【摘要】： 研究背景:口腔科交叉感染的問題已日益受到口腔專業(yè)人士和公眾的重視,目前國內(nèi)口腔科感染控制的重點(diǎn)集中在口腔器械的消毒,如高速手機(jī)、擴(kuò)銼針、拔牙鉗等的消毒,并已取得了一定的成果。但作為口腔醫(yī)師診治病人的基本設(shè)備口腔綜合治療臺,其內(nèi)部水路(dental unit waterlines,DUWL)的消毒卻被有意無意地忽略了。眾所周知,在一個(gè)消毒體系中,即便其中一個(gè)環(huán)節(jié)未控制好,將導(dǎo)致整個(gè)消毒體系的失敗。也就是說,即便手機(jī)已徹底消毒,如果DUWL出來的水是污染的,也將導(dǎo)致病人或醫(yī)師感染。近年來,國內(nèi)醫(yī)療機(jī)構(gòu)對口腔科手機(jī)、三用氣槍、出水系統(tǒng)等環(huán)節(jié)污染監(jiān)測研究較多,尤其是使用帶返流閥門和可高溫滅菌處理的手機(jī)已降低了病人之間相互感染的可能性。三用氣槍是口腔科治療中最常被應(yīng)用的器械之一,主要用于沖洗口腔和干燥牙體表面及窩洞,直接與醫(yī)務(wù)人員和病人接觸,而且三用氣槍的金屬頭反復(fù)消毒難以達(dá)到規(guī)定標(biāo)準(zhǔn):即使做到每人消毒一次,也很難將細(xì)微管道中的血液、細(xì)菌清除干凈,而且據(jù)報(bào)道是導(dǎo)致口腔疾病患者醫(yī)院感染常見因素之一。它與高速手機(jī)一樣,在停止的瞬間產(chǎn)生虹吸,由此造成的交叉感染已被實(shí)驗(yàn)室細(xì)菌學(xué)、病毒學(xué)、傳染科實(shí)驗(yàn)和臨床測試結(jié)果所證實(shí),有學(xué)者研究表明,三用氣槍內(nèi)部水進(jìn)行細(xì)菌培養(yǎng),污染率＞92%。并且三用氣槍是日常消毒鏈中最薄弱的環(huán)節(jié),因此,三用氣槍的消毒滅菌與防污染操作應(yīng)引起足夠的重視。 目的: 本研究的目的是通過調(diào)查某大型口腔醫(yī)院口腔綜合治療臺高速手機(jī)和三用氣槍水路常見口腔細(xì)菌的污染情況,了解高速手機(jī)和三用氣槍細(xì)菌污染的現(xiàn)狀和進(jìn)一步改進(jìn)消毒措施的必要性。 對象與方法: 每個(gè)星期五下班后,常規(guī)消毒口腔綜合治療臺后進(jìn)行采樣。分別采集80臺口腔綜合治療臺的入水口、醫(yī)生位三用氣槍、護(hù)士位三用氣槍及高速手機(jī)不同出水時(shí)段的水樣;用酒精燈燒灼已消毒三用氣槍出水口和手機(jī)出水口,用無菌試管連續(xù)接取水樣,分別接取三用氣槍出水及手機(jī)噴水口處取水樣,封口,存放4℃待測。 結(jié)果: 1.80臺口腔綜合治療臺的入水口、醫(yī)生位三用氣槍、護(hù)士位三用氣槍和高速手機(jī)中均驗(yàn)出有葡萄球菌、鏈球菌、放線菌,放線菌在入水口的菌種數(shù)最多。 2.三用氣槍的菌落數(shù)高于高速手機(jī)。 3.不同出水時(shí)段水樣的細(xì)菌數(shù)不同。三用氣槍水樣的細(xì)菌數(shù)量在第一個(gè)2ml分布最多,而第二個(gè)2ml次之,第三個(gè)2ml最少,似有增大的趨勢,高速手機(jī)在不同時(shí)段細(xì)菌數(shù)量差別無統(tǒng)計(jì)學(xué)意義。 4.80臺口腔綜合治療臺的水樣標(biāo)本中不同出水時(shí)段檢出的細(xì)菌種類和陽性率有所不同,其中葡萄球菌各時(shí)段差別有統(tǒng)計(jì)學(xué)意義,以第三個(gè)2ml最多,放線菌和鏈球菌的檢出各時(shí)段的差異則無統(tǒng)計(jì)學(xué)意義。 5.80臺口腔綜合治療臺的水樣標(biāo)本中不同科室的菌落數(shù)有所差別,其中牙周科的菌落數(shù)最多。 6.三用氣槍及高速手機(jī)水樣的細(xì)菌數(shù)以外科最高,然后依次為內(nèi)科、牙周科、正畸科,修復(fù)科最低,各科室細(xì)菌的差異有統(tǒng)計(jì)學(xué)意義。在細(xì)菌種類方面,各科室均以葡萄球菌檢出最多,其次依次為鏈球菌、放線菌。 結(jié)論: 1.在口腔綜合治療臺入水口的未經(jīng)處理的水樣中,均含有常見口腔感染菌。因此,牙科用水是一個(gè)潛在的感染源。 2.三用氣槍的污染比高速手機(jī)嚴(yán)重。 3.口腔綜合治療臺中三用氣槍及高速手機(jī)檢出細(xì)菌主要是葡萄球菌、鏈球菌和放線菌。 4.醫(yī)院檢測的綜合治療臺中三用氣槍及高速手機(jī)檢出細(xì)菌主要分布于外科。
[Abstract]:Background: The problem of cross infection in stomatology has been paid more attention to oral professionals and the public. At present, the focus of domestic stomatology infection control focuses on the disinfection of oral instruments, such as disinfection of high-speed mobile phones, extended needles, forceps, etc., and some results have been achieved. However, as the basic equipment oral comprehensive treatment table for the diagnosis and treatment of patients, the disinfection of the internal waterways (DUWL) has been inadvertently omitted. It is well known that in a sterilization system, even if one of the links is not controlled, the entire sterilization system will fail. That is, even if the cell