氧气湿化瓶消毒不严的监测与对策

氧气湿化瓶是医院输氧装置的一部分，文献报道，氧气湿化瓶污染是造成医院肺部感染的一个主要危险因素，其污染率高达６０％～８０％。《医院感染管理规范》中明确要求：连续使用中的氧气湿化瓶、雾化器、呼吸机及其管道等应定期消毒，湿化瓶应每日更换无菌水，用毕需消毒...     

臭氧用于氧气湿化瓶的消毒效果及保存方式和时限研究

氧疗是医院治疗和抢救患者的重要手段之一,但随着氧疗的应用,因氧疗而引起的院内感染也随之增多,有研究认为随着一次性输氧管的使用,输氧管道污染的关键是湿化瓶,湿化瓶污染与下呼吸道感染有密切关系[1].针对氧气湿化瓶的清洁消毒和保存,《消毒技术规范》规定采用含氯消毒剂浸泡、清水冲洗、晾干,清洁干燥封闭保存备用.     

医用氧气湿化瓶消毒保存方法改进

氧气湿化瓶的消毒管理是防止医院感染不容忽视的重要环节，据有关资料表明，氧气湿化瓶装置污染率为79．45％，且氧气湿化瓶污染与下呼吸道感染有密切关系。为防止因氧气湿化瓶污染引起医院内感染的发生，对氧气湿化瓶的消毒及保存方法进行了改进，取得满意的效果。     

应用酸性氧化电位水消毒后的氧气湿化瓶的包装及效期研究

[目的]研究酸性氧化电位水消毒后的氧气湿化瓶的包装及效期。[方法]把回收的湿化瓶经酸性氧化电位水消毒、干燥柜干燥后,采用低密度聚乙烯(LDPE)自封袋包装,研究其包装的可行性及在每个时段的细菌学监测指标是否符合规范要求,从而确定其包装及效期。[结果]采用LDPE自封袋包装的氧气湿化瓶在消毒后即刻及存放1周、2周、3周、4周、5周内包装均保持完好,且细菌检测符合《医院消毒卫生标准》对中度危险性医疗器材的细菌菌落总数要求。[结论]LDPE自封袋可作为酸性氧化电位水消毒后氧气湿化瓶的包装材料,且在保存的5周内细菌学检测结果均符合要求,5周可以作为消毒后氧气湿化瓶的保存期限。     

悬挂式方筛在氧气湿化瓶消毒中的应用

临床中,由于一次性吸氧管的普及,整个吸氧管路消毒的重点放在了氧气湿化瓶上.有研究[1]正明,潮湿的氧气湿化瓶为铜绿假单胞菌的繁殖提供了有利条件,且铜绿假单胞菌易形成生物被膜,促进铜绿假单胞菌在氧气湿化瓶中黏附和寄殖.根据<医院感染管理规范>的规定,对于连续使用的氧气湿化瓶,必须每日消毒,用毕终末消毒,干燥保存.     

氧气通气管抗浮消毒袋的制作及应用

鼻导管吸氧是呼吸系统最常用的医疗操作,但容易导致呼吸道感染[1]。根据中华人民共和国卫生部制定的《医院感染管理规范》要求,必须每日更换湿化液和消毒湿化瓶、氧气通气管等湿化器材[2]。目前湿化器材的消毒多采用含氯消毒剂500mg/L浸泡30min后用清水冲净、晾干,清洁干燥封闭保存备用[3]。浸泡消毒时物品必须浸没     

氧气湿化瓶及内芯的细菌培养调查与管理对策

氧气湿化瓶是吸氧过程中湿化氧气必不可少的装置,在临床上广泛使用,许多病人需要频繁或长时间使用氧气湿化瓶吸氧,潮湿的氧气湿化瓶为细菌的生长繁殖提供了有利条件,一旦氧气湿化液被污染,氧气湿化液中生长的细菌可以在氧气湿化过程中,形成微小的颗粒状气溶胶随氧气喷出而吸入下呼吸道,导致呼吸道感染,由此引起的院内感染也越来越多,有关氧气湿化瓶引起的医院感染也多有报道[1],但是,氧气湿化瓶其内芯污染所造成的医院感染报道很少,因此,了解氧气湿化瓶及内芯的医院感染情况与探讨其管理对策势在必行。2004年通过对我院22个科室有关氧气湿化…     

