solution to the problem of Legionella contamination of hospital water supplies.     

连云港市15株饮用水中分离的铜绿假单胞菌对抗生素和化学消毒剂抗性分析

目的 了解连云港市饮用水中分离的铜绿假单胞菌的耐药性和常见化学消毒剂的抗性,初步探究我市饮用水中铜绿假单胞菌危害风险。 方法 将连云港市2013年、2014年收集的饮用水中分离出的铜绿假单胞菌15株,按照统一纸片扩散法（K-B法）和悬液定量杀菌试验,检测其对抗生素和不同化学消毒剂的抗性。结果 15株分离菌株中,仅1株对氨曲南和庆大霉素耐药,其余菌株对所选抗生素均敏感;两种消毒剂均具有良好杀灭效果,碘消毒剂优于氯消毒剂。 结论 连云港市饮用水中检出铜绿假单胞菌对实验抗生素普遍敏感,但也有1株菌具有一定耐药,应引起足够的重视;常见化学消毒剂对其杀灭效果良好。     

五种常用消毒剂对金黄色葡萄球菌的杀灭效果评价

目的研究医院常用消毒剂乙醇、三氯片、碘伏、戊二醛、爱护佳免洗手消毒剂对医院不同来源金黄色葡萄球菌的杀灭效果,为有效控制医院感染提供科学依据。方法收集南昌大学第一附属医院临床送检标本和医护人员手及医院内周边环境物体表面采集的标本分离的金黄色葡萄球菌共48株。通过消毒剂与细菌直接接触作用,研究消毒剂在不同稀释浓度、不同作用时间、体外杀灭不同来源的金色葡萄球菌的效果。结果常规使用消毒剂如5 g/L碘伏、20 g/L戊二醛和爱护佳免洗手消毒剂(0.5%葡萄糖酸氯己定+70%乙醇)常温下作用5 min对不同来源金黄色葡萄球菌的杀灭率为100%;70%乙醇和1 g/L三氯片常温下作用5 min对不同来源金黄色葡萄球菌的杀灭率为96.5%~99.8%;但碘伏、戊二醛和免洗手消毒剂被高度稀释后即使提高作用时间但仍不能完全杀灭金黄色葡萄球菌。结论该院常规使用消毒剂能满足临床杀菌效果,但需要不断地监测消毒剂的有效浓度,防止杀菌能力降低。     

不同皮肤消毒剂在献血人群采血前应用效果对比观察

目的比较不同消毒剂对献血人群采血前皮肤消毒的效果。方法选择某中心血站2008年5月-2011年4月无偿献血者240例,按采血前使用皮肤消毒剂的不同,分为碘酊乙醇组、碘伏组及安尔碘组,每组80例。分别于消毒剂使用前后采样,比较3组消毒剂的消毒效果和干燥所需时间。结果碘酊乙醇、碘伏及安尔碘组消毒前后皮肤采样检测细菌总数差异均无统计学意义（均P＞0.05）,消毒后皮肤采样检测细菌总数分别为（0.74±0.36）CFU/cm2、（0.82±0.38）CFU/cm2和（0.65±0.31）CFU/cm2;消毒合格率均达100%;上述3组消毒剂干燥所需时间分别为（76.23±5.31）s、（104.64±6.82）s和（20.41±3.53）s,差异有统计学意义（F=5.703,P＜0.05）,安尔碘组消毒剂干燥所需时间明显少于碘酊乙醇组和碘伏组。结论安尔碘皮肤消毒剂适用于献血人群采血前的皮肤消毒,消毒效果好,待干时间较短。     

消毒剂杀灭溶血性链球菌试验效果观察

目的：观察消毒剂杀灭溶血性链球菌试验效果。方法：试验采用悬液定量杀菌试验方法，选择4种常用消毒剂：次氯酸钠、过氧乙酸、洗必泰和碘伏分别进行悬液定量杀灭溶血性链球菌试验。结果：次氯酸钠有效氯含量200mg／L、过氧乙酸含量为150mg／L、洗必泰含量为2000mg／L、碘伏有效碘含量200mg／L时，作用3min对溶血性链球菌的杀灭对数值大于5；次氯酸钠有效氯含量250mg／L、过氧乙酸含量为100mg／L、洗必泰含量为2500mg／L、碘伏有效碘含量250mg／L时，作用3min对大肠杆菌的杀灭对数值大于5。结论：次氯酸钠、过氧乙酸、洗必泰、碘伏4种消毒剂均可用于杀灭溶血性链球菌；溶血性链球菌对消毒剂的抗力低于大肠杆菌。     

