公共场所集中空调冷却水军团菌污染现状及人群感染水平的研究

发布时间：2018-04-20 17:58

  本文选题：中央空调 + 军团菌　； 参考：《浙江大学》2012年硕士论文

【摘要】：随着社会经济的发展,人们的生活、工作环境、工作条件都在不断的改善,许多公共场所都安装了全封闭式中央空调设备,自2003年SARS爆发以来,人们对居住、办公、商业、娱乐等公共场所环境的要求和空气卫生质量越来越高,开始对公共卫生安全有了进一步认识和重视。很多研究报道,公共场所集中空调通风系统大多存在严重的细菌污染,这对人体健康有潜在的危害,因此公共场所里的空调通风系统的室内卫生安全问题备受大众关注,也引起了各级政府卫生主管部门和广大公众对集中空调通风系统可能成为传染病的一种空气传播渠道的高度重视。为此国家卫生部相继颁布了一系列条例、规范,旨在加强公共场所集中空调通风系统卫生管理工作,确保公共卫生安全和人民群众身体健康。 1目的 了解绍兴市公共场所集中空调系统中军团菌污染的现状及暴露人群感染水平,为政府有关部门综合治理提供决策依据,有利于预防和控制呼吸系统传染病的流行和爆发,从而促进我市公共场所集中空调的卫生安全,保障大众健康。 2方法 2.1冷却水样品的来源和检测 2009年夏季和冬季随机抽查绍兴市酒店、宾馆、商场、超市、医院、证券公司、写字楼等公共场所的大型空调冷却塔中的冷却水,检测嗜肺军团菌浓度。 同时随机抽查集中中央空调通风系统风管里的积尘,检测积尘量、积尘中细菌总数、真菌总数。 2.2受试对象的分组和入选 非暴露人群组：2009-2010年采集山区厂矿工人血清标本265份以及高校体检的学生血清标本255份,两类人群血清标本共计520份,(在该单位连续工作5年以上),设为对照组。 暴露人群组：酒店、宾馆从业人员血清标本192份；超市工作人员血清标本190份；商场工作人员血清标本94份；另外还有证券公司工作人员血清标本35份。四类人群中男性212名；女性299名。此类人群血清标本共计511份,(在该单位连续工作5年以上)设为暴露组。 对照组人员所在工作场所均不安装使用集中中央空调,暴露组人员所在工作场所使用的集中中央空调5年内未清洗,也未更换新的空调。 2.3绍兴市中央空调冷却水的军团菌污染抽样调查结果分析 2.4中央空调冷却水的军团菌污染对工作人员军团菌感染风险的影响 2.5统计软件方法 采用SPSSV13.0软件对数据进行统计分析。两个总体率或构成比之间差别、多个总体率或构成比之间的差别的比较采用Pearson卡方检验,当总样本量40,或理论频数1时采用四格表资料的Fisher确切概率法。 3结果 3.1冷却水军团菌监测结果 本课题对绍兴市42家大酒店、宾馆、商场、超市、医院、证券公司、写字楼等公共场所的110只大型空调冷却塔在夏冬两季共440份冷却塔水作军团菌监测。结果显示,大型公共场所空调冷却塔水中军团菌总检出率为67.3%(74/110),其中超市为82.4%(14/17)、医院为78.6%(11/14)、证券公司71.4%(5/7)、酒店、宾馆为66.0%(33/50)、商场为62.5%(10/16)、写字楼为16.7%(1/6)。 3.1.1在夏季8-9月42家公共场所59只空调冷却塔进行检测,总检测率为72.9%(43/59),其中超市为88.9%(8/9)、医院为77.8%(7/9)、证券公司66.7%(2/3)、酒店、宾馆为70.4%(19/27)、商场为75.0%(6/8)、写字楼为33.3%(1/3)。 3.1.2在冬季2-3月检测42家公共场所51只空调冷却塔进行检测,总检测率为60.8%(31/51),其中超市为75.0%(6/8)、商场为50.0%(4/8)、酒店和宾馆为60.9%(14/23)、医院为80.0%(4/5)、证券公司75.0%(3/4)、写字楼未检出军团菌。 