phone has been thoroughly disinfected, if the water out of the DUWL is contaminated, the patient or physician will be infected. In recent years, domestic medical institutions have studied the pollution monitoring of stomatology mobile phones, three air guns and water outlet systems, especially the possibility of using the return flow valve and the mobile phone with high temperature sterilization treatment to reduce the mutual infection among the patients. the three-purpose air gun is one of the most commonly used instruments in the treatment of stomatology, mainly used for washing the surfaces of the oral cavity and the dry tooth body and the cavity, directly contacting the medical personnel and the patient, and repeatedly sterilizing the metal head of the three air guns to achieve the specified standard, It is also difficult to clean the blood and bacteria in the fine pipes, and it is reported that it is one of the common factors leading to nosocomial infection in patients with Parkinson's disease. As with the high-speed mobile phone, it has been proved by laboratory bacteriology, virology, Ames test and clinical test results that the cross infection caused by the siphonage at the stop moment has been confirmed by the laboratory bacteriology, virology, Ames test and clinical test results. The results show that the internal water of three air guns is used for bacterial culture, and the pollution rate is more than 92%. and the three-purpose air gun is the weakest link in the daily disinfection chain, and therefore, the disinfection and sterilization of the three air guns and the pollution prevention operation should be given enough attention. Objective: The purpose of this study is to investigate the status and further improvement of bacterial contamination of high-speed mobile phones and three air guns by investigating the contamination of high-speed mobile phones and three air guns in the oral cavity of a large stomatological hospital. Necessary for Poisonous Measures Sex. Object and Method: After work every Friday, often sampling is carried out after the comprehensive treatment of the oral cavity of the gauge disinfection oral cavity, 80 oral cavity comprehensive treatment stations, three air guns for doctors, three air guns for nurses and water samples of different water discharging periods of the high-speed mobile phone are respectively collected, the water outlets of the sterilized three air guns and the mobile phone are cauterized by using an alcohol lamp, a water outlet is continuously connected with a sterile test tube, a three-purpose air gun water outlet and a mobile phone water spray are respectively connected with the water sample Take out at the mouth Water sample, seal, store 4 鈩，

本文編號：2311834