医疗机构病房隔帘污染与清洁消毒现状及研究进展
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摘要
医疗机构中的隔帘作为保护患者隐私或床边隔离及屏障的主要物品广泛应用于病房、门诊诊室、功能检查科室等场所,属于高频接触物品。而医疗机构中的环境表面被病原微生物污染,特别是高频接触物体表面污染更为严重,是造成住院患者发生医院感染的病原微生物储源。隔帘作为常见高频接触物品由于体积较大、安装繁琐等原因其清洁消毒或更换往往不被重视,甚至被长期忽略。本文综述分析了近年来国内外关于病房隔帘污染和清洁消毒的相关研究,揭示隔帘污染会造成医院感染发生风险升高甚至医院感染暴发,并对隔帘的清洁和消毒及更换频率进行分析,提出医疗机构应该重视病房隔帘的清洁消毒和更换管理工作,以预防医院感染的发生,进一步提升医疗质量安全。
The curtains in the medical institutions are widely used in wards,outpatient clinics,functional examination departments and other places for protecting the patients' privacy or bedside isolation and barriers,and belong to high-frequency contact items.The environmental surfaces of hospitals are contaminated by healthcare-associated pathogens,especially the high-frequency contact objects have more serious surface contamination,which is the source of pathogens causing nosocomial infection in hospitalized patients.As a common high-frequency contact item,due to its large size and complicated installation,the cleaning,disinfection and replacement of curtains in hospital are ignored for a long time.This paper reviews and analyzes the recent research on the contamination,cleaning and disinfection of curtains in the hospital wards,revealing that contaminated curtains will increase the risk of nosocomial infection and even the outbreak of nosocomial infection.The cleaning,disinfection and replacement frequencies of curtains are analyzed,suggesting that medical institutions should pay attention to the the management of ward curtains to prevent the occurrence of nosocomial infections and improve the quality and safety of medical care.
The curtains in the medical institutions are widely used in wards,outpatient clinics,functional examination departments and other places for protecting the patients' privacy or bedside isolation and barriers,and belong to high-frequency contact items.The environmental surfaces of hospitals are contaminated by healthcare-associated pathogens,especially the high-frequency contact objects have more serious surface contamination,which is the source of pathogens causing nosocomial infection in hospitalized patients.As a common high-frequency contact item,due to its large size and complicated installation,the cleaning,disinfection and replacement of curtains in hospital are ignored for a long time.This paper reviews and analyzes the recent research on the contamination,cleaning and disinfection of curtains in the hospital wards,revealing that contaminated curtains will increase the risk of nosocomial infection and even the outbreak of nosocomial infection.The cleaning,disinfection and replacement frequencies of curtains are analyzed,suggesting that medical institutions should pay attention to the the management of ward curtains to prevent the occurrence of nosocomial infections and improve the quality and safety of medical care.
引文
[1]Boyce J M.Environmental contamination makes an important contribution to hospital infection[J].J Hosp Infect,2007,65(supp-S2):50-54.
[2]Rhinehart E,Walker S,Murphy D,et al.Frequency of outbreak investigations in US hospitals:results of a national survey of infection preventionists[J].Am J Infect Control,2012,40(1):2-8.
[3]Ali H,Nash JQ,Kearns AM,et al.Outbreak of a South West Pacific clone Pantone-Valentine leucocidin-positive meticillin-resistant Staphylococcus aureus infection[J].JHosp Infect,2012,80(4):293-298.
[4]Anderson DJ,Chen LF,Weber DJ,et al.Enhanced terminal room disinfection and acquisition and infection caused by multidrug-resistant organisms and Clostridium difficile(the Benefits of Enhanced Terminal Room Disinfection study):a cluster-randomized,multicenter,crossover study[J].Lancet,2017,389(10071):805-814.
[5]Weber DJ,Rutala WA,Miller MB,et al.Role of hospital surfaces in the transmission of emerging health care-associated pathogens:norovirus,Clostridium difficile,and Acinetobacter species[J].Am J Infect Control,2010,38(5):S25-S33.
[6]Otter JA,Yezli S,Salkeld JA,et al.Evidence that contaminated surfaces contribute to the transmission of hospital pathogens and an overview of strategies to address contaminated surfaces in hospital settings[J].Am J Infect Control,2013,41(5Suppl):S6-S11.
[7]陈炜,陈雪娥,金浩龙,等.重症监护病区物体表面细菌污染情况调查[J].中华医院感染学杂志,2016,26(24):5740-5741.
