北京市东城区公共场所军团菌危险因素与预防控制

目的通过对公共场所中央空调系统和淋浴系统的规模、消毒和清洁措施的现状进行调查评估,了解军团菌存在规律,提出高效可行的控制措施,降低军团菌病暴发流行的风险。方法采用问卷调查和访谈方式,收集公共场所中央空调和淋浴系统现状信息,并采集标本进行军团菌监测,对现状信息和监测结果进行综合分析。结果冷却水军团菌检出率11.30%,淋浴系统军团菌检出率6.57%,总检出率8.39%。结论中央空调系统和淋浴系统应进一步规范化管理,加强监测和效果评价。     

Disinfection of fabrics and carpets artificially contaminated with calicivirus: relevance in institutional and healthcare centres

Fabrics and carpets are used widely as surface coverings or linens in healthcare settings and are prone to contamination with infectious agents such as noroviruses (NoVs). Laundering, water cleaning and vacuuming are considered to be adequate for routine cleaning of these materials, but no standard procedure for their disinfection is available in case of contamination. Testing disinfectants for their efficacy against NoVs is difficult because these viruses cannot be cultivated in vitro. Therefore, feline calicivirus (FCV) has gained acceptance as a surrogate model for NoVs in disinfectant efficacy testing. The present study evaluated five disinfectants against FCV on various fabrics or carpets. FCV was dried on fabrics and carpets, followed by treatment with a given disinfectant for a defined contact time of 1, 5 or 10 min. The surviving virus was then eluted and titrated in Crandell-Reese feline kidney cells to determine virus inactivation. A disinfectant was considered to be effective if it inactivated at least 99% of the applied virus. Metricide, an activated dialdehyde-based product, was found to be the most effective disinfectant on all types of fabric and carpet, inactivating more than 99.99% of the virus in 1-10 min. In general, effectiveness of disinfectants increased with an increase in exposure time from 1 to 10 min. The disinfection of carpets was more difficult than the disinfection of fabrics; 100% polyester was the least amenable to disinfection. Only Metricide and Microbac-II (a phenolic compound) were able to inactivate 99% of FCV on 100% polyester. In summary, activated dialdehyde was found to be uniformly active against FCV on all types of material tested.     

A microbiological study of various food premises with an assessment of cleaning and disinfection practices.

A study of cleaning and disinfection methods in a variety of types of catering premises has been carried out. The level of bacterial contamination of the hands and of equipment was related to cleaning methods and to the type of catering establishment. Wiping cloths were frequently contaminated with Escherichia coli, and these may be important reservoirs of bacteria for contamination of the hands of catering staff. Regular and efficient cleaning of food surfaces and equipment was found to be more important than the use of a disinfectant as part of the cleaning process. Methods for reducing the risks of cross-contamination in catering premises are discussed.     

A microbiological study of various food premises with an assessment of cleaning and disinfection practices

A study of cleaning and disinfection methods in a variety of types of catering premises has been carried out. The level of bacterial contamination of the hands and of equipment was related to cleaning methods and to the type of catering establishment. Wiping cloths were frequently contaminated with Escherichia coli, and these may be important reservoirs of bacteria for contamination of the hands of catering staff. Regular and efficient cleaning of food surfaces and equipment was found to be more important than the use of a disinfectant as part of the cleaning process. Methods for reducing the risks of cross-contamination in catering premises are discussed.     

静脉用药调配中心转运药箱清洁消毒方法及效果研究

目的 对静脉用药调配中心(PIVAS)转运药箱的清洁消毒方法及效果维持时间进行研究,以保证患者的成品输液安全.方法 选取某院正常使用中的转运药箱64个,采用医用消毒湿巾清洁消毒后,分别于0、12、24、36、48 h进行目视检测和微生物检测,并进行统计分析.结果 清洁消毒0 h后,目测法和微生物检测法检测结果合格率均为...     