消毒剂对输血传播病毒DNA灭活效果的研究

目的 探讨对输血传播病毒(TTV)灭活效果好的化学消毒剂。方法 采用巢式聚合酶链反应(nPCR)技术,检测3种不同浓度的碘伏、高锰酸钾、煤酚皂液、“84”消毒液和金星消毒剂,对TTV DNA分别消毒处理10、30、60min和90min的灭活效果。结果 碘伏在常规使用浓度(0．5％～1％)对TTV DNA灭活效果好;高锰酸钾、来苏尔、“84”消毒液和金星消毒剂在高浓度下可灭活TTV DNA,而常规使用浓度对TTV DNA灭活效果不好。结论 碘伏是TTV较理想的化学消毒剂,消毒效果好,价廉、使用方便。     

医院使用中消毒剂的监测结果分析与管理

目的 了解使用中消毒剂的微生物污染状况,探讨使用中消毒剂的管理方法.方法 对全院各科室使用中消毒剂包括戊二醛、75％乙醇、聚维酮碘、快速手消毒液、碘酊进行采样检测,采样过程中记录消毒剂使用不规范的环节,分析原因,制定干预措施,督导干预措施有效实施,比较实施干预措施前后使用中消毒剂微生物污染状况.结果 实施干预措施前采集使用中消毒剂样本414份,合格363份,合格率87.68％,实施干预措施后采集使用中消毒剂样本361份,合格351份,合格率97.23％,实施干预措施前后比较,差异有统计学意义(P＜0.05).结论 必须重视使用中消毒剂的监测及管理,规范临床消毒剂的使用管理,正确使用消毒剂,有效预防和控制医院感染.     

Use of sodium dichloroisocyanurate granules for spills of body fluids

The use of chlorine-containing granules for disinfecting body fluid spills has been evaluated by hospital trials and laboratory tests. Hospital trials were carried out by nurses using 'Presept' disinfectant granules according to a protocol. In general they preferred using granules to bleach and, in 50 tests using granules on natural and artificial spills in wards, no organisms were recovered from the floor by contact plates after using the granules. Laboratory tests were carried out on 'Haz-Tab' granules, 'Biospot' disinfectant powder, 'Presept' disinfectant granules, 'Virusorb' absorbent powder and 'Titan' Sanitizer SU 357 using a standardized surface test. Available chlorine levels varied from 57.8% to 1.0% and the performance of products in the surface test varied with the chlorine level present. Granules containing a relatively high level of chlorine have the advantages that spilled material is contained and that a contact time of only 2-3 min is required before the spill can be safely removed.     

不同皮肤消毒剂与不同消毒方式消毒效果的比较研究

目的：探讨不同皮肤消毒剂与不同消毒方式的消毒效果,为临床使用提供依据。方法：选用临床常用的酒精、碘伏、复合碘和部分洗手消毒液,在受试者手背涂擦,通过消毒区采样,细菌培养,分别对消毒次数、棉签蘸取消毒液的量和皮肤干预措施后消毒效果等比较。结果：3种皮肤消毒剂消毒次数和干预措施后消毒次数污染情况无差异（P〉0.05）,用棉签蘸取棉签头1/2以上的消毒液量,其消毒效果最为理想（P〈0.05）。手部清洁处理时,选择湿巾法远远不如洗手和消毒凝胶液的清洁（P〈0.05）。结论：临床上常用的消毒液在进行皮肤消毒时棉签蘸取消毒液的量至少要达到棉签头1/2以上方能达到消毒效果;局部皮肤清洁应选用洗手和消毒凝胶涂擦法,清洁后再消毒可增强消毒效果。且消毒1次即能达到2次的效果。     

Evaluation of the microbicidal efficacy of Steris System I for digestive endoscopes using GERMANDE and ASTM validation protocols.