[8]Carling PC,Parry MF,Bruno-Murtha LA,et al.Improving environmental hygiene in 27intensive care units to decrease multidrug-resistant bacterial transmission[J].Crit Care Med,2010,38(4):1054-1059.
[9]Boyce JM,Havill NL,Havill HL,et al.Comparison of fluorescent marker systems with 2quantitative methods of assessing terminal cleaning practices[J].Infect Control Hosp Epidemiol,2011,32(12):1187-1193.
[10]Huang YS,Chen YC,Chen ML,et al.Comparing visual inspection,aerobic colony counts,and adenosine triphosphate bioluminescence assay for evaluating surface cleanliness at a medical center[J].Am J Infect Control,2015,43(8):882-886.
[11]Aftab HB,Zia B,Zahid MF,et al.Knowledge,attitude,and practices of healthcare personnel regarding the transmission of pathogens via fomites at a tertiary care hospital in Karachi,Pakistan[J].Open Forum Infect Dis,2015,3(1):ofv1208.
[12]Das I,Lambert P,Hill D,et al.Carbapenem-resistant Acinetobacter and role of curtains in an outbreak in intensive care units[J].J Hosp Infect,2002,50(2):110-114.
[13]Larocque M,Carver S,Bertrand A,et al.Acquisition of bacteria on health care workers"hands after contact with patient privacy curtains[J].Am J Infect Control,2016,44(11):1385-1386.
[14]Huslage K,Rutala WA,Sickbert-Bennett E,et al.A quantitative approach to defining"high-touch"surfaces in hospitals[J].Infect Control Hosp Epidemiol,2010,31(8):850-853.
[15]Shek K,Patidar R,Kohja Z,et al.Rate of contamination of hospital privacy curtains on a burns and plastic surgery ward:a cross-sectional study[J].J Hosp Infect,2017,96(1):54-58.
[16]Pittet D,Allegranzi B,Sax H,et al.Evidence-based model for hand transmission during patient care and the role of improved practices[J].Lancet Infect Dis,2006,6(10):641-652.
[17]陈萍,刘丁.中国近30年医院感染暴发事件的流行特征与对策[J].中国感染控制杂志,2010,9(6):387-392.
[18]Gastmeier P,Stamm-Balderjahn S,Hansen S,et al.How outbreaks can contribute to prevention of nosocomial infection:analysis of 1,022outbreaks[J].Infect Control Hosp Epidemiol,2005,26(4):357-361.
[19]Klakus J,Vaughan NL,Boswell TC.Meticillin-resistant Staphylococcus aureus contamination of hospital curtains[J].J Hosp infect,2008,68(2):180-190.
[20]Trillis F 3rd,Eckstein EC,Budavich R,et al.Contamination of hospital curtains with healthcare-associated pathogens[J].Infect Control Hosp Epidemiol,2008,29(11):1074-1076.
[21]Shek K,Patidar R,Kohja Z,et al.Rate of contamination of hospital privacy curtains in a burns/plastic ward:a longitudinal study[J].Am J Infect Control,2018,46(9)1019-1021.
[22]Ohl M,Schweizer M,Graham M,et al.Hospital privacy curtains are frequently and rapidly contaminated with potentially pathogenic bacteria[J].Am J Infect Control,2012,40(10):904-906.
[23]Catano JC,Echeverri LM,Szela C.Bacterial contamination of clothes and environmental items in a third-level hospital in Colombia[J].Interdiscip Perspect Infect Dis.2012,2012:207640.
[24]Woodland R,Whitham D,O'Neil B,et al.Microbiological contamination of cubicle curtains in an out-patient podiatry clinic[J].J Foot Ankle Res,2010,3:26.
[25]Woodard DR,Buttner M,Cruz P,et al.Microbial contamination of privacy curtains in the emergency department of a metropolitan hospital[J].J Hosp Infect,2018,100(3):e153-e154.
[26]周春妹,胡必杰,崔扬文,等.上海市部分医院病床隔帘病原菌污染的调查[J].中华医院感染学杂志,2015,25(11):2629-2631.
[27]金惠敏,王园娣,沈美华.病床隔帘细菌含量监测[J].中华医院感染学杂志,2010,20(6):862-862.
[28]Mahida N,Beal A,Trigg D,et al.Outbreak of invasive group A Streptococcus infection:contaminated patient curtains and cross-infection on an ear,nose and throat ward[J].J Hosp Infect,2014,87(3):141-144.