一种被褥洗涤工艺对棉胎与床垫等携带细菌的清除效果

目的 探讨一种被褥洗涤工艺对棉胎、床垫等的消毒效果。方法 2018年11月—2019年1月随机选取某院住院部神经外科、普通外科、神经内科3个病区普通病房的部分棉胎、床垫、枕芯作为研究对象，采用一种被褥洗涤工艺对其进行消毒、检测，比较使用10、30 d以及清洗消毒前后其细菌数的差异。结果 三个科室共抽取72个床单位的棉胎、床垫、枕芯。采用该被褥洗涤工艺清洗消毒后，棉胎、床垫、枕芯上均未检出大肠菌群、金黄色葡萄球菌，普通外科棉胎、床垫细菌污染率均为4.2%，其余科室棉胎、床垫、枕芯细菌数均合格。细菌数神经外科和神经内科棉胎、床垫、枕芯患者使用10、30 d细菌数与清洗消毒后细菌数比较，差异均有统计学意义（均P<0.01）；普通外科棉胎患者使用10、30 d细菌数与清洗消毒后细菌数比较，差异均无统计学意义（均P>0.05），但床垫、枕芯患者使用10、30 d细菌数与清洗消毒后细菌数比较，差异均有统计学意义（均P<0.01）。结论 该被褥洗涤工艺对棉胎、床垫等消毒效果可靠，可以预防因棉胎、床垫、枕芯污染致医院感染的发生。     

Disinfection or cleaning of hospital toilets—an evaluation of different routines

Four different cleaning routines for hospital toilets have been evaluated: (1) cleaning with disinfectant after each patient; (2) cleaning with a detergent after each patient; (3) cleaning with a disinfectant once a day; (4) cleaning with a detergent once a day. Samples were made with contact plates on toilet seats, wash-basins and tap handles three times a day. The lowest number of bacteria 0.1–0.3 c.f.u./cm² was found when disinfection was performed after each patient. Cleaning with a detergent lead to a 4–6 fold rise in contamination. Treatment of the surfaces once a day only showed counts between 2.6 and 8.9 c.f.u./cm². Thus, whether disinfection or cleaning was performed the number of bacteria found was low.     

Evaluation of disinfectants in the domestic environment under 'in use' conditions

An 'in use' test was developed to investigate effectiveness of disinfectant application and of detergent of hot water cleaning at kitchen, bathroom and toilet sites in the domestic environment. Detergent and hot water cleaning produced no observable reduction in microbial contamination. Single and daily application tests demonstrated that hypochlorite and phenolic disinfectants can be used to produce substantial reductions in bacterial contamination in the home. Results indicate that maximum protection afforded by disinfection is relatively brief; 3-6 h after disinfection, contamination levels were only marginally less than those observed at pretreatment. Some suggestions are made for improvements in home hygiene.     

Importance of environmental decontamination--a critical view

The level of evidence supporting different disinfection and cleaning procedures performed in healthcare settings worldwide is low. With respect to environmental surfaces, the final assessment of whether use of disinfectants rather than detergents alone reduces nosocomial infection rates in different clinical settings still awaits conclusive study. It must be kept in mind that the effect of surface disinfection is only transient microbial contamination will have reached its former level within a few hours. While resistance to biocides is generally not judged to be as critical as antibiotic resistance, scientific data support the need for proper use, i.e. avoidance of widespread application, especially in low concentrations and in consumer products. The decontamination ability of the substances used; prevention of resistance; and safety for patients, personnel and the environment; are the cornerstones that interact with each other. Future work should focus on this complex background. Targeted disinfection of environmental surfaces (those frequently touched) is an established component of infection control activities to prevent the spread of nosocomial (multi-resistant) pathogens, but of lesser importance than proper hand hygiene. However, since the use of disinfectants may pose a danger to staff, patients and the environment, prudent use combined with the application of proven safety precautions is important. Since emerging resistant pathogens will challenge healthcare facilities in future even more than today, well-designed studies addressing the role of disinfection in the healthcare-setting are needed.     

