医院消毒供应中心系列器械清洗装载架的研制及应用
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摘要
研究背景
医疗器械清洗是医院消毒供应中心工作内容的重要组成部分,医疗器械的清洗是消毒、灭菌的基础,是预防院内感染发生的关键环节。如医疗器械清洗不彻底,残留的有机物在微生物表面形成保护膜,可导致消毒、灭菌方法的失败,可引起院内感染暴发。因此,对医疗器械清洗质量的管理,越来越受到人们的重视,一些先进的清洗设备被广泛利用,辅助清洗用具也应运而生,如辅助清洗用具被合理应用,能使清洗设备发挥更好的效能。目前我院的清洗消毒设备为一套半自动清洗机,厂家所提供的辅助清洗用具为U型架和清洗筐,医疗器械中90%以上为轴节类器械,由于U型架规格单一,只适用于少量轴节类器械上架清洗,大部分不适合上架的器械摆放于清洗筐中,极易造成器械磨擦、碰撞,导致器械损伤,刀刃变钝；打开轴节的器械会重新关闭,致使清洗不彻底；对清洗不干净器械再次进行清洗,浪费人力、物力和时间。镊子是属于非轴节类器械的一种,传统方法把镊子平铺放于清洗筐内,由于镊子没有被有效固定好,清洗过程中会出现镊子叠加在一起,造成镊子清洗不彻底,干燥效果欠佳等问题。氧气吸入疗法是临床上常用的护理技术操作之一,现代医院感染学资料表明,呼吸道感染比例占医院感染的首位,氧气湿化瓶污染与下呼吸首感染有着密切的联系。传统方法在氧气湿化瓶清洗、干燥过程中存在工作效率低,耗费人力；干燥效果欠佳,水珠残留,易致细菌生长；氧气湿化瓶内壁存在隐性污染等问题,针对上述存在问题,我们研制了系列器械清洗装载架,以提高工作效率,减少器械损耗,减少对工作人员职业伤害,节约人力,节约能源,提高器械清洗质量,以达到消毒、灭菌前的要求。
研究目的和意义
1、研制“一种医疗器械清洗架”、“一种镊子清洗装载架”、“一种氧气湿化瓶及内芯装载架”,探讨其在相关医疗器械清洗中的优势及价值。
2、通过系列器械清洗装载架的研制,促进消毒供应中心清洗质量的提高,预防院内感染的发生。
方法
1.“一种医疗器械清洗架”的设计及效果评价。
该医疗器械清洗架是用5mm不锈钢圆支制成,由支柱、环钩、架背、底座4个部件构成。
效果评价：将回收的1222件轴节类器械先按照器械来源,再按类型随机分为实验组和对照组,实验组器械615件,对照组器械607件。由固定的1名工作人员进行操作。实验组：应用自制的医疗器械清洗架,对照组：使用厂家提供的U型架和清洗筐,将适用于U型架的器械固定于U型架上,将不适用于U型架的器械直接放于清洗筐内。两组采取相同的清洗方法(1)冲洗：将回收器械用流动自来水冲洗,并用毛刷刷洗轴节及缝隙数次,用流动水进行冲洗。(2)洗涤、漂洗：实验组将医疗器械清洗架连同器械依次放于半自动清洗机各清洗槽中；对照组将清洗筐连同U型架和器械依次放于半自动清洗机各清洗槽,两组均进行以下清洗程序,预浸泡→超声清洗→漂洗→高温槽消毒→上润滑油→干燥槽烘干。对两组器械清洗效果及清洗合格所需时间进行比较。
2.“一种镊子清洗装载架”的设计及效果评价。
该镊子清洗装载架用3mm不锈钢圆支制外框,用1.5mm不锈钢圆相互纵横交错形成一层镊子托架,镊子托架包含多个直接搁置镊子的方格框。
效果评价：将回收的2000个镊子随机分为实验组和对照组,实验组1000个,对照组1000个,由固定的1名工作人员进行操作,实验组应用自制镊子清洗装载架装载镊子；对照组应用清洗筐采用平铺法装载镊子。两组采用相同的清洗方法(详见医疗器械清洗架清洗方法)。对两组装载镊子的时间及镊子清洗效果进行比较。
3.“一种氧气湿化瓶及内芯装载架”的设计及效果评价。
该氧气湿化瓶及内芯装载架是用4mm不锈钢圆支构成矩形上托架、矩形下托架,在上托架和下托架边侧设有以4mm不锈钢圆支构成的内芯托架。
效果评价：将回收的1200套氧气湿化瓶及内芯经含氯消毒液浸泡后随机分为实验组和对照组,实验组600套,对照组600套,由固定的1名工作人员进行操作,载器组用氧气湿化瓶及内芯装载架进行终末漂洗装载送鼓风干燥箱内进行干燥,对照组用传统方法装载进行干燥。对两组终末漂洗装载过程所需时间、干燥效果、氧气湿化瓶及内芯侧翻情况进行比较。
数据分析采用Excel 2003中文版、SPSS13.0统计软件进行统计处理。
结果
1.一种医疗器械清洗架。
轴节类器械在相同的预处理后,用医疗器械清洗架装载清洗效果明显优于用U型架和清洗筐装载清洗效果。实验组的合格率为97.88%,显著高于对照组85.33%(x2=62.8778,p=0.000),说明实验组的清洗效果更好。提高工作效率,器械清洗合格所需时间,实验组比对照组节省160分钟,优点如下。
1.1提高了清洗质量。使用本清洗架时,器械的轴节、咬合口被充分打开并固定,由于没有了清洗框铁丝的障碍,可以促进超声波的传递,有利于多酶或碱性清洗液充分接触器械各部位,彻底分解器械上的有机物；同时能彻底冲洗清洗液,避免清洗液残留,有效提高了清洗质量。
1.2减少了器械损耗。将器械放置于清洗架后,可避免器械在冲洗槽的摆动脱出；在同一清洗架上,锋利的器械与其它器械分类放置,减少了器械松脱、缺损、刀锋变钝等情况,减少了器械损耗,延长了器械的使用寿命。
1.3减少职业损伤。工作人员在取放器械时不需用手扶持清洗架,可双手进行上架操作,避免被锐利器械损伤的危险。同时由于锐利器械如剪刀的刀尖、刀刃摆放方向一致,在取出器械时,工作人员只需手持器械的轴节部位,就可同时将多个器械取出减少职业损伤。
1.4适用范围广泛。医疗器械清洗架的支柱间距依据常用器械大小设计,同时兼顾特殊器械的规格设置,器械可放于相邻的两条支柱上,或放于相隔一条或两条支柱的支柱上,适用于多种规格的器械。
1.5提高工作效率。本医疗器械清洗架,器械有序摆放,清洗完毕后易于快速进行质量检查核对数量,同时能够批量取出器械,安全高效。
2.一种镊子清洗装载架。
实验组与对照组的装载镊子时间差异不显著(t=0.195,P=0.846),两组在装载镊子时间上没有差别。实验组的合格率96.3%显著高于对照组的合格率87.9%(x2=48.489,P=0.000),说明实验组清洗效果更好,优点如下。
