造血干细胞移植病房终末消毒方法的研究

发布时间：2018-03-30 09:06

本文选题：层流病房　切入点：消毒　出处：《吉林大学》2012年硕士论文

【摘要】：背景造血干细胞移植的患者在预处理后，其骨髓清空、免疫抑制，极易发生各种感染等并发症，如果不能有效预防和控制，将危及生命。层流病房作为造血干细胞移植患者行保护性隔离居住的必要条件起到至关重要的作用。目前，国内针对此类病房的终末消毒处理并没有形成统一模式。传统方法是采用过氧乙酸熏蒸结合有效氯等消毒剂做物体表面擦拭。研究表明，过氧乙酸可以造成眼睛、黏膜的损伤并具有一定的腐蚀性。而有效氯也同样存在刺激性气味、不稳定等特点。国内有关移植病房全环境保护的研究曾有报道，但是关于终末消毒处理却没有深入研究，未形成规范体系。目的改变传统熏蒸方法，寻求一种简便易行、经济安全、对患者、医务人员及环境损伤小的造血干细胞移植层流病房终末消毒方法，确保层流病房的洁净度。分析该病房环境因素对患者的影响及不同终末处理方法的经济效果。方法将过氧乙酸熏蒸和有效氯擦拭处理的病房列为对照组，空气层流和复方季铵盐消毒剂擦拭处理的病房列为实验组，分别比较对照组及实验组的空气沉降菌落培养计数、表面擦拭的物体表面菌落计数；比较同期随机入住实验组及对照组病房的患者的感染率；并进一步将病房沉降菌落进行培养、分析我院层流病房常见细菌及与患者感染之间的关系；用两种消毒方法的耗时时间以及床位周转率来分析比较实验组及对照组的经济效果。结果（1）实验组与对照组终末处理后，病房中心区及周边区空气培养菌落数比较无统计学差异，P分别为0.60与0.89；（2）实验组与对照组终末处理后，物体表面擦拭效果比较无统计学差异，P=0.98；（3）同期入住病房的白血病患者及重型再生障碍性贫血行抗胸腺细胞球蛋白（ATG）治疗患者在发热时间上无统计学差异，P=0.54；（4）我院层流病房常见菌落为凝固酶阴性葡萄菌（表皮葡萄球菌）、棒状杆菌、枯草芽孢杆菌等广泛存在于空气、人体的常见菌；（5）目前在我院层流病房患者发热的主要致病菌来自于患者本身携带的条件致病菌，，而层流病房在消毒检测合格后，正常运行，定期保养，就能够确保空气的洁净度，因此不会成为患者感染的主要因素；（6）实验组终末处理耗时6.5小时，床位周转率为147.8%；对照组终末处理耗时14.5小时，床位周转率为145.6%，每年收治病人总数相差2人，从而实验组能够为较多的患者提供入住治疗的机会。结论通过对实验组及对照组的分析，可以得出造血干细胞移植层流病房的终末处理方法可采用季铵盐类消毒剂擦拭病房的物体表面，加之空气层流机的运行即可完成。此方法简便易行，对患者及医务人员影响小，并且增加病房的周转率。
[Abstract]:Background Hematopoietic stem cell transplantation patients after pretreatment, bone marrow clearance, immunosuppression, easy to occur a variety of infections and other complications, if not effectively prevent and control, will endanger life. Laminar flow wards play a vital role as a necessary condition for protective isolation for patients undergoing hematopoietic stem cell transplantation. The traditional method is to use peracetic acid fumigation combined with available chlorine disinfectants to wipe the surface of objects. Studies have shown that peracetic acid can cause the eyes. The damage of mucous membrane is corrosive, and the available chlorine also has the characteristics of irritating smell and instability. Domestic research on the whole environmental protection of transplant ward has been reported, but there has been no in-depth study on the final disinfection treatment. No normative system has been formed. Objective to change the traditional fumigation method and to seek a simple, economical and safe method for terminal disinfection in laminar flow ward of hematopoietic stem cell transplantation (HSCT) with little damage to patients, medical personnel and environment. To ensure the cleanliness of the laminar flow ward, to analyze the influence of environmental factors on the patients and the economic effect of different end treatment methods. Methods the wards treated with peracetic acid fumigation and available chlorine wiping were classified as the control group. The air laminar flow and compound quaternary ammonium salt disinfectant cleaning ward were listed as the experimental group. The air sedimentation colony culture count and the surface bacterial colony count of the surface wiped object were compared between the control group and the experimental group. The infection rate of the patients in the experimental group and the control group were compared, and the common bacteria in the laminar flow ward and the relationship between the bacteria and the infection in the laminar flow ward were analyzed. The economic effects of the experimental group and the control group were analyzed and compared by using the time consuming time and bed turnover rate of the two disinfection methods. Results 1) there was no significant difference in the number of air cultured colonies between the experimental group and the control group after final treatment (P = 0.60 and 0.89 respectively) after the end treatment between the experimental group and the control group, there was no significant difference between the experimental group and the control group after the end treatment. There was no significant difference in the effect of surface swab on the surface of the object. There was no significant difference in the febrile time between the patients with leukemia and the patients with severe aplastic anemia treated with antithymocyte globulin (ATG) at the same time (P0. 54) laminar flow in our hospital. The common bacteria in the ward were coagulase-negative grape bacteria (Staphylococcus epidermidis, Corynebacterium). Bacillus subtilis and other bacteria widely exist in the air. The common bacteria in the human body are 5) at present, the main pathogens of fever in patients in our hospital's laminar flow ward come from the conditional pathogens carried by the patients themselves, and the laminar flow wards, after being disinfected and tested properly, operate normally. Regular maintenance can ensure the cleanliness of the air, so it will not be the main factor of infection.) the final treatment time of the experimental group is 6.5 hours, the bed turnover rate is 147.8 hours, and the final treatment time of the control group is 14.5 hours. The bed turnover rate is 145.6, and the total number of patients treated is 2 different each year, so that the experimental group can provide more patients with the opportunity to stay in the treatment. Conclusion through the analysis of the experimental group and the control group, It can be concluded that the terminal treatment method for laminar flow ward of hematopoietic stem cell transplantation can be done by wiping the surface of the ward with quaternary ammonium disinfectant and the operation of air laminar flow machine. This method is simple and easy to carry out and has little influence on patients and medical personnel. And increased ward turnover.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R187

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