一种被褥洗涤工艺对棉胎与床垫等携带细菌的清除效果

目的探讨一种被褥洗涤工艺对棉胎、床垫等的消毒效果。方法 2018年11月—2019年1月随机选取某院住院部神经外科、普通外科、神经内科3个病区普通病房的部分棉胎、床垫、枕芯作为研究对象,采用一种被褥洗涤工艺对其进行消毒、检测,比较使用10、30 d以及清洗消毒前后其细菌数的差异。结果三个科室共抽取72个床单位的棉胎、床垫、枕芯。采用该被褥洗涤工艺清洗消毒后,棉胎、床垫、枕芯上均未检出大肠菌群、金黄色葡萄球菌,普通外科棉胎、床垫细菌污染率均为4.2%,其余科室棉胎、床垫、枕芯细菌数均合格。细菌数神经外科和神经内科棉胎、床垫、枕芯患者使用10、30 d细菌数与清洗消毒后细菌数比较,差异均有统计学意义(均P0.01);普通外科棉胎患者使用10、30 d细菌数与清洗消毒后细菌数比较,差异均无统计学意义(均P0.05),但床垫、枕芯患者使用10、30 d细菌数与清洗消毒后细菌数比较,差异均有统计学意义(均P0.01)。结论该被褥洗涤工艺对棉胎、床垫等消毒效果可靠,可以预防因棉胎、床垫、枕芯污染致医院感染的发生。     

Reprocessing endoscopes: United States perspective

Endoscopes are used frequently for the diagnosis and therapy of medical disorders. For example, greater than 10000000 gastrointestinal endoscopic procedures are performed each year in the United States. Failure to employ appropriate cleaning and disinfection/sterilization of endoscopes has been responsible for multiple nosocomial outbreaks and serious, sometimes life-threatening, infections. Flexible endoscopes, by virtue of the site of use, have a high bioburden of microorganisms after use. The bioburden found on flexible gastrointestinal endoscopes following use has ranged from 10(5) to 10(10)CFU/ml, with the highest levels being found in the suction channels. Cleaning dramatically reduces the bioburden on endoscopes. Several investigators have shown a mean log(10) reduction factor of 4 (99.99%) in the microbial contaminants with cleaning alone. Cleaning should be done promptly following each use of an endoscope to prevent drying of secretions, allow removal of organic material, and decrease the number of microbial pathogens. Because the endoscope comes into intimate contact with mucous membranes, high-level disinfection is the reprocessing standard after each patient use. High-level disinfection refers to the use of a disinfectant (e.g., FDA-cleared chemical sterilant or high-level disinfectant) that inactivates all microorganisms (i.e., bacteria, viruses, fungi, mycobacteria) but not high levels of bacterial spores. The disinfection process requires immersion of the endoscope in the high-level disinfectant and ensuring all channels are perfused for the approved contact time (e.g., for ortho-phthaladehyde this is 12 min in the US). Following disinfection, the endoscope and channels are rinsed with sterile water, filtered water, or tapwater. The channels are then flushed with alcohol and dried using forced air. The endoscope should be stored in a manner that prevents recontamination. A protocol that describes the meticulous manual cleaning process, the appropriate training and evaluation of the reprocessing personnel, and a quality assurance program for endoscopes should be adopted and enforced by each unit performing endoscopic reprocessing.     

Pseudomonas aeruginosa outbreak in a haematology-oncology unit associated with contaminated surface cleaning equipment

An outbreak of six cases of hospital-acquired Pseudomonas aeruginosa infections (two pneumonia two septicaemia, two skin/wound infection) occurred between August and September 2000 in an adult haematology-oncology unit at a tertiary-care centre. During the outbreak, hospital-acquired infection (HAI) incidence density rates rose from 29.4 to 62.3 (P < 0.05) infections per 1000 days at risk (i.e., neutropenic days). A systematic outbreak management system was actioned in accordance with a German draft guideline. Multiple samples from the patients' environment were tested for the presence of P. aeruginosa. A total of 4.5% of samples from sanitary equipment and 20.0% of samples from surface cleaning equipment were found to be contaminated with P. aeruginosa. Genotypic analysis by pulsed-field gel electrophoresis showed different patterns for all (N = 6) of the patient isolates, however, two of the patient isolates were identical in comparison with environmental isolates from cleaning equipment (four samples) and sanitary equipment (one sample). Our investigation revealed that the cleaning staff had used cleaning solution instead of disinfectants for decontamination of the patients' environment. The outbreak was terminated after re-adoption of surface disinfection, application of sterile filters on taps and shower heads, chemical disinfection of the washbasin drains, and appointment of a hospital hygiene nurse to a previously unfilled position. After institution of the control measures, HAI incidence densities decreased to pre-outbreak level. This investigation emphasizes the need to carefully evaluate cleaning and disinfection practices for patient care, particularly in neutropenic patients.     

