1 Instruments, equipment and materials
1.1 Instruments: ① YOP-4 photoelectronic dust particle counter; ② FA-1 multi-stage impact air microbial sampling; ③ hot-ball anemometer; ④ room thermometer; ⑤ ventilation wet and dry meter; ⑥ pump; ⑦ sound level meter.
1.2 Equipment: ① air filter (homemade); ② blower; ③ oscillator; ④ low-pressure suction; ⑤ micro-motor; ⑥ low ozone ultraviolet lamp 20 W × 2; ⑦ lighting; ⑧ the size of the cap of the vials of medicine automatic cutting machine; ⑨ ampoule automatic cutting mark device; ⑩ ampoule fixation box; (11) the safety bottles (homemade); (12) vials of medicine fixation box 2 units (homemade); (13) a disposable Dual-pass shunt and inlet needle; (14) cut flow negative pressure switch limiter 2 sets; B15?Foot-controlled negative pressure switch; B16?Timing disinfection switcher 2 sets.
1.3 Material: steel plate, aluminum and stainless steel plate.
2 Combination and fabrication
According to the procedure of liquid dispensing, the above equipment and materials are combined and fabricated into a purification bench, see the attached figure.
2.1 The purification bench is 130 cm long, 60 cm wide and 168 cm high, with the upper part equipped with air supply fan, air inlet, air supply duct (with ultraviolet lamp inside), coarse filter, sound insulation material and high-efficiency air filter. When the air blower works, the outdoor air is sent in from the air inlet and enters into the air blower through the coarse filter, the sound insulation material is added around the air blower to reduce the noise, and the coarse filtered air is sent into the air duct to be sterilized by the ultraviolet lamp and then sent to the purification studio through the high-efficiency filter. So far, the air is both sterilized and dust filtered to purify the air.
2.2 The purification studio is set on the left side of the table, with a height of 50 cm, a length of 90 cm and a width of 60 cm, and an ultraviolet light is set in the center of the top
Attachment Diagram of Intravenous Myocardial Injection Purification and Dispensing Table
1 Air supply
4 High-efficiency Filter
7 Oscillator
10 Negative Pressure Meter
13 Suction Switch
12 Suction Switch
13 Suction switch16 Sterilization switch
2 Air supply duct
5 Protective mesh
8 Exhaust duct
11 Medicine pumping switch
14 Lighting switch
17 Bottle opener
3 Observation window for ultraviolet lamp
6 Protective door
9 Power supply Main switch
12 Oscillation switch
15 Bottle opener switch
18 Exhaust port
Line lamp (controlled by the protective door) and lighting, protective net (to protect the high-efficiency filters) and hooks 2. Purification room is set in front of the plexiglass protective door (controlled by the timed disinfection switch, the routine automatic disinfection of 45 min closed by itself), the protective door on the staff both protective effect, but also the role of timed disinfection. Built-in drug oscillator (adjustable timer) negative pressure tube, safety bottle (negative pressure out of the hole and inlet holes and leakage holes composed of both negative pressure, but also to prevent the role of liquid reflux), dual-pass shunt, inlet needles, vials, ampoules fixed box.
2.3 The lower part of the worktable is equipped with an exhaust duct, automatic cutting device for large and small vials and ampoules. It is equipped with switches and signal display lamps for total power supply, air supply fan, negative pressure time limit for cutting flow, oscillator timing, automatic cutting of large and small vials and ampoules.
3 clinical application
3.1 Preparation of powder medicine and suction: the operator's right hand holds the bottle, the bottle neck end parallel to the protective cover, 1 s or so, the bottle cap is automatically cut without affecting the rubber plug, will be dispensed with bottles of medicine were placed in the bottle fixed box, disinfected with iodophor spray cap chipping, to be dry, respectively, will be a dual-pass suction shunt needle and a dual-pass shunt negative needle inserted into the bottle, the other end were inserted into the liquid bottle and ampoule, respectively The other end is inserted into the liquid bottle and the safety bottle respectively (to prevent negative pressure suction into the liquid to the negative pressure tube and then back into the bottle, if suction into the negative pressure can be discharged through the leakage channel mouth), open the cut-flow negative pressure limiter switch or foot-control negative pressure switch, with the above operation method, so that negative pressure is generated in the vials, and the liquid is inflowed into the vials for 2-3 s for 2~3 ml, turn off the negative pressure switch, and then pull out the needles and then fix the needles respectively in accordance with the aseptic operation. The needle was removed and fixed on the double-pass shunt switch rack for the next batch of similar drugs to be prepared. Put the medicine bottle into the timed oscillator after oscillation, take it out and put it into the fixed box of medicine bottle, after sterilizing the medicine bottle by iodophor spray, use the negative pressure to inhale the medicine into the infusion bottle, then insert the disposable infusion needle and put it on the infusion stand for spare. If the liquid is used for intramuscular injection, the dissolved liquid can be drawn out directly with an empty needle in the purification room.