In the light of more and more invasive procedures being carried out in digestive endoscopy using sterile devices, it appears necessary to put in place a process of endoscope reprocessing capable of ensuring the complete elimination of micro-organisms contaminating the device. We undertook a study of the microbial efficacy of STERIS SYSTEM 1 (SS1) which purports to achieve this objective. The channels of a gastroscope and a colonoscope were contaminated with suspensions of Pseudomonas aeruginosa, Aspergillus niger and Bacillus subtilis spores. Two procedures were then followed: (1) manual washing only, and (2) treatment in SS1 without prewashing. Recoveries of organisms were made from each channel according to a standard methodology to discover any survivors. Contamination controls we re assessed to measure the logarithmic reduction between the initial contamination and that recovered from the channels. Six cycles per micro-organisms, per type of endoscope, and per type of procedure were carried out. From an initial contamination leve l of 10(6) micro-organisms per endoscope, no micro-organisms were recovered in 35 of the 36 cycles with the SS1. In one cycle with the colonoscope, three B. subtilis organisms were recovered from the channels. Washing only gave microbial reductions which varied according to the micro-organism tested. The maximum reduction with washing alone was by a factor of 10(3 +/- 0.1)for B. subtilis and the minimum reduction factor was 10(3 +/- 0.3)for P. aeruginosa. Considering the results obtained with SS1 without prewashing and the efficacy obtained from washing only, the washing step offers an additional antimicrobial assurance reduction factor of between 10 and 103.1. This study shows that SS1, integrated into an overall reprocessing procedure for digestive endoscopes, is capable of delivering the complete elimination of contaminating micro-organisms in a reduced time and eliminates the toxic risk of reprocessing associated with aldehyde based disinfectants.     

4种皮肤消毒剂消毒效果比较

目的 比较4种皮肤消毒剂的使用效果及时问，探讨更方便临床使用且效果更好的消毒剂。方法 将4种皮肤消毒剂分成3组，碘酒、乙醇为一组，碘伏、安尔碘各为一组；受试组不知使用的目的，分别对每组消毒剂使用前、后采样，观察消毒剂的消毒效果，同时计算消毒剂的干燥时间。结果 安尔碘组不但消毒效果肯定，而且干燥时间最短；碘酒、乙醇组消毒效果肯定，但干燥时间较长；碘伏正确使用时效果肯定，但存在不正确使用的现象，且干燥时间较长；3组消毒剂的消毒效果差异无统计学意义（P〉0．05），但所需干燥时间差异有统计学意义（P〈0．01）。结论 0．2％安尔碘用于皮肤消毒效果最好，主张作为首选的注射消毒剂；其次为碘酒、乙醇；碘伏的不规范使用与其干燥时间太长有关，且其黏度较大妨碍了胶布固定的牢固程度，临床注射时不主张首选。     

口岸常用3种消毒剂对芽孢的杀灭效果观察

目的研究3种口岸卫生处理常用含氯消毒剂对细菌芽孢的杀灭效果。方法采用载体定量杀菌实验对3种含氯消毒剂杀灭枯草芽孢的效果进行比较观察。结果在常温下,用含有效氯200mg/L的二元制二氧化氯液体消毒剂作用10min;含有效氯400mg/L的一元制二氧化氯消毒粉剂作用10min;含有效氯250mg/L的氧化还原电位泡腾片制剂作用5min;对载体内枯草杆菌黑色变种芽孢的杀灭率均≥99.97%。结论 3种消毒剂杀灭微生物效果随浓度增加、作用时间延长而增强。3种消毒剂在同样条件下,对细菌芽孢杀灭效果有明显差异,其中固体泡腾片消毒剂杀灭效果优于其他两种。     

Investigations of intrinsic Pseudomonas cepacia contamination in commercially manufactured povidone-iodine