医用小型平板电脑现场清洁消毒方法研究

目的对临床使用的医用平板电脑污染程度进行调查,比较3种清洁消毒方法的有效性。方法采用手持式ATP荧光检测仪对平板电脑前后表面进行涂擦采样,研究分为基线阶段和清洁消毒阶段,基线阶段对使用中平板电脑进行采样,清洁消毒阶段采用生理盐水纱布、乙醇纱布、卫生湿巾3种方法对平板电脑进行擦拭后分别进行采样。结果基线阶段:基线组共采集20台平板电脑,合格率为0,ATP检测相对光单位值(RLU)中位数为218.00。清洁消毒阶段:生理盐水纱布组、乙醇纱布组和卫生湿巾组各采集10台平板电脑,合格率分别为50.00%、0和60.00%,ATP检测RLU中位数分别为28.50、79.00和29.00。4组ATP检测RLU间两两比较,除生理盐水纱布组与卫生湿巾组比较差异无统计学意义(P=0.97),其余组别两两比较差异均有统计学意义(均P0.001)。结论日常医疗工作中医用平板电脑污染严重,卫生湿巾是较为理想的清洁消毒方法,但清洁消毒间隔时限还有待于进一步研究论证。     

The importance of cleaning for the overall results of processing endoscopes

Reprocessing comprises three steps: cleaning, disinfection and-if required-sterilisation. While the extents of disinfection and of sterilisation are quantitatively defined, there are only imprecise (qualitative) definitions of cleaning. There are two main reasons for accurate cleaning. First organic and inorganic materials that remain on inner and outer surfaces will interfere with the efficacy of the disinfectants. In case of endoscopes this will lead to channel blockages; they remain undisinfected. Second the bioburden found on endoscopes after use can be very high. Data available demonstrate that a bacterial burden of up to 10(9)cfu/endoscope channel can be expected. Therefore it is necessary to perform a thorough cleaning. Studies using endoscopes showed a reduction in microbial counts by a factor of approximately 10(4) by cleaning (manual and mechanical). Therefore in 2001 the German Society of Hospital Hygiene (DGKH) specified its requirements and recommendations for determining cleaning efficacy separately from those for disinfection. Cleaning and disinfecting can be done manually or mechanically, but it seems impossible to validate manual processes. However our studies in two different washer-disinfectors (WD) showed differences in cleaning efficacy. The tested cleaning processes showed different efficacies. Not all cleaning processes showed better results than water alone with regard to visible cleanliness and to a microbiological reduction E. faecium. Our results show that the evaluation of cleanliness exclusively by visible inspection is not sufficient, particular for the lumens of endoscopes. The results also show that a cleaning process may be very effective also in reducing micro-organisms present.     

Cleaning of blood-contaminated reprocessed angiographic catheters and spinal needles.

OBJECTIVES: To evaluate the efficacy of a multistep cleaning method using a cleaner and a chemical disinfectant on blood-contaminated angiographic catheters and spinal needles intended to be sterilized by hydrogen peroxide gas plasma. METHOD: A mixture of radiopaque iodine contrast, bovine blood (plus ethylenediaminetetraacetic acid), and a suspension of Bacillus subtilis spores was used to simulate catheterization and needle use. The mixture was a 1:1 proportion of contrast and blood, inoculated so that there was a final concentration of B subtilis spores of 1.0x10(6) colony-forming units (CFU)/mL. The inoculated devices were cleaned using a hydrogen peroxide solution at a concentration of 1.5+/-0.5 percent by weight, followed by distilled water with enzymatic detergent. After drying, the devices were sterilized with hydrogen peroxide gas plasma. RESULTS: The initial B subtilis spore concentration inoculated into catheters and needles varied from 2.12x10(4) to 2.74x10(7) CFU/mL. The residual load of B. subtilis spores after cleaning varied from zero (no count) to a maximum of 200 CFU/device. The multistep cleaning procedure was responsible for an average 5log10 reduction of B. subtilis spores in the catheter and needle lumens. CONCLUSIONS: The hydrogen peroxide and enzymatic detergent aqueous solutions were shown to be efficacious when used as part of a multistep cleaning method. The low level of microbial contamination prior to sterilization with hydrogen peroxide gas plasma assured that the intended sterility assurance level was reached.     