3.2空调风管积尘量及其微生物检测结果 3.2.12009年风管积尘量及微生物污染检测结果 2009年8月对4家大酒店、4家超市、2家商场集中空调通风系统进行风管微生物污染的检测,10家公共场所中中等污染7家,严重污染3家,检测结果见表3-7。检测结果显示：(1)管道积尘量：最高41.27g/m2,最低0.21g/m2,均值19.03g/m2,大酒店均值为23.64g/m2,超市均值为17.91g/m2,商场均值为7.50g／m2；(2)积尘中细菌总数：最高54000cfu/g,最低260cfu/g,均值7900cfu/g,其中大酒店均值为5400cfu/g,超市均值为12500cfu/g,商场超市均值为5500cfu/;(3)积尘中真菌总数：最高870000cfu/g,最低300,均值83000cfu/g,其中大酒店为11OOOOcfu/g,超市为67000cfu/g,商场超市为59000cfu/g);(4)污染程度：中等污染程度居多,占整体的70%,严重污染占30%,说明集中空调通风系统的风管里普遍存在污染。 3.2.22010年风管积尘量及微生物污染检测结果 在2010年8月对9家大酒店、宾馆4家、医院4家、1家超市、1家商场集中式空调通风系统进行风管微生物污染的检测。19家公共场所中中等污染14家,严重污染3家,检测结果见表3-8。(1)管道积尘量：最高56.04g/m2,最低0.34g/m2,均值10.62g/m2,其中大酒店均值为6.08g/m2,商场均值为12.83g/m2,超市均值为26.83g/m2,宾馆均值为14.27g/m2,医院均值为12.58g/m2；(2)积尘中细菌总数：最高68000cfu/g,最低410cfu/g,均值13000cfu/g,其中大酒店均值为7200cfu/g,商场均值为16000cfu/g,超市均值为32000cfu/g,宾馆均值为17000cfu/g,医院均值为15000cfu/g;(4)污染程度：轻度污染程度占10.52%,中等污染程度居多,占整体的73.68%,严重污染占15.79%。 3.3嗜肺军团菌抗体结果 3.3.1对照人群嗜肺军团菌抗体检测结果 在520名对照人群中检出军团菌抗体阳性的共计25份,总阳性率为4.81%,其中学生255名,阳性率3.92%(10/255)；厂矿工人265名,阳性率5.66%(15/265)。 3.3.2暴露人群嗜肺军团菌抗体检测结果 在511名暴露人群中检出军团菌抗体阳性的共计76份,阳性率为14.87%,其中超市工作人员190名,阳性率18.95%(36/190),商场工作人员94名,阳性率14.89%(14/94),证券工作人员35名,阳性率14.29%(5/35),酒店宾馆192名,阳性率10.94%(21/192)。 4结论 公共场所集中空调系统中军团菌污染及风管中积尘量和微生物的污染严重,对照人群中军团菌抗体阳性率为4.81%,暴露人群中军团菌抗体阳性率为14.87%,有必要在军团菌高发季节(夏冬季)加强对各大宾馆饭店、大型商场超市及医院等空调通风系统现状进行军团菌监测与监控,为政府有关部门进行综合治理提供决策依据,也为《公共场所集中空调通风系统卫生规范》提升为国家标准提供可靠的依据,有利于预防和控制公共场所中空气微生物污染的传播,保证公共场所里输送空气的卫生质量,保障人群的公共卫生安全。
[Abstract]:With the development of social economy , people ' s living , working environment and working conditions are constantly improving , and many public places have been installed with all - enclosed central air - conditioning equipment .

