评估不同麻醉时点的微生物感染风险情况

摘要:目的　了解麻醉不同时点（期间）手术环境致病微生物的检出情况，从而评估不同麻醉时点的微生物感染风险，为今后控制因麻醉过程导致的患者医院感染提供参考依据。方法　对全院手术室每日第一例全麻手术的相关器材进行采样，规定预计手术时间≥2 h以上者可以进行采样，采样对象有静脉三通旋转阀、氧气流量调节钮、减压阀门、螺纹管接口、麻醉机呼出气入口、麻醉机呼吸回路氧气入口，共采集了84例手术的504个采样点（84例手术，每例手术均采集上述6个采样点，共504个采样点），并在麻醉操作前（时点0）、麻醉操作后5 min（时点1 麻醉操作后5 min）、麻醉操作后2 h（时点2 麻醉操作后2 h）进行采样和细菌培养检测。结果　静脉三通旋转阀在时点0的标本未培养出细菌，合格率为100.0%，但时点1检出阳性61例，合格率为27.4%，时点2检出阳性84例，合格率为0.0%；氧气流量调节钮、减压阀门、螺纹管接口、麻醉机呼出气入口以及麻醉机呼吸回路氧气入口的细菌数均在允许范围内，各时点的合格率均为100.0%。静脉三通旋转阀及螺纹管接口时点0时无细菌检出，其余检测点在各时点均有细菌检出。在检出的细菌中，3个时点均以凝固酶阴性葡萄球菌所占比例最高，其次为棒状杆菌，鲍曼不动杆菌。棒状杆菌在静脉三通旋转阀、螺纹管接口及麻醉机呼出气入口时点1时未检出，但在麻醉操作后5 min及麻醉操作后2 h各采样点均被检出。鲍曼不动杆菌在静脉三通旋转阀时点1及时点2及减压阀门各时点均被检出。结论　在手术患者麻醉过程中，静脉三通旋转阀污染比例较高，致病菌主要为凝固酶阴性葡萄球菌、棒状杆菌及鲍曼不动杆菌。在麻醉过程中应严格执行无菌操作规范，控制因麻醉过程引起的医院感染。

Risk assessment on microbial infection at different anesthesia point

Abstract: Objective To understand the state of detection of pathogenic microorganisms under operation environment at different anesthesia point (during), and to assess microbial infection risk at different anesthesia point, and to provide the reference basis for the future control of hospital infection during the anesthesia process. Methods We daily sampled the related equipments of first case of general anesthesia surgery in operating room. We proscribed that expected operation time more than 2h could be sampled. We took sampling from three rotary valve, oxygen flow control knob, relief valves, threaded pipe interface, anesthesia machine breath entrance, anesthesia machine breathing loop oxygen entrance. A total of 504 sampling points from 84 cases of operation were collected. We took sampling and cultured bacterium before anesthesia operation (time 0), after 5 minutes of anesthesia operation (time 1) and after 2h of anesthesia operation (time 2). Results We did not culture bacteria in specimens of three rotary valve at time 0, and the compliance rate was 100.0%. But we detected 61 positive cases at point 1, and the compliance rate was 27.4%. Moreover, 84 positive cases were detected at point 2, and the compliance rate was 0.0%. The number of bacterium of oxygen flow control knob, relief valves, threaded pipe interface, breath entrance of anesthesia machine and anesthesia machine breathing loop oxygen inlet were totally within the scope of the permit, and the compliance rate was 100.0% at each time point. We did not detect bacteria in the three rotary valve and the threaded pipe interface at time 0. We detected bacterium in the rest sampling sites at each point. In the detection of bacterium, three time points were mainly Coagulase Negative Staphylococcus, followed by Corynebacterium, Acinetobacter Baumannii. We did not detect Corynebacteria in three rotary valve and threads interface and anesthesia machine breath entrance at time 0, but we can detect it in each sampling sites at time 1 and time 2. Acinetobacter Baumannii was detected in three rotary valve at tim1 and time2 and it was also detected in relief valves at each time point. Conclusion In the process of surgery during anesthesia, the contamination proportion of three rotary valve is higher. Pathogenic bacteria mainly were Coagulase Negative Staphylococcus Aureus, Corynebacteria and Acinetobacter Baumannii. Specification of sterile operation must be strictly implemented in the process of anesthesia, and we should control the hospital infection caused by the anesthesia process.