1. Necessity:
① sterilization effect monitoring method of professionalism, do not test do not know the results;
② new wards, new disinfection equipment, new disinfectants should be done to monitor the effect.
③ special objects, special needs, must do effect monitoring. Such as pre-transplantation, ICU wards, critically ill patients.
2. Scientific: scientific experimental design, skilled technology, reliable results, accurate analysis, results evaluation.
3. Normative: based on authoritative norms, in line with its basic principles. Such as the determination of the timing of the test, the selection of standard strains, the number of specimens, the number of repetitions, the establishment of experimental methods.
Second, the classification of monitoring methods:
1, according to the nature of the detection method:
① Physical methods: measurement of pressure sterilization temperature, measurement of ultraviolet intensity, etc.;
② Chemical methods: a variety of chemical indicator card;
③ Biological methods: thermophilic / chytridiomycetes sterilization effect of the monitoring of the number of natural bacterial survival monitoring;
2, according to the nature of disinfection and sterilization objects:
① air disinfection:
② surface disinfection:
3. According to the specific disinfection objects:
① pressure steam sterilization:
② a variety of instruments:
③ chemical disinfectants:
④ ultraviolet lamp sterilization effect:
⑤ hand and skin Disinfection effect:
⑥ Air disinfection effect:
⑦ Object surface disinfection effect:
III. Necessary conditions:
1. Professional laboratory:
2. Necessary equipments and devices:
3. Selection of experimental methods:
4. Skillful experimental techniques:
IV. The Ministry of Health on the infection management in hospitals of more than 500 beds. The Ministry of Health of 500 beds or more hospital infection management quality indicators:
(1) hospital infection rate ≤ 10%; sterilization incision infection ≤ 0.5%
(2) hospital infection underreporting rate of ≤ 20%;
survey sample size of not less than 10% of the annual monitoring of the number of patients
(3) hospitals must be disinfection, sterilization effect of regular monitoring.
Sterilization pass rate must reach 100%
(4) disinfectants and sterilants in use should be biological and chemical monitoring. Quarterly biological monitoring of disinfectants, bacterial content must be & lt; 100cfu/ml, shall not detect pathogenic microorganisms; sterilizing agent monthly test, shall not detect microorganisms. Chemical monitoring should be based on the performance of disinfection and sterilization agents regularly monitored.
(5) pressure steam sterilization for process, chemical and biological monitoring. Ethylene oxide must be process monitoring per pot, chemical monitoring per package, and monthly biological monitoring. Pressure steam pots must do a B-D test on the first pot of each day.
(6) UV lamp intensity monitoring: 1 time per quarter; new lamp 30W ≥ 90?W / cm2, old lamp ≥ 70?W / cm2 < / p>
(7) gastroenteroscopy and other diagnostic and treatment equipment disinfection standards shall not detect pathogenic microorganisms; laparoscopes, arthroscopes, etc. should be sterilized and processed, and no microorganisms shall be detected.
(8) into the human body tissue, blood, organs of medical supplies should be sterilized, shall not detect pathogenic microorganisms; contact with mucous membranes of medical supplies ≤ 20cfu / g (or 100 cm2) total bacterial count; contact with the skin of the total bacterial count of medical supplies ≤ 200cfu / g (or 100 cm2), shall not detect pathogenic microorganisms.
(9) mothers and babies in the same room, baby room surfaces and health care workers shall not be detected Salmonella hand.
(10) hospitals of various types of environmental air, object surfaces, health care workers hand bacterial count standards:
Environmental categories of air, object surfaces, health care workers hand
cfu/cm3 cfu/cm2 cfu/cm2
Ⅰ class of laminar flow clean operating room, ≤10 ≤5 ≤5
clean wards
Ⅱ type of General operating rooms, maternity wards, ≤200 ≤5 ≤5
Infant rooms, general isolation wards
Class Ⅲ pediatrics, gynecology examination rooms, ≤500 ≤10 ≤10
Injections, medication exchange, treatment,
Emergency, laboratories, general wards
Class Ⅳ Infectious diseases and wards - ≤15 ≤15
Class Ⅳ Infectious diseases and wards - ≤15 ≤15
Class Ⅳ Infectious disease departments and wards - ≤15 ≤15
V. In order to ensure that the hospital disinfection and sterilization is reliable, the hospital disinfection and sterilization effect should be carefully monitored
1, there are many factors affecting disinfection and sterilization, making it difficult to ensure the effect of disinfection and sterilization.
2, sterilization effect of biological monitoring of professional, difficult to create the conditions, the results of the evaluation of the difficulty of the long experimental cycle.
3, the chemical test reagent method is more complex, the results are accurate; test paper method is simple and easy to implement, but the accuracy is poor.
Six, pressure steam sterilization effect of monitoring:
(a) BD test paper:
Check the status of the sterilizer process, and can not react to the sterilizer use of the sterilized items in the actual sterilization effect. Found positive should be carried out sterilizer performance check debugging.
