手术皮肤消毒剂灭菌效果临床观察

目的 了解手术室常用皮肤、黏膜消毒剂的消毒、灭茼效果，寻找高效、安全的消毒剂。方法 将160例择期手术患者分为8组各20例，分别采用3％碘酊75％乙醇、1．5％碘酊75％乙醇、1％活力碘、0＋5％活力碘、0．1％活力碘、75％乙醇、0．5％氯己定和0，1％氯己定消毒手术部位，观察消毒效果。结果 8种（组）消毒剂的杀菌率分别为100.0％、100．0％、100．0%、89．9％、83．2％、83．9％、89．7％和82．8％；合格率分别为100．0％、100．0％、100．0％、90．0％、90．0％、80．0％、90．0％和75．0％。结论 3％碘酊75％乙醇、1．5％碘酊75％乙醇、1％活力碘消毒效果好，但前2种（组）对皮肤、黏膜刺激性较大。待干时间长，适用于无菌要求高的择期手术；1％活力碘分别对皮肤、黏膜刺激性小，安全性可靠，省时方便，为较理想的消毒剂。     

高频电刀引发皮肤消毒液着火的实验研究

目的 探讨电刀引发着火与皮肤消毒液的关系,为安全使用电刀提供依据.方法 将30只大耳白兔随机分为乙醇组、碘酊组、碘伏组3组,每组10只,分别接受75％乙醇、2％碘酊、0.45％～0.55％碘伏消毒,观察消毒后不同时间使用不同输出功率电刀的着火次数.结果 碘伏消毒在所有时点和各个电刀功率下着火次数均为0;乙醇组相同功率各时点着火次数相差不大;50W、60 W、70 W、80 W功率着火次数相对高于20 W、30 W、40 W;碘酊组0～20 s着火次数相对高于其他时点.乙醇组着火次数相对高于碘酊组.结论 碘伏消毒后使用电刀不着火;乙醇着火概率较碘酊高,且高功率(＞50 W)较低功率(＜40 W)更易着火.     

静脉用药调配中心75%乙醇不同喷雾量消毒瓶塞效果观察

目的 探讨75%乙醇不同喷雾量消毒瓶塞的消毒效果及待干时间,以选择适宜喷雾量。方法 选择同批号西林瓶200瓶,随机分成对照组、实验A组、实验B组和实验C组,每组50瓶。对照组采用75%乙醇擦拭消毒,实验组采用75%乙醇喷雾式消毒,每个西林瓶消毒1次,实验A组、B组、C组单次喷雾量分别为0.10 mL、0.13 mL和0.16 mL。分别记录每瓶西林瓶消毒后的待干时间并取样进行细菌培养。结果 四组均未检出细菌,合格率为100%。对照组与实验A、B、C组的消毒待干时间分别为(77.82±13.02)s、(61.76±8.26)s、(69.60±8.84)s和(78.62±8.46)s,组间比较除对照组与实验C组差异无统计学意义（P>0.05）外,其余两两比较差异有统计学意义（均P<0.01）。结论 静脉用药调配中心选择75%乙醇单次喷雾量0.13 mL对瓶塞进行消毒,可保证消毒效果且减少消毒待干时间,提高工作效率。     

介绍一种放置碘酊、乙醇瓶的固定架

在临床护理操作中，一般采用胶布将乙醇、碘酊瓶进行“8”字固定，以便携带。但随着现代医学的迅速发展，这种固定方法已经不符合医院感染管理要求。鉴此，笔者自行设计了一种放置乙醇、碘酊瓶的固定架，临床使用1年多，效果满意，介绍如下。     

碘酊污染衣物用维生素C脱碘

临床护理中，常需用2％碘酊进行皮肤消毒，由于不慎将碘酊污染工作服、被服、治疗巾等，通常采用75％乙醇脱碘或用“84”液浸泡后再洗涤，易留下痕迹，既不美观，又费时费力。为此，我们改用维生素C注射液脱碘清洗，省时、省力，效果满意，介绍如下。     

过氧乙酸与乙醇消毒听诊器听筒效果比较

目的比较过氧乙酸与乙醇消毒听诊器听筒的效果。方法将发热门诊60例发热待查患者听诊胸肺部后的60个听筒随机分为对照组与观察组各30个,分别用0.5%过氧乙酸棉球擦拭消毒和75%乙醇棉球擦拭消毒。两组听诊器听筒于消毒前、消毒后晾干由操作者取样本放入无菌试管内送细菌培养。结果观察组听筒消毒后细菌菌落数和病原菌污染阳性率显著低于对照组(均P0.01)。结论以0.5%过氧乙酸消毒听诊器听筒,灭菌效果优于75%乙醇。     

