影响透析用水微生物指标的多因素分析

 目的 掌握某省医院血液透析中心的水处理系统管理和维护现状，分析反渗膜及管路消毒等相关因素与透析用水检出细菌菌落总数、内毒素水平的关系，识别风险因素并探讨改进措施。方法 采集18所医院血液透析中心反渗机组出水口和输水管路回水口透析用水，经薄膜过滤法富集，在20℃下TGEA培养168 h，进行细菌菌落计数，平行水样检测内毒素。同时设计问卷调查水处理系统管理和维护信息。结果 采样距反渗膜更换间隔时长与回水口菌落总数、回水口及出水口内毒素呈正相关。采样距上一次管路消毒间隔时间与回水口和出水口内毒素呈负相关，专业工程师配备与回水口菌落总数及出水口内毒素呈负相关，软管长度与回水口内毒素呈正相关。回归分析结果显示，投入使用时长、透析机台数、在透析患者数等因素也对透析用水微生物指标有影响。结论 反渗膜的维护更换、输水管路消毒、专业工程师配备、透析中心规模及管路长度均为透析用水微生物指标的主要影响因素。各医院的水处理系统管理和维护存在差异，应通过质量控制推进使其达到同质化。

Multivariate analysis on microbial indicators of dialysis water

Objective To investigate the management and maintenance status of dialysis water treatment system in hemodialysis center of hospitals in a province, analyze the relationship between the relevant factors such as reverse osmosis membrane, pipeline disinfection and the total bacterial colony count and endotoxin level detected in dialysis water, identify risk factors and explore improvement measures. Methods Dialysis water from outlet of reverse osmosis unit and backwater inlet of water pipeline in 18 hospitals was collected and enriched by membrane filtration method,specimens were cultured on tryptone glucose extract agar (TGEA) for 168 hours at 20℃, bacterial colony counting were conducted and endotoxin of parallel water specimens was detected. Questionnaire was designed to investigate the management and maintenance information of dialysis water system. Results The interval length between sampling time and reverse osmosis film replacement was positively correlated with the total number of bacterial colonies at the backwater inlet, as well as endotoxin at backwater inlet and outlet of reverse osmosis unit. Interval length between sampling time and the last time pipeline disinfection was negatively correlated with endoto-xin at backward inlet and outlet of reverse osmosis unit, allocation of professional engineers was negatively correlated with the total number of bacterial colonies at backwater inlet and endotoxin at outlet, while the length of the hose was positively correlated with endotoxin at backwater inlet. Regression analysis showed that the duration of using, the number of dialyzers and the number of dialysis patients also affected the microbial indicators of dialysis water. Conclusion Maintenance and replacement of reverse osmosis membrane, disinfection of water pipeline, allocation of professional engineers, scale of dialysis center and length of pipeline are the main influencing factors of microbial indicators of dialysis water. There are differences in the management and maintenance of water treatment system in different hospitals, so it should be promoted by quality control to achieve homogeneity.