氧气湿化液污染引起肺部感染菌群调查

[目的]探讨创伤救治中心重症监护病房(ICU)氧气湿化液细菌污染与病人肺部感染的关系,为防治提供防范措施。[方法]取ICU病房氧气湿化瓶37个,对正在使用中的氧气湿化液进行细菌培养,同时对37例ICU病人下呼吸道痰液行细菌培养,对其细菌进行分离、鉴定。[结果]37瓶湿化液细菌培养29瓶阳性,共检出15种69株细菌,主要以革兰阴性杆菌为主(57.97%),22例痰培养有致病菌生长,其细菌分布以革兰阴性杆菌为主,12例痰培养与湿化液所分离的细菌一致。[结论]氧气湿化液细菌污染是造成院内肺部感染的重要病源之一,对湿化液的定期更换和彻底消毒是预防医院感染的重要措施。     

湿化瓶系统的消毒与保存方法的改进

氧气疗法是医院常用的护理技术操作,如果病人使用的湿化瓶系统污染,就极易引起院内感染,湿化瓶系统包括氧流量管、过滤管、氧气连接管、湿化瓶.本院自2008年以来对湿化瓶系统的消毒与保存方法进行了改进,有效地控制了医院感染发生.     

氧气湿化瓶干燥架的改良设计与应用

氧气湿化瓶是医院抢救和治疗危重病人的必备装置,而氧气湿化瓶污染是氧疗病人院内感染的重要因素之一。我院氧气湿化瓶在实行集中式管理过程中发现,消毒后大量的湿化瓶在晾干(干燥)存放环节中极易造成二次污染,干燥时间相对延长,耗费人力,不便于批量处置。而丁志红[1]设计的干燥架由聚氯乙烯塑料制作,工艺相对复杂不耐用,盘架一体,不便于消毒处理;李红娥等[2]设计的氧气湿化瓶干燥盘结构相对繁琐,不适宜     

消毒后备用湿化瓶的干燥方法及存放时间探讨

目的探讨消毒后备用湿化瓶干燥方法及存放时间，为其妥善保存提供依据，减少因湿化瓶保存不当而污染造成的医院内感染。方法对消毒后的84个氧气湿化瓶随机分为A组和B组各42个，分别采用自然晾干和氧气吹干2种不同的干燥方法，在不同月份连续7d进行细菌监测，并对结果进行分析。结果采用氧气吹干法的湿化瓶比自然晾干法的湿化瓶可多保存1d。结论消毒后备用湿化瓶的保存时间，应根据季节不同，干燥方法不同，确定不同的有效保存时间。     

A comparison of the rate of bacterial contamination for prefilled disposable and reusable oxygen humidifiers

BACKGROUND: Prefilled disposable oxygen humidifiers are considered to prevent nosocomial pneumonia in hospital wards. However, their usefulness in intensive care units (ICUs) has not yet been established. In this study, we evaluated and compared contamination in prefilled disposable oxygen humidifiers and that in reusable oxygen humidifiers. METHODS: Six oxygen outlets in the ICU were used. Prefilled disposable oxygen humidifiers and reusable oxygen humidifiers were attached to each wall-mounted oxygen outlet using a 2-way connector. Nonsterile nasal cannulae and tubes were connected to the humidifiers through which 5 L/min of oxygen was delivered continuously. Water samples (5 mL) from each humidifier were collected on the first day and every 7 days thereafter for a period of 56 days. Each water sample was incubated aerobically at 35 degrees C for 48 hours and observed daily for bacterial growth. RESULTS: Bacterial growth was observed only once in one sample from each humidifier type. Gram-positive cocci, 40 colony-forming units in the disposable oxygen humidifier and 10 colony-forming units in the reusable oxygen humidifier, were detected. Dust was observed from the 35th day onward only in the reusable oxygen humidifier. CONCLUSION: In the ICU, bacterial contamination does not occur in oxygen humidifiers even after 56 days of continuous use. However, dust does accumulate in the reusable oxygen humidifier after 35 days of continuous use.     