1 Purpose

To understand the present situation and the level of infection in the centralized air - conditioning system in Shaoxing public places , provide the decision - making basis for the comprehensive management of government departments concerned , which is conducive to the prevention and control of the epidemic and outbreak of infectious diseases in the respiratory system , so as to promote the health and safety of the central air - conditioning in the public places of our city and guarantee the public health .

2 Method

2.1 Sources and detection of cooling water samples

In the summer and winter of 2009 , the cooling water in large air - conditioning cooling towers of Shaoxing city hotels , hotels , shopping malls , supermarkets , hospitals , securities companies , office buildings and other public places was randomly selected to detect the concentration of the ophila .

At the same time , randomly check the dust accumulated in the air duct of the central air - conditioning ventilation system , detect the amount of dust , the total number of bacteria in the dust and the total number of fungi .

2.2 Grouping and Inclusion of Test Objects

Non - exposed group : 265 serum samples from mountain factory miners in 2009 - 2010 and 255 serum samples from college physical examination . The serum samples of the two groups were 520 , ( more than 5 years of continuous work in the unit ) , and the control group was set up .

Exposure group : 192 samples of serum samples from hotel and hotel employees ;
190 parts of serum specimen of supermarket staff ;
94 parts of serum specimen of the staff in the mall ;
In addition , 35 samples were collected from the staff of the securities company , 212 from the four categories ;
A total of 511 women from these groups were exposed to exposure to a total of 511 serum specimens ( more than 5 years in continuous work in the unit ) .

No centralized central air conditioner is installed in the working place where the control group personnel are located , and the centralized central air conditioner used at the working place of the exposed group personnel is not cleaned during 5 years , and the new air conditioner is not replaced .

2.3 Analysis on the Sampling Survey Results of the Contamination Sampling of the Central Air - conditioning Cooling Water in Shaoxing City

2.4 Effect of Air - conditioning Cooling Water on the Risk of Infection of Staff Members

2.5 Statistical software method

Statistical analysis of data was performed with SPSS V13.0 software . The difference between the two overall rates or the composition ratios , the comparison between the multiple overall rates or the composition ratios was examined by Pearson chi - square , and Fisher ' s exact probability method of four - grid data was used when the total sample size 40 , or theoretical frequency 1 , was 1 .

3 Results

3.1 Monitoring Results of Cooling Water Corps

The results showed that the total detection rate was 67.3 % ( 74 / 110 ) , 78.6 % ( 11 / 14 ) , 76.4 % ( 5 / 7 ) , 66.0 % ( 33 / 50 ) , 62.5 % ( 10 / 16 ) in the mall and 16.7 % ( 1 / 6 ) in office building .

3.1 . 1 The total detection rate is 72.9 % ( 43 / 59 ) . The total detection rate is 72.9 % ( 43 / 59 ) , in which the supermarket is 89.9 % ( 8 / 9 ) , the hospital is 77.8 % ( 7 / 9 ) , the securities company 66.7 % ( 2 / 3 ) , the hotel , the hotel is 70.4 % ( 19 / 27 ) , the mall is 75.0 % ( 6 / 8 ) , the office building is 33.3 % ( 1 / 3 ) .

3.1 . 2 In winter 2 - 3 months , 51 air - conditioning cooling towers were tested , the total detection rate was 60.8 % ( 31 / 51 ) , in which the supermarket was 75.0 % ( 6 / 8 ) , the store was 50.0 % ( 4 / 8 ) , the hotel and the hotel were 60.9 % ( 14 / 23 ) , the hospital was 80.0 % ( 4 / 5 ) , the securities company was 75.0 % ( 3 / 4 ) , and the office building was not detected .

3.2 Air - conditioning duct dust collection and microbial detection results

3.2 . 1Air duct dust collection and microbial contamination detection results in 2009

In August 2009 , 4 major hotels , 4 supermarkets , 2 stores centralized air conditioning and ventilation system were detected , 7 of 10 public places had moderate pollution and 3 serious pollution , the results are shown in Table 3 - 7 . The results show that : ( 1 ) The volume of pipeline dust : up to 41.27g / m2 , the lowest 0.21g / m2 , the average value 19.03g / m2 , the average value of the hotel is 23.64g / m2 , the average supermarket is 17.91g / m2 , the mean value of the mall is 7.50g / m2 ;
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