手术皮肤消毒剂灭菌效果临床观察

目的 了解手术室常用皮肤、黏膜消毒剂的消毒、灭菌效果,寻找高效、安全的消毒剂.方法 将160例择期手术患者分为8组各20例,分别采用3%碘酊75%乙醇、1.5%碘酊75%乙醇、1%活力碘、0.5%活力碘、0.1%活力碘、75%乙醇、0.5%氯己定和0.1%氯己定消毒手术部位,观察消毒效果.结果 8种(组)消毒剂的杀菌率分别为100.0%、100.0%、100.0%、89.9%、83.2%、83.9%、89.7%和82.8%;合格率分别为100.0%、100.0%、100.0%、90.0%、90.0%、80.0%、90.0%和75.0%.结论 3%碘酊75%乙醇、1.5%碘酊75%乙醇、1%活力碘消毒效果好,但前2种(组)对皮肤、黏膜刺激性较大,待干时间长,适用于无菌要求高的择期手术;1%活力碘分别对皮肤、黏膜刺激性小,安全性可靠,省时方便,为较理想的消毒剂.     

过氧乙酸与乙醇消毒听诊器听筒效果比较

目的比较过氧乙酸与乙醇消毒听诊器听筒的效果。方法将发热门诊60例发热待查患者听诊胸肺部后的60个听筒随机分为对照组与观察组各30个,分别用0.5%过氧乙酸棉球擦拭消毒和75%乙醇棉球擦拭消毒。两组听诊器听筒于消毒前、消毒后晾干由操作者取样本放入无菌试管内送细菌培养。结果观察组听筒消毒后细菌菌落数和病原菌污染阳性率显著低于对照组（均P〈0.01）。结论以0.5%过氧乙酸消毒听诊器听筒,灭菌效果优于75%乙醇。     

自制安瓿小帮手

临床工作中，医务人员折断安瓿时，划破右手指皮肤的现象时有发生。我科用一次性输血器自制安瓿小帮手，使用中避免了划破右手指的现象，提高了安全性，且简便易行，介绍如下。制作方法：取1副一次性输血器，将茂菲氏管1／3剪去，留取另一端2／3和输血管道5cm左右；取1个塑料小瓶（厦门星鲨制药有限公司生产的维生素B6药瓶），将瓶盖钻一小孔，输血管道穿过小孔打一小结，串在瓶盖上，塑料小瓶内装75％乙醇，将茂菲氏管浸泡在乙醇中备用，瓶内乙醇每日更换。     

纳米银消毒凝胶防治血液透析患者导管相关性感染的前瞻性研究

目的观察纳米银消毒凝胶作为血液透析深静脉置管外用抗菌剂的疗效及安全性。方法将我院使用深静脉置管的62例维持性血液透析患者随机分为3组，对照组20例，深静脉置管处不使用药物；莫匹罗星组21例，深静脉置管处使用莫匹罗星软膏；纳米银消毒凝胶组（纳米银组）21例，深静脉置管处使用纳米银消毒凝胶。比较3组深静脉置管穿刺部位及导管内细菌培养阳性率，并观察纳米银组治疗开始时及观察终点肝功能的变化。结果（1）本组62例，16例穿刺部位或导管内细菌感染，感染率为25．8％，其中置管6周后感染12例（占75％）；（2）3组深静脉置管穿刺部位细菌培养阳性率分别为40．O％、14．3％和9．5％，莫匹罗星组与纳米银组较对照组明显降低，差异有统计学意义（P〈0．05），莫匹罗星组与纳米银组间无统计学差异（P〉0．05）；（3）导管内细菌培养阳性率分别为10．0％、4．8％和4．8N，3组间无统计学差异（P〉0．05）；（4）纳米银组开始时及观察终点肝功能无统计学差异（P〉0．05）。结论纳米银消毒凝胶可有效降低透析用深静脉置管相关性感染发生率，是透析用深静脉置管外用抗菌剂的良好选择。     

Urinary catheter sterilization with microwave oven

Studies were conducted utilizing a home microwave oven to sterilize catheters commonly used for intermittent self-catherization. Red rubber urinary catheters were inoculated with common clinical uropathogens and were placed in sealed brown paper bags or Ziploc plastic freezer bags and microwaved at full power for various timed intervals. Differences were noted in killing time for some strains or species of bacteria. Twelve minutes at full power appeared to be sufficient time for complete sterilization of most catheters placed in plastic bags. Cold spots were noted in the oven; suggestions are made for placing the bags in certain areas to achieve complete sterilization of contaminated catheters. Repeat sterilization did not affect the integrity of catheters or the plastic bags. A water heat sink of constant volume was employed during the sterilization process. Six catheters could be sterilized at one time. This convenience allows patients reuse of catheters and provides less chances of self-inoculation due to reuse of contaminated catheters for intermittent self-catherization.     

