西安市医疗机构压力蒸汽灭菌器灭菌性能评价

目的了解西安市医疗机构压力蒸汽灭菌现状,为压力蒸汽灭菌的监测和质量管理提供依据。方法以2012—2014年西安市属医疗机构的消毒供应中心为研究对象,分别采用物理、化学、生物监测法对其压力蒸汽灭菌器进行综合评价。结果共监测西安市135所医疗机构,包括40所三级医疗机构和95所二级及以下医疗机构。共收集样本540份,合格样本454份,总合格率为84.07%。其中三级医疗机构压力蒸汽灭菌监测合格率为93.13%,高于二级及以下医疗机构的80.26%,差异有统计学意义(χ~2=13.91,P0.01)。化学PCD和生物标准测试包的合格率:三级医疗机构为100%,二级及以下医疗机构90%。二级及以下医疗机构记录表格中的温度合格率为88.42%,但实测温度合格率仅为38.95%,实测温度合格率远低于三级医疗机构的72.50%,差异有统计学意义(χ~2=12.68,P0.01)。各年度压力蒸汽灭菌器实测温度134℃的比率均较低,而132℃的比率维持在50.00%左右,实测温度与记录温度相差-4~1℃,温度差为-2.5~0.5℃的占80.00%,主要不合格温度集中在130~131℃,占82.61%。结论西安市不同级别医疗机构压力蒸汽灭菌效果差异较大,物理监测措施不规范,应加强重点部门的物理参数监督,保证医疗机构灭菌质量,减少医源性感染的发生。

Sterilization performance of pressure steam sterilizers in medical institutions of Xi’an city

ObjectiveTo understand the current situation of pressure steam sterilization in medical institutions in Xi’an city, and provide reference for the monitoring and quality control of pressure steam sterilization. MethodsCentral sterile supply departments（CSSDs） in medical institutions in Xi’an in 2012-2014 were investigated. Physical, chemical, and biological monitoring methods were used to evaluate the pressure steam sterilizers. ResultsA total of 135 medical institutions in Xi’an were monitored, including 40 tertiary medical institutions and 95 secondary and below medical institutions. A total of 540 specimens were collected, 454 were qualified, overall qualified rate was 84.07%. Qualified rate of monitoring result of pressure steam sterilization of tertiary medical institutions was higher than secondary and below medical institutions（93.13% vs 80.26%, χ2=13.91，P＜0.01）. Qualified rates of chemical PCD and biological test pack of tertiary as well as secondary and below medical institutions were 100% and ＞90% respectively. The qualified rate of recoded temperature in secondary and below medical institutions was 88.42%, but actually measured temperature was 38.95%，which was significantly lower than 72.50% of tertiary medical institutions（χ2=12.68，P＜0.01）. The rates of the measured temperature>134℃ of pressure steam sterilizer in each year were all low, but measured temperature＜132℃ was about 50.00%, difference between actually measured temperature and recorded temperature was -4℃-1℃，difference between -2.5℃-0.5℃ accounted for 80.00%，the main unqualified temperature was 130℃-131℃，accounting for 82.61%. ConclusionEfficacy of pressure steam sterilization is different in different levels of medical institutions in Xi’an, physical monitoring measures are not standardized, the supervision of physical parameters in key sectors should be strengthened to ensure the sterilization quality of medical institutions and reduce the occurrence of iatrogenic infection.