(b) Indicator tape:
Indicates whether the sterilization process, and can not reflect the actual sterilization effect of the sterilized items.
(C) chemical indicator card:
Detect the sterilization effect of each package of sterilized items. It is recommended that each package of sterilized articles in the center of a piece of chemical indicator card, to be sterilized, depending on the degree of discoloration (sterilization effect) to decide whether to use.
(D) biological indicators for systematic monitoring:
The use of biological sterilization indicators to check the effect of pressure steam sterilization is the most scientific and reliable monitoring method. By the Chinese Academy of Preventive Medical Sciences Institute of Epidemiological Microbiology, Beijing Xin Sihuan Disinfection Technology Development Center joint production and marketing of thermophilic lipophilic bacillus spores (SS1, K31) is an internationally recognized standard strain. It is now made into standard bacterial slices for checking the effect of pressure steam sterilization test.
w Characteristics of the strain:
1, the bacterium is aerobic bacillus, the bacterial propagation body is negative for Gram's staining is purple, the bacterial bacterial cells peacock green coloring. Its bacterial propagation body on the medium requirements of low, in the bromocresol purple glucose peptone agar on the growth of good, rough surface was beige.
2, the optimal growth and reproduction temperature of 56-65 ℃, culture 24h can form colonies, 37 ℃ 24h can not see colonies.
3, this bio-indicator carrier for high-level filter paper sheet, the amount of bacteria stained 5 × 105-106cfu / piece, encapsulated in a small paper bag, heat death time of 121 ℃, 3.9min positive, 19min negative; D10 value of 1.3-1.9min, in line with the United States Pharmacopoeia, the eleventh edition of the regulations Standard. The bacterium is non-toxic, thermal resistance is stable, in the refrigerator at 4 ℃ for one year without a significant decline in resistance, at room temperature (about 20 ℃) can be stored for 1 month.
w How to use:
1, the bacillus tablets will be used when the small paper bag containing slices of bacteria in the center of the sterilized items (the number of slices of bacteria placed in each pot in accordance with the provisions of the Ministry of Health).
2, after sterilization, and then aseptically removed from the paper bag of slices, put into the bromocresol violet culture tube. At the same time, the unsterilized bacterial pieces into another tube of medium for control.
3, 56 ℃ -60 ℃ culture, 48h observation results, the control tube for the beige; if the color of sterilized slices of bacteria culture medium is still the same mauve color, negative (-), said sterilization is complete; such as yellow for the positive (+), said sterilization is not complete.
w Media composition and preparation:
1, composition: tryptone 10g, glucose 5g, distilled water 1000ml, 1.6% bromocresol violet alcohol solution indicator 1ml.
2, preparation:
(1) 1.6g of bromocresol violet dissolved in 98.4ml of 96% alcohol solution shaking well;
(2) Dissolve the first three ingredients, mediate pH7.0-7.2, add the indicator and shake well;
(3) Dispense 5ml of each tube, sterilize it at 121℃ for 20min, and then put it into 4℃ refrigerator for storage and spare.
w Precautions:
1, to prevent the indicator alcohol volatilization and make the content of bromocresol violet is too high (bromocresol violet content is too high can inhibit the growth of bacteria);
2, the bacterial slice should be taken out of the culture in a timely manner after sterilization;
3, prohibit the slice of bacteria in contact with any disinfectant and radioactive sources so as not to affect the resistance.
VII, chemical disinfectant disinfection effect monitoring:
(a) disinfectant effective content test:
1, mainly effective content of unstable disinfectants, such as peroxyacetic acid, chlorine disinfectants, etc. should be content test.
2, chemical reagent titration method is more complicated but the results are accurate; test paper method is convenient and fast, but the accuracy is poor. Dedicated chlorine test paper - more accurate; composite test paper (can be measured with peracetic acid, chlorine disinfectants) - less accurate. Glutaraldehyde test paper; iodine-containing, ozone-containing test paper is yet to be studied.
(B) chemical disinfectants using the number of bacteria contaminated solution detection
1, select and use a good neutralizer:
2, do: correspondence, concentration, proportion appropriate
3, neutralizer selection principles:
① itself does not have an impact on the bacteria
② really remove the bactericidal factor
③ generation of bacteria does not have an impact on the bacteria
③ the product of the bacteria <
④Complete control
★ Test grouping:
① Bacterial solution + drug solution culture
② (drug + bacterial solution) + neutralizer culture
③ Neutralizer + bacterial solution culture
④ (drug + neutralizer) + bacterial solution culture
⑤ PBS + bacterial solution culture
⑥ PBS culture
⑦ Neutralizer culture
⑥ PBS culture
⑥ PBS culture
⑥ PBS culture
⑦ Neutralizer culture
⑧ Medium culture