2.1提高清洗质量。镊子垂直插于清洗装载架上,镊子被充分暴露,没有被遮挡,清洗剂能接触到镊子的各个部位,有效提高清洗质量。
2.2提高干燥效果。镊子垂直放置,清洗剂由高向低流动,避免清洗剂的残留,提高干燥效果。2.3装载数量多。与平铺法相比,装载数量较多,每个镊子只占用两个相邻方格框,一个镊子装载架可装载约150个镊子,比平铺法装载量约增加100个,比重叠法装载量约增加50个。
3.一种氧气湿化瓶及内芯装载架
终末漂洗、装载氧气湿化瓶及内芯时间比较,载器组所需时间显著少于对照组(t=-18.557,P=0.000)；载器械组的干燥率94.7%显著高于对照组的干燥率82.8%(x2=42.074,P=0.000),说明载器组干燥效果更好。载器组的侧翻率0%显著低于对照组的侧翻率16%(x2=104.348,P=0.000),说明载器组的侧翻率较低,效果如下。
3.1固定及干燥效果好,干燥过程持续有效、稳定。氧气湿化瓶倒置于上下托架上,固定效果良好。由于重力的作用有利于氧气湿化瓶壁上残留水滴往下流,氧气湿化瓶开口向下,提高干燥速度。氧气湿化瓶固定于托架3上,能避免氧气湿化瓶侧翻,内芯倒放于装载架的内芯托架4上,干燥效果良好。
3.2提高工作效率。使用装载架后,装载架连同固定于氧气湿化瓶托架上的氧气湿化瓶及固定于内芯托架上的内芯直接放入干燥箱内进行干燥,干燥结束后将装载架直接取出,大大提高了工作效率
3.3装载量多,工作流程整体性好。装载架每次能摆放30套氧气湿化瓶(含内芯),装载数量较多,由于内芯细小容易丢失,而装载架既能装载氧气湿化瓶,又能装载内芯,能有效避免内芯的丢失,整体操作性好。
结论
“一种医疗器械清洗架”具有提高清洗质量；减少器械损耗；减少职业伤害；适用范围广；工作效率高的优点。“一种镊子清洗装载架”具有提高清洗质量；提高干燥效果；装载数量多的优势。“一种氧气湿化瓶及内芯装载架”具有固定及干燥效果好,干燥过程持续有效、稳定；提高工作效率；装载量多,工作流程整体性好的。本文研制3种器械清洗装载架,与传统方法相比,在清洗质量、干燥效果、工作效率方面有一定优势,具有推广应用价值,是医院消毒供应中心理想的辅助清洗用具。
BACKGROUND
The clean of medical equipment is an important part of the work in a disinfection and supply center, is also a key link before sterilization of medical instruments, which is related to the safety of medical treatment. Currently the disinfection equipment in my hospital is a semi-automatic washing machine, and the auxiliary cleaning equipments are the U-shape frames and cleaning baskets provided by manufacturers, more than 90% medical devices are axis section instruments, due to a single U-frame size, which is only fit for a few of axis section instruments, most of them are not suitable for display but in the washing basket which is very likely to make friction and collision between the instruments, resulting in instrument damage, blunt blade; open shaft section of the instrument will be re-closed, which will result in an not complete clean; Repeated clean would waste manpower, resource and time. Forceps are non-axial section instruments, which clean in traditional way need to be tiled or overlapped in basket. But in this way forceps have not been fixed effectively, the forceps would be overlapped each other which effected the progress of clean and the evaporation. Oxygen inhalation therapy is one of commonly used in clinical nursing skills. The data of modern hospital infection showed that the infection of respiratory was in the first place of the infections during hospital, respiratory infections are closely related to the pollution of oxygen humidifier bottles. In traditional way, the process of clean and evaporate the oxygen bottles has a series of problems, such as low-efficient and labor-intensive; dry not enough to inhibit the grow of bacterium; polluted recessively by oxygen wet bottle wall. To solve these problems, new cleaning equipment shelves were research to improve cleaning quality, ensure the quality of disinfection, reduce the loss of equipment, decrease occupational injuries to staff and improve efficiency.