聚羟基丁酸酯可吸收缝线灭菌方法的实验研究

目的：研究不同的灭菌方法对聚羟基丁酸酯（PHB）可吸收缝线的降解性和力学特性的影响。方法：将聚羟基丁酸酯（PHB）可吸收缝线进行酒精浸泡、环氧乙烷、紫外线照射三种方法进行灭菌处理后,用细菌培养检测灭菌效果,用粘度法测定聚合物分子量从而观察缝线的降解性,用拉伸试验测定缝线的力学特性。结果：①酒精浸泡灭菌组有10%检出细菌,环氧乙烷及紫外线灭菌组未检出细菌;②紫外线照射灭菌和酒精浸泡灭菌组可使缝线黏度下降并具有显著性差异,环氧乙烷对缝线黏度下降的影响没有显著性差异;③经酒精和紫外线灭菌后缝线的断裂强度降低明显,差异具有显著性,经环氧乙烷灭菌后缝线的断裂强度降低无显著性差异。经紫外线灭菌后缝线的断裂伸长率明显降低,差异具有显著性,经酒精和环氧乙烷灭菌后缝线的断裂伸长率无明显降低。结论：环氧乙烷灭菌对PHB可吸收缝线的降解性和力学特性影响较小,是PHB可吸收缝线较理想的灭菌方法。     

甲醛氧化浓氨熏蒸法灭菌的实验研究

采用甲醛氧化浓氨熏蒸法与甲醛氧化熏蒸法对 3种细菌的灭活效果进行对比观察。结果 :常规用量时 ,两种方法对细菌的灭活率分别为 76 .7%和 73.3% ;大剂量 (高浓度 )时 ,两种方法对细菌的灭活率均为 10 0 %。经统计学处理 ,P>0 .0 5 ,二者差异无显著性。提示两种方法对 3种细菌的灭活效果是一致的。采用甲醛氧化浓氨熏蒸法既可避免甲醛毒性对医护人员身体的危害 ,又不影响其灭菌效果 ,有效消毒时限为 46 h,值得推广应用。     

气雾熏蒸法与浸泡消毒法消毒吸痰管效果比较

目的比较2%强化戊二醛(下称戊二醛)气雾熏蒸法与浸泡消毒法消毒吸痰管的效果.方法消毒按5周期(1个周期12 d)进行,每周期将200根使用过的吸痰管经初步处理,即5% 84消毒液浸泡30 min后清水冲洗干净晾干.将每周期200根吸氮管随机均分为实验组和对照组,实验组采用戊二醛原液气雾熏蒸法消毒4 h,对照组采用戊二醛原液浸泡消毒30 min,12 d为1个周期.两组分别于第1、6、12天对消毒后的吸痰管及消毒过程中的戊二醛采样行细菌菌落数计数,并观察有无细菌生长.结果两组每周期第1、6天吸痰管和消毒液标本均未检测出细菌,且无致病微生物生长;每周期第12天对照组吸痰管和消毒液标本均检测出细菌,实验组未检测出细菌.结论气雾熏蒸法消毒灭菌效果可靠,具有节约开支、使用方便、有利于吸痰管的保存与放置等优点.     

两种灭菌方法对新生儿脐带套安全性能的影响

目的探讨新生儿脐带套的安全有效灭菌方式。方法将由气门芯、索线制作成统一规格的脐带套800根均分为改良组和传统组,改良组采用预真空压力蒸汽灭菌器灭菌8min．传统组煮沸15min后置75％乙醇溶液浸泡备用。两组有效期均为2周。结果有效期内传统组消毒灭菌合格率84．。0％,改良组合格率100％,差异有统计学意义（P〈0．01）;两组跨越实验合格率和拉力比较．差异无统计学意义（均P〉0．05）。结论采用预真空压力蒸汽灭菌法对脐带套灭菌效果可靠。不影响脐带套的拉力．可替代传统方法。     

Povidone Iodine and Skin Disinfection before Initiation of Epidural Anesthesia

Background: Povidone iodine (PI) solution is used commonly for skin disinfection before epidural and spinal anesthesia. Although there have been reports indicating the presence of microbial contaminants in PI solution, none have evaluated the prevalence of PI contamination. The aims of this study were to assess the frequency of bacterial contamination of previously opened bottles of PI solution and to compare the effectiveness of new and previously opened bottles of PI solution for skin disinfection.

Methods: Twenty previously opened and ten previously unopened multiple-use bottles of PI solution were evaluated for microbial contamination. In addition, final swabs and PI solution used for skin disinfection in 80 patients undergoing elective epidural analgesia were evaluated.

Results: The inside of the bottle cap or the PI solution from 40% of the multiple-use PI bottles in use were contaminated. There was no growth from any previously unused PI bottles. Povidone iodine from newly opened bottles provided more effective skin decontamination than did solution from previously opened bottles.     