可重复使用的消毒诊疗物品保存方法研究

目的探讨可重复使用消毒物品的保存期限,为临床应用提供依据。方法湿化瓶、面罩、呼吸机螺纹管、吸痰器连接管经清洗消毒后随机将：A组用预先经低温等离子灭菌后的食品包装袋按诊疗需求进行包装,B组放在铺好的治疗盘内;同时又将经A组包装后的诊疗物品随机分为A1组放在临床治疗室内,A2组放在供应室无菌室内,检测四组不同保存方法的污染率。结果 A组7d内未出现污染,B组1d出现污染,4d污染率达50.00%（P〈0.05）;A1组8d开始污染,A2组12d开始污染（P〈0.05）。结论可重复使用的消毒物品在干燥无菌保存条件下,治疗室内保存时限为7d,供应室保存时限为10d。     

Multipatient use of prefilled disposable oxygen humidifiers for up to 30 days: patient safety and cost analysis

BACKGROUND: Prefilled disposable oxygen humidification units have been shown to decrease the likelihood of contamination when compared to reusable oxygen humidification units. However, prefilled disposable humidifiers are expensive when used for single patients, especially in areas of high turnover, and it is not known whether these units need to be routinely changed before they are empty. The number of patients safely using a prefilled disposable humidifier has not been documented in previously reported work. Are patients at risk of nosocomial infections due to cross-contamination when prefilled disposable oxygen humidifiers are applied to multi-patient use? What are the cost benefits of multiple patient use of prefilled disposable oxygen humidifiers? When local practice or physician preference dictates the use of humidification for low-flow oxygen, these questions need to be answered. METHODS & MATERIALS: Data were collected over two time periods to address changes due to seasonal variations and include area of use, number of patients, and quantitative cultures for aerobic microorganisms (including Legionella). Each disposable humidifier was monitored for a period of 1 month or until only 1 inch of water remained. Costs of using reusable humidifiers and prefilled humidifiers and therapist/nurse time to initiate therapy with both units were compared. During this period, 60 reusable humidifiers were also cultured for aerobic microorganisms and Legionella. RESULTS: We report results on 1,311 of the 1,315 disposable prefilled oxygen humidifiers used. We saw no significant growth in any of the prefilled disposable humidifiers for periods of up to 30 days, with > 100 humidifiers having been used by > 20 patients. CONCLUSIONS: Our results show that prefilled disposable oxygen humidifiers can be used without cross-contamination, on multiple patients, for a period of 1 month. The use of prefilled humidifiers in this way represents a substantial cost saving when compared to reusable humidifiers.     

Factors affecting the development of precipitating antibodies in workers exposed to contaminated humidifiers

A total of 601 sera from groups of workers exposed to heavily and moderately contaminated humidifiers respectively were examined by the double diffusion test for precipitating antibodies to humidifier extracts. Clinical information was obtained using a standardized questionnaire. Skin-prick tests to control, to three common inhalant antigens and to an extract from the humidifier were performed in 103 subjects exposed to a heavily contaminated humidifier. In this environment a strong inverse relationship between current smoking and precipitins was detected (P less than 0.001). Pack years smoked had no bearing on precipitin level. In the larger study there was a clear dose response effect of smoking on precipitins. The effect of smoking appeared to reverse within 3 years. Duration of exposure also had a major effect on the development of precipitins with a clear 'dose response' again being seen in the larger study. These relationships did not apply in the groups exposed to moderately contaminated humidifiers. Levels of airborne antigen were measured using a competitive ELISA inhibition assay and were found to be much lower in sites with moderately contaminated humidifiers than at sites with heavily contaminated humidifiers. Our results suggest that the airborne antigen level is crucial in determining the pattern and strength of precipitin response in smokers and non-smokers exposed to contaminated humidifiers.     

输氧装置消毒方法的研究

目的 采用不同消毒方法对输氧装置的不同部位进行细菌学调查,强化对输氧装置的消毒管理.方法 对我院4个病区输氧装置中湿化瓶、中心供氧孔、输氧连接管口3个部位各300份样本于消毒前采样分析污染程度,并采用500 mg/L含氯消毒剂、0.5%过氧乙酸溶液和0.2%碘附消毒,比较最佳的消毒模式.结果 消毒前所有样本细菌培养阳性率为100%,湿化瓶菌落均数超过3万cfu/ml,中心供氧孔菌落均数超过28万cfu/ml,输氧管菌落均数超过1万cfu/ml,消毒后各组灭菌率均达标,500 mg/L含氯消毒剂灭菌率达100%.含氯消毒剂、过氧乙酸溶液和0.5%碘伏消毒效果比较,差异有统计学意义（P＜0.05）.结论 输氧连接管口和湿化瓶的污染相当严重,3种消毒方法均能达到高水平消毒,但含氯消毒剂消毒效果最佳.     