Research Purpose
1. Develop "a kind of cleaning shelf for medical instruments", "a kind of loading shelf for forceps cleaning", "a kind of loading shelf for oxygen humidifier bottles and inner cores", and discuss their advantages and values in the cleaning process of relative medical instruments.
2. Development on series of loading shelves for instruments cleaning can improve the cleaning quality of disinfection and supply center, ensure the quality of disinfection and sterilization products, and avoid the inflection incurrence of the hospital.
Methods:
1. Evaluation for the design and effectiveness of "a kind of cleaning shelf for medical instruments".
The round support, made of 5mm stainless steel, is composed of support, ring hook, frame back and base.
Effectiveness evaluation:1222 pieces of cardo instruments can be randomly divided into experimental group and control group by instruments resource and then by the type, and there shall be 615pieces of instruments in experimental group and 607 pieces of instruments in control group. In experimental group, it is operated by one fixed operator, and the self-made shelf for medical instruments cleaning shall be used. In control group, the type U fixture and cleaning basket provided by the manufacturer shall be used, and the applicable instruments shall be fixed on the type U fixture, while the inapplicable instruments shall be directly put into the cleaning basket. The same cleaning methods shall be used for the two groups. (1) Flushing:the recycled instruments shall be washed by flowing water, brushed its cardo and slits for times by the hairbrush, and then washed by flowing water. (2) Cleaning and rinsing: the experimental group shall put the shelf for medical instruments cleaning and the instrument into each rinse tank of the semi-automatic cleaner; while the control group shall put the cleaning basket with type U fixture and the instruments into each rinse tank of the semi-automatic cleaner, and then the two groups shall start cleaning in accordance with the following procedures:presoaking for the ultrasonic cleaning→rinsing→disinfection for high temperature groove→soaking for lubrication oil→drying for the drying tank. The cleaning effectiveness and cleaning time of the two groups of instrument shall be compared.