[29]张玉,侯铁英.医院感染暴发的特征及研究进展[J].中华医院感染学杂志,2014,24(21):5455-5457.
[30]王莎莎,刘运喜,秘玉清,等.中国近13年医院感染暴发事件流行特征分析[J].中华医院感染学杂志,2018,28(18):2786-2788.
[31]Dancer SJ.How do we assess hospital cleaning?A proposal for microbiological standards for surface hygiene in hospitals[J].J Hosp Infect,2004,56(1):10-15.
[32]中华人民共和国国家质量监督检验检疫总局,中国国家标准化管理委员会.GB 15982-2012医院消毒卫生标准[S].中华人民共和国国家质量监督检验检疫总局,中国国家标准化管理委员会,2012.
[33]Deangelis D L,Khakoo R.Hospital privacy curtains:cleaning and changing policies-are we doing enough?[J].Am J Infect Control,2013,41(6):S33.
[34]中华人民共和国国家卫生和计划生育委员会.WS/T510-2016病区医院感染管理规范[S].中华人民共和国国家卫生和计划生育委员会,2016.
[35]李六亿,贾会学.《病区医院感染管理规范》释义[J].中华医院感染学杂志,2017,27(15):3366-3369.
[36]董宏亮.病房中的隔帘多久洗一次?[DB/OL].https://mp.weixin.qq.com/s/kWcVAVy9Pvn2uiMt-3uOtQ,2018-12-3.
[37]中华人民共和国卫生部卫生法制与监督司.消毒技术规范[S].2002.
[38]湖北省质量监督技术局.可重复使用医用织物洗涤消毒技术规范DB42/T802-2012[S].2002.
[39]北京市质量监督技术局.医院布草洗涤卫生规范DB11/662-2009[S].2009.
[40]徐敏,熊薇,梁建生,等.湖北省8所医院洗衣房的管理现状及对策[J].医学与社会,2014,27(8):49-51.
[41]Sood G,Huber K,Dam L,et al.A pilot observational study of hydrogen peroxide and alcohol for disinfection of privacy curtains contaminated by MRSA,VRE and Clostridium difficile[J].J Infect Prev,2014,15(5):189-193.
[42]Schweizer M,Graham M,Ohl M,et al.Novel hospital curtains with antimicrobial properties:a randomized,controlled trial[J].Infect Control Hosp Epidemiol,2012,33(11):1081-1085.
[43]Pulliam JR.Lower infection rates after introduction of a photocatalytic surface coating[J].Am J Infect Control,2015,43(2):180-181.
[44]Kotsanas D,Gillespie E.Disposable antimicrobial and sporicidal privacy curtains:cost benefit of hanging longer[J].Am JInfect Control,2016,44:854-855.
[45]董全芳.纳米TiO2病床隔帘与普通涤纶病床隔帘病原菌污染的对比分析[J].家庭医药,2018,(4):125-126.
[46]凌小瑞,李文辽,施亦东,等.掺杂纳TiO2棉织物的自清洁性能[J].印染,2013,39(9):9-11.
[47]郭晓玲,张彤,曹陈华,等.负载掺杂纳米TiO2耐久抗菌织物的制备与表征[J].纺织学报,2017,38(6):163-168.
[48]杨梓薇,周顺利,王锐,等.纳米二氧化钛负载棉织物的制备及性能[J].高等学校化学学报,2017,38(10):1880-1887.
[49]Winter G.Curtains hide risks to health and hygiene[J].Nurs Stand,2014,28(46):27.
[50]Rinck G.Comparison of antimicrobial and standard privacy curtains:efficacy and cost analysis[J].Am J Infect Control,2010,38(5):e14.
[2]Rhinehart E,Walker S,Murphy D,et al.Frequency of outbreak investigations in US hospitals:results of a national survey of infection preventionists[J].Am J Infect Control,2012,40(1):2-8.
[3]Ali H,Nash JQ,Kearns AM,et al.Outbreak of a South West Pacific clone Pantone-Valentine leucocidin-positive meticillin-resistant Staphylococcus aureus infection[J].JHosp Infect,2012,80(4):293-298.
[4]Anderson DJ,Chen LF,Weber DJ,et al.Enhanced terminal room disinfection and acquisition and infection caused by multidrug-resistant organisms and Clostridium difficile(the Benefits of Enhanced Terminal Room Disinfection study):a cluster-randomized,multicenter,crossover study[J].Lancet,2017,389(10071):805-814.
