CAJ | 학술논문

目的：研究层流手术室术中手术器械在不同时间段的细菌污染状况，探讨手术器械污染与器械是否暴露在空气中的关联性，为降低术中手术器械不安全因素、预防和控制手术部位感染的发生提供依据。方法选取医院2013年3－11月进行神经外科手术患者120例，随机分为A、B、C 3组，每组各40例，A组手术器械使用后直接放置在无菌台，完全暴露在空气中；B组手术器械使用后放置在无菌台并加以棉织布治疗巾覆盖；C组手术器械使用后放置在无菌台并加以无纺布治疗巾覆盖，分别于手术开始前、术中4、5、6、7 h5个时段对每台手术使用的手术器械取3个样本进行细菌培养，将结果进行比较。结果 A、B、C 3组手术器械被检测器械均为600件，合格率分别为91．00％、96．50％、99．33％，3组合格率比较差异有统计学意义（ P＜0．05）；在各时段比较中，在手术开始至术中4 h内3组手术器械均未检测出有细菌生长，3组器械合格率均为100．00％，3组间差异无统计学意义；术中5 h时A、B、C 3组器械合格率分别为95．00％、100．00％、100．00％，3组合格率比较差异有统计学意义（ P＜0．05）；术中6 h时A、B、C 3组器械合格率分别为81．67％、92．50％、99．17％，3组合格率比较差异有统计学意义（P＜0．05），B、C两组间合格率比较差异有统计学意义（P＜0．05）；术中7 h时A、B、C 3组器械合格率分别为78．33％、90．00％、97．50％，3组合格率比较差异有统计学意义（ P＜0．05），B、C两组间合格率比较差异也有统计学意义（P＜0．05）。结论监测结果表明，手术中无菌器械的污染与器械是否直接暴露在空气中有关，且呈正相关，器械表面的血迹也增加其污染率，因此术中对使用过的器械加以治疗巾覆盖可降低其污染率，同时器械护士也应注意及时擦净器械表面的血迹。目的：研究層流手術室術中手術器械在不同時間段的細菌汙染狀況，探討手術器械汙染與器械是否暴露在空氣中的關聯性，為降低術中手術器械不安全因素、預防和控製手術部位感染的髮生提供依據。方法選取醫院2013年3－11月進行神經外科手術患者120例，隨機分為A、B、C 3組，每組各40例，A組手術器械使用後直接放置在無菌檯，完全暴露在空氣中；B組手術器械使用後放置在無菌檯併加以棉織佈治療巾覆蓋；C組手術器械使用後放置在無菌檯併加以無紡佈治療巾覆蓋，分彆于手術開始前、術中4、5、6、7 h5箇時段對每檯手術使用的手術器械取3箇樣本進行細菌培養，將結果進行比較。結果 A、B、C 3組手術器械被檢測器械均為600件，閤格率分彆為91．00％、96．50％、99．33％，3組閤格率比較差異有統計學意義（ P＜0．05）；在各時段比較中，在手術開始至術中4 h內3組手術器械均未檢測齣有細菌生長，3組器械閤格率均為100．00％，3組間差異無統計學意義；術中5 h時A、B、C 3組器械閤格率分彆為95．00％、100．00％、100．00％，3組閤格率比較差異有統計學意義（ P＜0．05）；術中6 h時A、B、C 3組器械閤格率分彆為81．67％、92．50％、99．17％，3組閤格率比較差異有統計學意義（P＜0．05），B、C兩組間閤格率比較差異有統計學意義（P＜0．05）；術中7 h時A、B、C 3組器械閤格率分彆為78．33％、90．00％、97．50％，3組閤格率比較差異有統計學意義（ P＜0．05），B、C兩組間閤格率比較差異也有統計學意義（P＜0．05）。結論鑑測結果錶明，手術中無菌器械的汙染與器械是否直接暴露在空氣中有關，且呈正相關，器械錶麵的血跡也增加其汙染率，因此術中對使用過的器械加以治療巾覆蓋可降低其汙染率，同時器械護士也應註意及時抆淨器械錶麵的血跡。
목적：연구층류수술실술중수술기계재불동시간단적세균오염상황，탐토수술기계오염여기계시부폭로재공기중적관련성，위강저술중수술기계불안전인소、예방화공제수술부위감염적발생제공의거。방법선취의원2013년3－11월진행신경외과수술환자120례，수궤분위A、B、C 3조，매조각40례，A조수술기계사용후직접방치재무균태，완전폭로재공기중；B조수술기계사용후방치재무균태병가이면직포치료건복개；C조수술기계사용후방치재무균태병가이무방포치료건복개，분별우수술개시전、술중4、5、6、7 h5개시단대매태수술사용적수술기계취3개양본진행세균배양，장결과진행비교。결과 A、B、C 3조수술기계피검측기계균위600건，합격솔분별위91．00％、96．50％、99．33％，3조합격솔비교차이유통계학의의（ P＜0．05）；재각시단비교중，재수술개시지술중4 h내3조수술기계균미검측출유세균생장，3조기계합격솔균위100．00％，3조간차이무통계학의의；술중5 h시A、B、C 3조기계합격솔분별위95．00％、100．00％、100．00％，3조합격솔비교차이유통계학의의（ P＜0．05）；술중6 h시A、B、C 3조기계합격솔분별위81．67％、92．50％、99．17％，3조합격솔비교차이유통계학의의（P＜0．05），B、C량조간합격솔비교차이유통계학의의（P＜0．05）；술중7 h시A、B、C 3조기계합격솔분별위78．33％、90．00％、97．50％，3조합격솔비교차이유통계학의의（ P＜0．05），B、C량조간합격솔비교차이야유통계학의의（P＜0．05）。결론감측결과표명，수술중무균기계적오염여기계시부직접폭로재공기중유관，차정정상관，기계표면적혈적야증가기오염솔，인차술중대사용과적기계가이치료건복개가강저기오염솔，동시기계호사야응주의급시찰정기계표면적혈적。