2. Evaluation for the design and effectiveness of "a kind of shelf for forceps cleaning"
The frame is designed by 3mm stainless steel round support, and the forceps bracket including several grid quadrangles for laying up the forceps, is formed by 1.05 mm crisscrossing stainless round steels.
Effectiveness evaluation:the 2000 recycled forceps shall be randomly divided into experimental group and control group, and there shall be 1000 forceps in each group, operated by one fixed personnel. The experimental group shall load the forceps by self-made load shelf for forceps cleaning; while the control group shall load the forceps by tile mode. The same cleaning methods shall be used for the two groups (Details, please see cleaning methods for the cleaning shelves of medical instruments). Make comparisons for the time for loading forceps and the effectiveness of the forceps cleaning.
3. Evaluation for the design and effectiveness of "a kind of loading shelf for oxygen humidifier bottles and inner cores"
The rectangular upper and lower brackets are constructed by 4mm stainless steel round support, and the inner core bracket constructed by 4mm stainless steel round support, is designed at the side of the upper and lower brackets
Effectiveness evaluation:the 1200 recycled oxygen humidifier bottles and the inner cores socked in chlorine disinfect solution shall be randomly divided into loading group and control group, and there shall be 600 sets in each group, operated by one fixed personnel. The loading group shall make the end rinsing by oxygen humidifier bottles and loading shelves of the inner cores, and then drying in air dry oven. Make comparisons for the time for end rinsing and loading, drying effectiveness and the rollover of oxygen humidifier bottles and inner cores in the two groups.
The statistical process for data analysis shall use Excel 2003 Chinese version and statistical software SPSS13.0.
Results
1. A kind of cleaning shelves for medical instruments
After the same pre-processing of the cardo instruments, the cleaning effectiveness of the loading shelves for medical instruments cleaning is obviously better than the effectiveness of type U fixture and cleaning basket. The acceptability of the experimental group is 97.88%, obviously higher than 85.33% of the control group (x2=62.8778, p=0.000), and it shows that the cleaning effectiveness of the experimental group is much better. For improving work efficiency and cleaning time of the instruments, the experimental group has saved 160 minutes comparing to the control group. The advantages are as following:
1.1 Improvement for cleaning quality. While using the cleaning shelf, the instrument cardo and joints are completely opened and fixed. Without the prevention of the iron wire in the cleaning basket, the transmission of the ultrasonic wave can be promoted, and the multienzyme or alkaline washing liquid can contact with each parts of the instrument to completely decompose the organics; at the same time, the washing liquid can be completely washed to avoid residue of the washing liquid and improve the cleaning quality.
1.2 Having reduced instruments wear. Locating the instrument behind the cleaning shelf can avoid swing and pulling the instrument away the washing tank; at the same cleaning shelf, the sharp instruments and other instruments shall be located separately to avoid the instruments release, damages and loss, and blunting of the edge, instruments wear and extend the use life of the instruments.
1.3 Reducing occupational injury. The operator need not support the cleaning shelf by hands while picking and placing the instruments and can carry out shelving to reduce the risk of injury by sharp instruments. At the same time, because the sharp instruments, such as the points of scissors and knife edge, are placed with same direction, when picking the instruments, the operator can just support the cardo parts of the instruments and pick several instruments at one time to reduce the occupational injury.
1.4 Wide application scope. The support spacing of the shelf for medical instruments cleaning is designed in accordance with the size of normal instruments, taking account of the specifications of the specific instruments. The instruments can be placed adjacent two supports or each one or two supports, with application to instruments with various specifications.