[5]Weber DJ,Rutala WA,Miller MB,et al.Role of hospital surfaces in the transmission of emerging health care-associated pathogens:norovirus,Clostridium difficile,and Acinetobacter species[J].Am J Infect Control,2010,38(5):S25-S33.
[6]Otter JA,Yezli S,Salkeld JA,et al.Evidence that contaminated surfaces contribute to the transmission of hospital pathogens and an overview of strategies to address contaminated surfaces in hospital settings[J].Am J Infect Control,2013,41(5Suppl):S6-S11.
[7]陈炜,陈雪娥,金浩龙,等.重症监护病区物体表面细菌污染情况调查[J].中华医院感染学杂志,2016,26(24):5740-5741.
[8]Carling PC,Parry MF,Bruno-Murtha LA,et al.Improving environmental hygiene in 27intensive care units to decrease multidrug-resistant bacterial transmission[J].Crit Care Med,2010,38(4):1054-1059.
[9]Boyce JM,Havill NL,Havill HL,et al.Comparison of fluorescent marker systems with 2quantitative methods of assessing terminal cleaning practices[J].Infect Control Hosp Epidemiol,2011,32(12):1187-1193.
[10]Huang YS,Chen YC,Chen ML,et al.Comparing visual inspection,aerobic colony counts,and adenosine triphosphate bioluminescence assay for evaluating surface cleanliness at a medical center[J].Am J Infect Control,2015,43(8):882-886.
[11]Aftab HB,Zia B,Zahid MF,et al.Knowledge,attitude,and practices of healthcare personnel regarding the transmission of pathogens via fomites at a tertiary care hospital in Karachi,Pakistan[J].Open Forum Infect Dis,2015,3(1):ofv1208.
[12]Das I,Lambert P,Hill D,et al.Carbapenem-resistant Acinetobacter and role of curtains in an outbreak in intensive care units[J].J Hosp Infect,2002,50(2):110-114.
[13]Larocque M,Carver S,Bertrand A,et al.Acquisition of bacteria on health care workers"hands after contact with patient privacy curtains[J].Am J Infect Control,2016,44(11):1385-1386.
[14]Huslage K,Rutala WA,Sickbert-Bennett E,et al.A quantitative approach to defining"high-touch"surfaces in hospitals[J].Infect Control Hosp Epidemiol,2010,31(8):850-853.
[15]Shek K,Patidar R,Kohja Z,et al.Rate of contamination of hospital privacy curtains on a burns and plastic surgery ward:a cross-sectional study[J].J Hosp Infect,2017,96(1):54-58.
[16]Pittet D,Allegranzi B,Sax H,et al.Evidence-based model for hand transmission during patient care and the role of improved practices[J].Lancet Infect Dis,2006,6(10):641-652.
[17]陈萍,刘丁.中国近30年医院感染暴发事件的流行特征与对策[J].中国感染控制杂志,2010,9(6):387-392.
[18]Gastmeier P,Stamm-Balderjahn S,Hansen S,et al.How outbreaks can contribute to prevention of nosocomial infection:analysis of 1,022outbreaks[J].Infect Control Hosp Epidemiol,2005,26(4):357-361.
[19]Klakus J,Vaughan NL,Boswell TC.Meticillin-resistant Staphylococcus aureus contamination of hospital curtains[J].J Hosp infect,2008,68(2):180-190.
[20]Trillis F 3rd,Eckstein EC,Budavich R,et al.Contamination of hospital curtains with healthcare-associated pathogens[J].Infect Control Hosp Epidemiol,2008,29(11):1074-1076.
[21]Shek K,Patidar R,Kohja Z,et al.Rate of contamination of hospital privacy curtains in a burns/plastic ward:a longitudinal study[J].Am J Infect Control,2018,46(9)1019-1021.
[22]Ohl M,Schweizer M,Graham M,et al.Hospital privacy curtains are frequently and rapidly contaminated with potentially pathogenic bacteria[J].Am J Infect Control,2012,40(10):904-906.
[23]Catano JC,Echeverri LM,Szela C.Bacterial contamination of clothes and environmental items in a third-level hospital in Colombia[J].Interdiscip Perspect Infect Dis.2012,2012:207640.
[24]Woodland R,Whitham D,O'Neil B,et al.Microbiological contamination of cubicle curtains in an out-patient podiatry clinic[J].J Foot Ankle Res,2010,3:26.