Effect of gas-plasma sterilization on the osteoinductive capacity of demineralized bone matrix.

The current study evaluated the effect of low-temperature hydrogen peroxide gas plasma sterilization on the osteoinductive capability of human demineralized bone matrix using a rat model. Twelve athymic rats received three separate implants consisting of steam-sterilized demineralized bone matrix (negative control), sterile-harvest demineralized bone matrix (positive control), and gas-plasma-sterilized demineralized bone matrix. A demineralized bone matrix pellet from each sterilization group was placed individually into one of three separate soft tissue pockets created in the epaxial musculature of each rat. All 12 rats were euthanized 9 weeks after implantation. Each implantation site was removed along with 0.5-cm normal tissue around the implant. Histologic examination was done on each implant site to determine the presence or absence of new bone, cartilage, or bone marrow elements. All 12 sterile harvest demineralized bone matrix sites histologically contained new bone elements, whereas none of the negative control or gas plasma sterilized demineralized bone matrix sites contained any of these same elements. The results of this study indicate that demineralized bone matrix sterilized with low-temperature, gas-plasma sterilization loses its osteoinductive capacity in a manner similar to that of steam-sterilized demineralized bone matrix, making low-temperature, gas- plasma sterilization unsuitable as a method of secondary sterilization of demineralized bone matrix.     

Effect of radiation, heat, and aging on in vitro wear resistance of polyethylene

Radiation cross-linking increases the wear resistance of polyethylene used in total hip replacement. Radiation also generates residual free radicals, which are detrimental to long-term properties of polyethylene. Two approaches are used to stabilize the residual free radicals and terminally sterilize the components. One is postirradiation annealing with gas sterilization and the other is postirradiation melting with gamma sterilization in nitrogen. The hypothesis of the current study is that postirradiation annealing followed by gamma sterilization in nitrogen will result in more free radicals in polyethylene than gamma sterilization either in air or in nitrogen alone. To test this hypothesis, concentration of residual free radicals was quantified in polyethylene that was annealed and gamma sterilized in nitrogen and control polyethylenes gamma sterilized in air versus in nitrogen. Three crosslinked polyethylenes that were melted and gas sterilized also were included in the study. The effects of residual free radicals were studied by accelerated aging. Oxidation levels and weight loss in bidirectional pin-on-disk tests were determined before and after aging. Polyethylene that was subjected to postirradiation annealing and gamma sterilization resulted in 58% more residual free radicals than control polyethylenes. Weight loss of the annealed polyethylene increased by 16-fold on accelerated aging and had three times higher oxidation levels than that measured in control polyethylenes after aging. In contrast, polyethylenes that were stabilized with postirradiation melting and terminally gas sterilized showed no detectable residual free radicals. Accelerated aging did not affect the weight loss and oxidation levels of melted polyethylenes.     

Are the common sterilization methods completely effective for our in-house 3D printed biomodels and surgical guides?

IntroductionIn-hospital 3D printing is being implemented in orthopaedic departments worldwide, being used for additive manufacturing of fracture models (or even surgical guides) which are sterilized and used in the operating room. However, to save time and material, prints are nearly hollow, while 3D printers are placed in non-sterile rooms. The aim of our study is to evaluate whether common sterilization methods can sterilize the inside of the pieces, which would be of utmost importance in case a model breaks during a surgical intervention.Material and methodA total of 24 cylinders were designed and printed with a 3D printer in Polylactic Acid (PLA) with an infill density of 12%. Manufacturing was paused when 60% of the print was reached and 20 of the cylinders were inoculated with 0.4 mL of a suspension of S epidermidis ATTCC 1228 in saline solution at turbidity 1 McFarland. Printing was resumed, being all the pieces completely sealed with the inoculum inside. Posteriorly, 4 groups were made according to the chosen sterilization method: Ethylene Oxide (EtO), Gas Plasma, Steam Heat or non-sterilized (positive control). Each group included 5 contaminated cylinders and 1 non-contaminated cylinder as a negative control. After sterilization, the inside of the cylinders was cultured during 7 days.ResultsWe observed bacterial growth of just a few Forming Colony Units (FCU) in 4 out of 5 positive controls and in 2 out of 5 contaminated cylinders sterilized with Gas Plasma. We could not assess any bacterial growth in any of the EtO or Steam Heat samples or in any of the negative controls. Pieces sterilized under Steam Heat resulted completely deformed.ConclusionsHigh temperatures reached during the procedure of additive manufacturing can decrease the bacterial load of the biomodels. However, there is a potential risk of contamination during the procedure. We recommend sterilization with EtO for in-hospital 3D-printed PLA hollow biomodels or guides. Otherwise, in case of using Gas Plasma, an infill of 100% should be applied.