Six month tracking of microbial growth in a metalworking fluid after system cleaning and recharging

Large volumes of metalworking fluids (MWFs) are used in manufacturing industries for cooling and lubrication of metal pieces and tools during machining. MWFs accumulate microbial growth through continuous recirculation and reuse. We studied the progression of microbial contamination for 6 months after dumping, cleaning and recharging (DCR) of a large semi-synthetic MWF system managed with several biocides. Fresh, uncontaminated fluid was added to the system after extensive cleaning. The following samples were collected and analyzed: pre-DCR fluid (before system cleaning); neat fluid diluted to 6% with water; in use MWF 12 h and 1, 3 and 6 months post-DCR. Samples were analyzed for total microorganism concentrations by direct counting using fluorescence microscopy and by plate counting on various media (R2A, BHI, Middlebrooks and rose bengal under aerobic conditions). In addition, PCR was performed for the detection of mycobacteria. There was a rapid progression in the total bacterial counts as determined by fluorescence microscopy: 5.7 x 10(7) cells/ml in the pre-DCR used fluid, no measurable bacteria in the neat fluid, 6.9 x 10(6) cells/ml after 12 h and 2.2 x 10(6), 3.6 x 10(8) and 6.1 x 10(8) cells/ml after 1, 3 and 6 months, respectively. On average, only 0.2% of the direct count organisms were quantified on R2A cultures. PCR showed the presence of mycobacteria in the used MWF at 3 and 6 months. Mycobacteria were also identified from cultures on Middlebrooks and R2A. This study demonstrates that standard methods for cleaning MWF systems are inadequate since residual bacteria in the system can rapidly repopulate the newly charged MWF.     

Disinfection for infection prevention over the course of time

In recent years and decades increasingly more emphasis has been placed on alcohol-based solutions for hygienic and surgical hand disinfection. Traditional handwashing with soap and water has been largely replaced in the everyday clinical setting, as has the use of disinfectant soap-based solutions for surgical hand disinfection. It has been possible in recent years to reduce the exposure time for alcohol-based hand disinfection in surgery from 5 to 3 minutes, and there are plans to reduce this even further. The growing awareness of the tolerability issues has also given rise to favorable developments here. There have also been dramatic changes in preoperative skin disinfection. The non-alcoholic solutions with a slow onset of action (e.g. iodophors) have been virtually replaced by alcohol-based solutions of demonstrated efficacy. Non-alcoholic solutions continue to be used for disinfection of mucous membranes, but iodine-based products are being phased out here. The term “instrument disinfection” has been largely supplanted now by the expression “instrument reprocessing or medical device decontamination” (which is also underpinned by legislation) and it takes account of the trend towards thermal disinfection. Meticulous cleaning is thus an indispensable precondition for sterilization, which normally follows disinfection. The greatest lack of consensus at European level relates to surface disinfection. Routine, parallel cleaning and disinfection of all surfaces close to and remote from the patient is being increasingly replaced by selective disinfection, whenever warranted, of surfaces close to the patient. The problem here is that medical personnel continue to view cleaning and disinfection as interchangeable tasks. This situation is further compounded by the fact that hospitals are finding it increasingly more difficult to assure adequately successful cleaning and disinfection outcomes. To ensure effective infection control, cleaning and disinfection of surfaces in special situations must also be assured whenever warranted outside the regular working hours. Disinfection and decontamination of highly complex medical devices that pose special challenges (heat-sensitive devices with an intricate design and, correspondingly, with surfaces that are difficult to access, e.g. flexible endoscopes) will present the main challenge in the future. There is still much to be accomplished here to assure the hygienic safety of the patient.     