OBJECTIVE: Laboratory investigations were initiated with a povidone-iodine antiseptic solution that was intrinsically contaminated with Pseudomonas cepacia. These investigations were helpful in understanding the microbicidal and chemical properties of iodophor solutions and the mechanism by which P cepacia can survive in iodine-containing antiseptics. DESIGN: Included in these studies were: prolonged survival of P cepacia; available and free iodine determinations; microbial challenge studies; and scanning electron microscopic examination of contaminated antiseptic. RESULTS: P cepacia survived in this iodophor antiseptic up to 68 weeks from the date of manufacture. A uniform concentration of 1% available iodine was found in all lots of povidone-iodine tested as specified on the product label, but free iodine (I2) values varied greatly. Low free iodine levels of 0.23 to 0.46 ppm were associated with the contaminated lot of povidone-iodine. Solutions of povidone-iodine with varying levels of free iodine were rapidly microbicidal when challenged with cells of P cepacia derived from culture broth and washed or adapted to growth in water. P cepacia cells taken directly from contaminated povidone-iodine survived for significantly longer periods of time. Large numbers of P cepacia were found embedded in extracellular material and among strands of glycocalyx between cells as shown by scanning electron microscopy. CONCLUSIONS: The physical thickness of cellular and extracellular material that forms on surfaces could protect embedded organisms from the microbicidal action of disinfectants and antiseptics and subsequently allow for extended microbial survival times. Manufacturers should be aware that distribution piping surfaces colonized with bacteria may be a source of product contamination and resistant organisms.     

Two sources of contamination of a hydrotherapy pool by environmental organisms

As a result of occasional water discolouration, the hydrotherapy pool of a large teaching hospital was monitored for free and combined chlorine, alkalinity, calcium hardness, total dissolved solids and cyanuric acid levels together with bacteriological analysis. The hose pipe supplying the pool and the dual water pumps were also examined as potential sources of bacterial contamination. The pool water yielded high counts of Pseudomonas vesicularis, Pseudomonas aeruginosa, and CDC Group IV C2, even in the presence of adequate levels of free chlorine. This was found to be due to high concentrations of cyanuric acid which resulted in a 'chlorine lock'. The source of the P. vesicularis and CDC Group IV C2 was found to be the pool hose and this problem was alleviated by flushing it with water each day before use. The source of the P. aeruginosa was the pool pumps, and was eradicated by regularly shock dosing them with 6-8 ppm of free chlorine.     

2017年云南省农村水厂饮用水消毒现状调查

目的 了解云南省农村生活饮用水消毒状况,加强生活饮用水水质管理,为有针对性地改善供水条件和保证饮用水安全提供参考依据。方法 对2017年云南省129个县2 883个农村水厂消毒现状进行调查,按照《生活饮用水标准检验方法》（GB/T5750 - 2006）采集水厂丰水期出厂水进行微生物指标（菌落总数和总大肠菌群）和与消毒方式相对应的消毒剂指标（二氧化氯或游离余氯）的检测。结果 调查的2 883个农村水厂中,有1 353个有消毒措施,占46.93%,使用比例较高的消毒剂为漂白粉（占69.99%,947/1 353）和液氯（占12.71%,172/1 353）。消毒剂余量合格率方面,大型集中式供水水厂（70.81%,131/185）高于小型集中式供水水厂（60.17%,695/1 155）,合格率差异有统计学意义（χ2 = 7.631,P＜0.01）;有卫生许可证的水厂（71.28%,201/282）高于无卫生许可证的水厂（59.07%,625/1 058）,合格率差异有统计学意义（χ2 = 14.022,P＜0.01）;微生物指标合格率方面,有消毒处理工艺的水厂（81.82%,1 107/1 353）与无消毒处理工艺的水厂（66.93%,1 024/1 530）差异有统计学意义（χ2 = 82.571,P＜0.01）。结论 云南省农村水厂使用的消毒剂以漂白粉为主;较大规模、具备卫生许可证的水厂消毒剂余量合格率显著高于较小规模、不具备卫生许可证的水厂;有消毒措施的水厂饮用水微生物指标合格率显著高于没有消毒设施的水厂。     

Hospital use of chlorine disinfectants in a hepatitis B endemic area--a prevalence survey in twenty hospitals

A survey was conducted to assess the uses of chlorine disinfectants in twenty hospitals in Hong Kong. In the 149 areas visited, the charge nurses were interviewed on the use of chlorine disinfectants. A high proportion of uses (44%) were not at the recommended dilution and only 88 (57%) of the 154 samples were within +/- 10% of the manufacturers quoted chlorine content. Samples with inadequate chlorine were found among all six types of chlorine disinfectants, although sodium dichloroisocyanurate tablets conformed to the quoted strength on 88% occasions. Higher usage frequency and better dilution practices were noted for hospitals with a disinfectant policy.