OBJECTIVE To study the bacterial pollution of surgical instruments in laminar flow operating rooms in different time periods and explore the correlation between the contaminated surgical instruments and their exposure to air so as to provide evidence to reduce insecurity of intraoperative surgical instruments and prevent surgical site infections .METHODS A total of 120 patients who underwent surgeries in neurosurgery department from Mar 2013 to Nov 2013 were enrolled in the study and randomly divided into the group A ,B ,and C ,with 40 cases in each group;the surgical instruments of the group A were directly placed on the sterile table and fully exposed to the air after they were used ,the surgical instruments of the group B were placed on the sterile table and covered with cot‐ton cloth towel after they were used ,and the surgical instruments of the group C were placed on the sterile table and covered with non‐woven towel after they were used;three samples were collected from the surgical instru‐ments that were used before the surgery ,or at 4 ,5 ,6 ,or 7 hours during the surgery so as to perform bacterial culture ,and the results were observed and compared .RESULTS Totally 600 surgical instruments were tested in each of the three groups ,and the qualified rate was 91 .00% in the group A ,96 .50% in the group B ,99 .33% in the group C ,there was significant difference in the qualified rate among the three groups (P<0 .05) .The bacterial growth was not found from the start of surgery to the surgery within 4 hours ,the qualified rates of the instru‐ments of all the three groups were 100 .00% ,there was no significant difference .At 5 hours during the surgery , the qualified rate of the surgical instruments was 95 .00% in the group A ,100 .00% in the group B ,100 .00% in the group C ,there was significant difference in the qualified rate among the three groups (P<0 .05) .At 6 hours during the surgery ,the qualified rate of the surgical instruments was 81 .67% in the group A ,92 .50% in the group B ,99 .17% in the group C ,there was significant difference in the qualified rate among the three groups (P<0 .05) ,and there was significant difference in the qualified rate between the group B and the group C (P<0 .05) .At 7 hours during the surgery ,the qualified rate of the surgical instruments was 78 .33% in the group A , 90 .00% in the group B ,97 .50% in the group C ,there was significant difference in the qualified rate among the three groups (P<0 .05) ,and there was also significant difference in the qualified rate between the group B and the group C (P<0 .05) .CONCLUSION The surveillance result indicates that the contamination of the sterile instru‐ments is related to the direct exposure to the air and is positively correlated ,the bloodstains on the surfaces of the surgical instruments may increase the contamination rate ,therefore ,to reduce the contamination rate ,the used surgical instruments should be covered with towels ,and the nurses need to be aware of the bloodstains on the sur‐faces of the instruments .