本文選題：層流病房　切入點：消毒　出處：《吉林大學(xué)》2012年碩士論文

【摘要】：背景造血干細胞移植的患者在預(yù)處理后，其骨髓清空、免疫抑制，極易發(fā)生各種感染等并發(fā)癥，如果不能有效預(yù)防和控制，將危及生命。 層流病房作為造血干細胞移植患者行保護性隔離居住的必要條件起到至關(guān)重要的作用。目前，國內(nèi)針對此類病房的終末消毒處理并沒有形成統(tǒng)一模式。傳統(tǒng)方法是采用過氧乙酸熏蒸結(jié)合有效氯等消毒劑做物體表面擦拭。研究表明，過氧乙酸可以造成眼睛、黏膜的損傷并具有一定的腐蝕性。而有效氯也同樣存在刺激性氣味、不穩(wěn)定等特點。國內(nèi)有關(guān)移植病房全環(huán)境保護的研究曾有報道，但是關(guān)于終末消毒處理卻沒有深入研究，未形成規(guī)范體系。 目的改變傳統(tǒng)熏蒸方法，尋求一種簡便易行、經(jīng)濟安全、對患者、醫(yī)務(wù)人員及環(huán)境損傷小的造血干細胞移植層流病房終末消毒方法，確保層流病房的潔凈度。分析該病房環(huán)境因素對患者的影響及不同終末處理方法的經(jīng)濟效果。方法將過氧乙酸熏蒸和有效氯擦拭處理的病房列為對照組，空氣層流和復(fù)方季銨鹽消毒劑擦拭處理的病房列為實驗組，分別比較對照組及實驗組的空氣沉降菌落培養(yǎng)計數(shù)、表面擦拭的物體表面菌落計數(shù)；比較同期隨機入住實驗組及對照組病房的患者的感染率；并進一步將病房沉降菌落進行培養(yǎng)、分析我院層流病房常見細菌及與患者感染之間的關(guān)系；用兩種消毒方法的耗時時間以及床位周轉(zhuǎn)率來分析比較實驗組及對照組的經(jīng)濟效果。 結(jié)果（1）實驗組與對照組終末處理后，病房中心區(qū)及周邊區(qū)空氣培養(yǎng)菌落數(shù)比較無統(tǒng)計學(xué)差異，P分別為0.60與0.89；（2）實驗組與對照組終末處理后，物體表面擦拭效果比較無統(tǒng)計學(xué)差異，P=0.98；（3）同期入住病房的白血病患者及重型再生障礙性貧血行抗胸腺細胞球蛋白（ATG）治療患者在發(fā)熱時間上無統(tǒng)計學(xué)差異，P=0.54；（4）我院層流病房常見菌落為凝固酶陰性葡萄菌（表皮葡萄球菌）、棒狀桿菌、枯草芽孢桿菌等廣泛存在于空氣、人體的常見菌；（5）目前在我院層流病房患者發(fā)熱的主要致病菌來自于患者本身攜帶的條件致病菌，，而層流病房在消毒檢測合格后，正常運行，定期保養(yǎng)，就能夠確�？諝獾臐崈舳龋虼瞬粫蔀榛颊吒腥镜闹饕蛩�；（6）實驗組終末處理耗時6.5小時，床位周轉(zhuǎn)率為147.8%；對照組終末處理耗時14.5小時，床位周轉(zhuǎn)率為145.6%，每年收治病人總數(shù)相差2人，從而實驗組能夠為較多的患者提供入住治療的機會。結(jié)論通過對實驗組及對照組的分析，可以得出造血干細胞移植層流病房的終末處理方法可采用季銨鹽類消毒劑擦拭病房的物體表面，加之空氣層流機的運行即可完成。此方法簡便易行，對患者及醫(yī)務(wù)人員影響小，并且增加病房的周轉(zhuǎn)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.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R187

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