重复使用的氧气湿化装置与一次性氧气湿化装置用后的比较研究

目的 重复使用的氧气湿化装置与一次性氧气湿化装置进行使用后细菌学分析.方法 随机抽取老年科6个病区用后的可重复使用的氧气湿化装置与一次性氧气湿化瓶,将吸氧患者随机分为3组,A组用冷开水作为氧气湿化液,B组用蒸馏水作为氧气湿化液,C组用AQUAPAK一次性氧气湿化装置.A组和B组在每周一和周四更换湿化瓶前采样,C组在每瓶一次性氧气湿化装置使用结束后采样,按<医院消毒卫生标准>消毒液的采样方法 采样后送检验科检验.结果 A组61个样本中带菌率为81.97%,B组71个样本中带菌率为47.89%,C组52个样本中带菌率为0.3种湿化瓶使用后的污染率比较差异显著.A,B组间进行比较,A组细菌平均严重等级高于B组,A组革兰阴性菌种类的等级及革兰阳性菌的带菌率均高于B组.结论 无论是用冷开水还是蒸馏水作为氧气湿化液,湿化液均有不同程度的污染,在目前各医疗机构尚无统一湿化液选择标准以及消毒规范的背景下,对长期吸氧的患者,建议选择一次性氧气湿化装置,以期减少患者院内感染的发生率.

Abstract：

Objective To carry out bacteriological analysis between re-used and disposable oxygen humidification devices. Methods Reused oxygen equipment and disposable oxygen moisture bottles from 6 randomly selected elderly wards were collected, patients who used oxygen will be randomized into 3 groups, group A used cold water as the oxygen humidification liquid, group B used distilled water as humidification liquid, group C used AQUAPAK disposable oxygen humidification devices, sample taking in group A and group B happened on every Monday and Thursday before the replacement of sample moisture bottles, sample was taken in group C after the use of disposable oxygen humidification devices, according to "hospital disinfection health standards" (GB5982-1995)sampling method of disinfection liquid sample was taken and sent to test in the disinfectant laboratory. Results Of 61 samples in group A bacteria cartier rate was 81.97%, bacteria carrier rate of 71 samples in group B was 47.89%, of 52 samples in group C the carrier rate was 0. The comparing of bacterial contamination rate of three kinds of oxygen moisture bottles after using was statistically significant. Take group A, B for comparison, the average severity level of bacteria in group A is higher than group B. In group A, the level of the Gram-negative bacteria as well as Gram-positive bacteria colonization was higher than group B. Conclusions Whether use of cold water or distilled water, oxygen humidification liquids have different degrees of pollution. Currently there is no general criteria and norms in the context of sterilization of oxygen humidification, for patients on long-term oxygen using, to choose disposable oxygen humidification device to reduce the incidence of hospital infections is recommended.     

Amoebae and humidifier fever

One hundred and nineteen sera from workers at four different work sites exposed to different contaminated humidifiers were examined by the immunofluorescent antibody (IFA) technique for antibodies to the amoebae Acanthamoeba polyphaga and Naegleria gruberi. Twenty-five of the sera were from workers with humidifier fever (HF) and six from workers with work related asthma (WRA) shown to be due to the contaminated humidifiers. A positive IFA test was found to correlate precipitin reaction to humidifier antigen, but did not correlate with smoking habit, work related symptoms (detected by standard questionnaire) or with HF or WRA. Amoebae were identified in all humidifiers studied.     

氧气湿化瓶集中化消毒供应的探讨

目的 加强医院氧气湿化瓶的消毒管理。方法 对氧气湿化瓶的清洗、消毒进行集中化处理,由供应科专业人员对氧气湿化瓶进行清洗、消毒、包装。结果 加强医院氧气湿化瓶的消毒管理,细菌培养合格率由集中化处理前的45.6％上升为100％,大大提高了氧气湿化瓶的清洗、消毒质量。结论 通过对氧气湿化瓶进行中心化清洗、消毒,规范化管理,保...     

不同消毒方法对氧气湿化瓶消毒效果比较

目的研究不同消毒方法对氧气湿化瓶的消毒效果,选择最佳消毒方案。方法采用棉拭涂抹采样和细菌定量检测方法 ,对臭氧高强紫外线消毒法和消毒液浸泡法消毒氧气湿化瓶的效果进行了比较观察。结果经清洗干燥后的氧气湿化瓶在臭氧高强紫外线消毒柜消毒50 min,检测130件氧气湿化瓶,消毒效果平均合格率为96.92%。将清洗后的氧气湿化瓶置于含有效氯250 mg/L含氯消毒剂溶液中浸泡30 min,检测130件氧气湿化瓶,消毒效果平均合格率为70%。结论紫外线消毒柜对氧气湿化瓶消毒效果明显优于消毒液浸泡法,且前者易于保存。