3.2 Suction of ampoule: After opening the ampoule automatic cutting machine and cutting the ampoule, after sterilization, put it in the limit hole of ampoule fixing box of different specifications and break it by hand, then put it into the hole of the fixing box, and then draw out the liquid in the ampoule bottle through the double-pass shunt needle, and then pull the sliding plate under the box of ampoule to the right, and then the empty ampoule will fall into the waste box automatically. If you clear the ampoule in the box, pull the sliding spring plate under the box again, so that all of them fall into the waste storage box.
3.3 Excluding toxic gases: If you need to exclude toxic gases in the purification room, open the switch of the exhaust fan, and the harmful gases will be discharged from the pipeline automatically.
4 Monitoring methods and results
4.1 Air monitoring: according to GB 15982-1995 [2] requirements. Purification studio and treatment room operation process at the same time sampling, respectively, in the corners and the middle of each cloth 1 sampling point, purification studio corners of the point from the purification room wall 10 cm. treatment room corners from the wall 100 cm, and each point and the vertical height of the ground for 100 cm. sampling by sedimentation method, the flat plate in the purification chamber exposed to 30 min, treatment room after exposure to 5 minutes at 37 ℃ constant temperature incubation. The colonies were counted at 24 h.
4.2 Determination of wind speed and dust concentration: 4 points for wind speed, 5 points for dust concentration, and YOP-4 photoelectronic dust particle counter was used to determine the value.
4.3 Monitoring results: the average total number of bacterial colonies in the purification studio is 3 cfu/cm3; the total number of bacterial colonies in the treatment room is 671 cfu/cm3, suggesting that the number of bacterial colonies in the purification studio is significantly lower than that in the treatment room.
The average wind speed of the four points of the purification workstation was 0.57 m/s, and the average value of the dust concentration in the space of 0.3μm was 5.4 grains/L, and that of 0.5μm was 1.7 grains/L.
5 Discussion
5.1 Preventing airborne bacterial infections: Because the air of the wards in our country has not been purified, the number of airborne bacteria in the treatment room is 10～200 times higher than that of the advanced countries. 200 times [1]; in the preparation of I.V., a large number of airborne bacteria present in the air can contaminate the liquid in the infusion bottle through various links, which is a major factor in increasing the contamination of injection dilution [3]. Measures to prevent the contamination of I.V. fluid, hospitals commonly used disinfection methods are physical, chemical, natural ventilation, herbal spray, vinegar, alteration of the treatment room and other methods [4-10]. According to Mao and Ling et al [10], the sterilization rate of 3% hydrogen peroxide spray was 85.6%; lactic acid fumigation was 76.33%; cangzhu fumigation was 90.75%, and ultraviolet irradiation was 81.56%. However, all the above disinfectants are corrosive and labor-intensive, material and time-consuming, while leaving an odor in the air. We through the research combination of trial production of intravenous myocardial injection purification dispensing workbench, by the clinical application of more than 600 times, there is no infection, safe, time-saving, automatic cutting size bottle cap, suction and extraction of liquid, oscillation and automatic purification of air and other functions, so that the dispensing of liquids to achieve the scientific, aseptic, confirmed by the determination: purification of the number of colonies within the room on average of 3 cfu / m3, the treatment room for the 671 cfu /m3, a reduction of 98.95%; 0.3μm average dust concentration of 5.4 particles / L, 0.5μm for 1.7 particles / L, and Yang Yulan [9] reported 10,000-grade air purification room regulations parameters 0.5μm for 350 particles / L compared to a reduction of 99.51%. The measured value of colony count (specified as 500 cfu/m3) was reduced by 99.4% in comparison.
5.2 Advantages: ① automatic sterilization and purification of air to avoid contaminated air into the liquid bottle and vials to ensure the sterility of the drug. ② Ensure that the empty needle is not contaminated during the suction and pumping process. ③ The vials and ampoules are mechanically and quickly cut and the drugs are automatically oscillated, which reduces the labor of nurses and shortens the dispensing time. ④The use of mechanical cutting of bottle caps ensures the standardization of the disinfection area of bottle caps. ⑤ The use of disposable double-pass splitter suction and pumping of drugs prevents the invasion of pathogenic microorganisms in the process of drug dispensing.
(This work has been supported by the Infection Surveillance Committee of Sichuan Provincial Department of Health, Sichuan Provincial Science and Technology Commission, Sichuan Provincial Administration of Medicine, Director Deng Yunqing of Nursing Department of the Second Affiliated Hospital of West China University of Medical Sciences, Chief Nurse Yu Chengbi and Attending Physician Ding Chenghuai of Provincial Post and Telecommunication Hospital, and Director Zhao Fo-rong of Nursing Department of the Affiliated Stomatological Hospital of West China University of Medical Sciences, and so on, and is gratefully acknowledged)