Evaluation of disinfectants in the domestic environment under 'in use' conditions.

An ''in use'' test was developed to investigate effectiveness of disinfectant application and of detergent of hot water cleaning at kitchen, bathroom and toilet sites in the domestic environment. Detergent and hot water cleaning produced no observable reduction in microbial contamination. Single and daily application tests demonstrated that hypochlorite and phenolic disinfectants can be used to produce substantial reductions in bacterial contamination in the home. Results indicate that maximum protection afforded by disinfection is relatively brief; 3-6 h after disinfection, contamination levels were only marginally less than those observed at pretreatment. Some suggestions are made for improvements in home hygiene.     

The surveillance of the aeraulic and hydraulic system reduce environmental Aspergillus contamination in hospital

The aim of this work was to value the evolution of environmental Aspergillus contamination in hospital with respect to aeraulic system and bathrooms works. An analysis on levels of air and surface Aspergillus contamination were determined in patient's rooms and various common sites in a ward of an hospital in Genoa in 1999. As high contamination levels were found, in summer 1999 a radical disinfection and revision of the aeraulic system was settled. In spite of these interventions some samples maintained an high contamination level, even if from only two rooms, so a further disinfection of bathrooms and surfaces became necessary. A period of sampling was conducted after this last intervention until November 2002. At the beginning of our surveillance 59% positive samples and about 50% of them with high contamination level (>1000 CFU/m3) were found. After the revision of the aeraulic system the reduction of positive samples was significative (14.2%), besides all the positive samples regarded only two rooms. In the last valuation period, after a further disinfection of bathrooms and surfaces of the above mentioned rooms, all the samples taken resulted with a contamination level lower than 10 CFU/m3. This findings underlines the importance of environmental surveillance looking for all the contaminated sources; in particular the aeraulic and hydraulic system as well as the proximity hospital building yard not sufficiently protected.     

Is disinfection of mechanical ventilation tubing needed at home?

INTRODUCTION: Home mechanical ventilation is used to treat chronic alveolar hypoventilation. Maintenance protocols for home ventilation circuits (HVC) remain empirical and unproven. We have investigated (1) the cleanliness and sterility of the HVC used by home ventilated patients and (2) the efficiency of tubing cleaning and decontamination protocols recommended to them and used for 12 months or more. METHOD: HVC cleanliness was assessed in 39 severe restrictive ventilated patients (16 (T) tracheostomy vs. 23 (N) noninvasive) and in 7 new valves as control. In the first experiment (Exp1), a visual and bacteriologic inspection of the expiratory valve (Eva) was conducted during a consultation in our centre. Eva visual cleanliness was assessed on a 10-point scale and Eva bacteriologic contamination analysis was performed on a dry smear. In the second experiment (Exp2), these analyses were repeated after a cleaning sequence chosen at random, either chemical (ammonium-chlorhexidine complex) (A) or mechanical by dishwasher (B). RESULTS: In Exp1, 69% of Eva were dirty. Dirtiness was worse in (T) than in (N) (5.3 vs. 2; p<0.001). There was a significant positive correlation between visual cleanliness and bacteriologic contamination (r=0.56; p<0.001). Eva in group (T) were more contaminated than in group (N) (p<0.001). Eva contamination rates reached 22% in group (N) but without the presence of any potentially pathogenic organisms (PPO) and 81% in group (T) where 19% were PPO. In Exp2, EVA visual cleanliness was better after dishwasher cleaning (B) compared to chemical (A) (0.16 vs. 1.05; p<0.001) with similar bacteriological decontamination. CONCLUSION: HVC from noninvasive ventilated patients are dirty but not contaminated by PPO. We recommend washing them in a dishwasher or with detergent and hot water without specific disinfection. PPO contaminated 1/5 of invasive HVC, for which we recommend dishwasher cleaning. Decontamination is only indicated when tubing is visually very dirty or/and when tracheostomized patients are particularly sensitive to respiratory tract infections. The expiratory valve must be carefully washed specifically, with care that its balloon is not placed under water.