[25]Woodard DR,Buttner M,Cruz P,et al.Microbial contamination of privacy curtains in the emergency department of a metropolitan hospital[J].J Hosp Infect,2018,100(3):e153-e154.
[26]周春妹,胡必杰,崔扬文,等.上海市部分医院病床隔帘病原菌污染的调查[J].中华医院感染学杂志,2015,25(11):2629-2631.
[27]金惠敏,王园娣,沈美华.病床隔帘细菌含量监测[J].中华医院感染学杂志,2010,20(6):862-862.
[28]Mahida N,Beal A,Trigg D,et al.Outbreak of invasive group A Streptococcus infection:contaminated patient curtains and cross-infection on an ear,nose and throat ward[J].J Hosp Infect,2014,87(3):141-144.
[29]张玉,侯铁英.医院感染暴发的特征及研究进展[J].中华医院感染学杂志,2014,24(21):5455-5457.
[30]王莎莎,刘运喜,秘玉清,等.中国近13年医院感染暴发事件流行特征分析[J].中华医院感染学杂志,2018,28(18):2786-2788.
[31]Dancer SJ.How do we assess hospital cleaning?A proposal for microbiological standards for surface hygiene in hospitals[J].J Hosp Infect,2004,56(1):10-15.
[32]中华人民共和国国家质量监督检验检疫总局,中国国家标准化管理委员会.GB 15982-2012医院消毒卫生标准[S].中华人民共和国国家质量监督检验检疫总局,中国国家标准化管理委员会,2012.
[33]Deangelis D L,Khakoo R.Hospital privacy curtains:cleaning and changing policies-are we doing enough?[J].Am J Infect Control,2013,41(6):S33.
[34]中华人民共和国国家卫生和计划生育委员会.WS/T510-2016病区医院感染管理规范[S].中华人民共和国国家卫生和计划生育委员会,2016.
[35]李六亿,贾会学.《病区医院感染管理规范》释义[J].中华医院感染学杂志,2017,27(15):3366-3369.
[36]董宏亮.病房中的隔帘多久洗一次?[DB/OL].https://mp.weixin.qq.com/s/kWcVAVy9Pvn2uiMt-3uOtQ,2018-12-3.
[37]中华人民共和国卫生部卫生法制与监督司.消毒技术规范[S].2002.
[38]湖北省质量监督技术局.可重复使用医用织物洗涤消毒技术规范DB42/T802-2012[S].2002.
[39]北京市质量监督技术局.医院布草洗涤卫生规范DB11/662-2009[S].2009.
[40]徐敏,熊薇,梁建生,等.湖北省8所医院洗衣房的管理现状及对策[J].医学与社会,2014,27(8):49-51.
[41]Sood G,Huber K,Dam L,et al.A pilot observational study of hydrogen peroxide and alcohol for disinfection of privacy curtains contaminated by MRSA,VRE and Clostridium difficile[J].J Infect Prev,2014,15(5):189-193.
[42]Schweizer M,Graham M,Ohl M,et al.Novel hospital curtains with antimicrobial properties:a randomized,controlled trial[J].Infect Control Hosp Epidemiol,2012,33(11):1081-1085.
[43]Pulliam JR.Lower infection rates after introduction of a photocatalytic surface coating[J].Am J Infect Control,2015,43(2):180-181.
[44]Kotsanas D,Gillespie E.Disposable antimicrobial and sporicidal privacy curtains:cost benefit of hanging longer[J].Am JInfect Control,2016,44:854-855.
[45]董全芳.纳米TiO2病床隔帘与普通涤纶病床隔帘病原菌污染的对比分析[J].家庭医药,2018,(4):125-126.
[46]凌小瑞,李文辽,施亦东,等.掺杂纳TiO2棉织物的自清洁性能[J].印染,2013,39(9):9-11.
[47]郭晓玲,张彤,曹陈华,等.负载掺杂纳米TiO2耐久抗菌织物的制备与表征[J].纺织学报,2017,38(6):163-168.
[48]杨梓薇,周顺利,王锐,等.纳米二氧化钛负载棉织物的制备及性能[J].高等学校化学学报,2017,38(10):1880-1887.
[49]Winter G.Curtains hide risks to health and hygiene[J].Nurs Stand,2014,28(46):27.
[50]Rinck G.Comparison of antimicrobial and standard privacy curtains:efficacy and cost analysis[J].Am J Infect Control,2010,38(5):e14.