1.5 Improvement for work efficiency. The instruments can be placed in order on the shelves for medical instruments cleaning, and it is easy to check the quality and quantity after cleaning and pick instruments by lot at one time with safety and high efficiency.
2. A kind of loading shelf for forceps cleaning
The difference of the loading time for experimental group and control group is not obvious (t=0.195, P=0.846), so there is no time difference between the two groups. The dryness factor 96.3% of experimental group is higher than the dryness factor 87.9%(x2=48.489, P=0.000) of experimental group, and it shows that the drying effectiveness of experimental group is much better. The advantages are as following:
2.1 Improvement for cleaning quality. The forceps are inserted vertically in the loading shelf for cleaning, with complete exposure of the forceps and without any shelter, in order that the cleaning agent can contact each part of the forceps to improve cleaning quality efficiently.
2.2 Improvement for drying effectiveness. As the forceps are placed vertically, the cleaning agent can flow from high to low to avoid the residue of the cleaning agent to improve drying effectiveness.
2.3 With much loading quantity. Comparing to the tile mode, the loading quantity is much more, and every forceps only occupies the two adjacent grid quadrangles. A forceps loading shelf can load about150 forceps, more 100 than the tile mode, and more 50 than overlap method.
3. A kind of loading shelf for oxygen humidifier bottles and inner cores
Comparing to the time for end rinsing, loading oxygen humidifier bottles and inner cores, time for the loading group is obviously less than the control group (t =-18.557, P=0.000); the dryness factor of the loading group is obviously higher than the dryness factor 82.8%(x2=42.074, P=0.000)of the control group, and it shows that the drying effectiveness of the loading group is much better. The rollover factor 0% of the loading group is obviously lower than the rollover factor 16%(x2= 104.348, P=0.000) of the control group, it shows that the rollover factor of the loading group is much lower. The effectiveness is as following:
3.1 Good fixing and drying effectiveness, and effective and stable drying process. The oxygen humidifier bottles are inverted on the upper and lower brackets and the fixed effect is good. As the action of the gravity is benefit for the flowing of the residue water on the wall of oxygen humidifier bottles and the openings f the bottles are downward, the drying speed can be improved. The oxygen humidifier bottles are fixed on the bracket 3, which can avoid the rollover of the oxygen humidifier bottles, and the inner cores are placed on the inner core bracket 4, which can keep good drying effectiveness.
3.2 Improvement for work efficiency. After using the loading shelves, the loading shelves, oxygen humidifier bottles on the brackets and the inner cores fixed on the inner core brackets shall be put into the drying oven for drying, and after the drying, the shelves can be picked out directly, which has greatly improved work efficiency.
3.3 With much loading quantity and good integrity for workflow. The loading shelf can only accommodate 30 oxygen humidifier bottles (including inner cores) each time. The loading quantity is much more, as the inner cores are tiny and can be lost easily, while the loading shelf can not only load the oxygen humidifier bottles, but also load the inner cores, which can avoid the loss of inner cores to keep good operation property.
Conclusion
"A kind of shelf for medical instruments cleaning" has the advantages of improving cleaning quality, decreasing the instruments damages, reducing the occupational injuries, wide application scope and high work efficiency. "A kind of loading shelf for forceps cleaning" has the advantages of improving cleaning quality and drying effectiveness, with great loading quantity. "A kind of loading shelf for oxygen humidifier bottles and inner cores has the advantages of good fixing and drying effectiveness, continuously effective and stable drying process, improving work efficiency, great loading quantity and good integrity for workflow. The three kinds of loading shelves for instruments cleaning researched in this paper, comparing to the traditional ways, have some specific advantages in cleaning quality, drying effectiveness and work efficiency, which are worthy to be popularized and utilized, and they are the ideal assistant cleaning tools for disinfection and supply center in hospital.
医疗器械清洗是医院消毒供应中心工作内容的重要组成部分,医疗器械的清洗是消毒、灭菌的基础,是预防院内感染发生的关键环节。如医疗器械清洗不彻底,残留的有机物在微生物表面形成保护膜,可导致消毒、灭菌方法的失败,可引起院内感染暴发。因此,对医疗器械清洗质量的管理,越来越受到人们的重视,一些先进的清洗设备被广泛利用,辅助清洗用具也应运而生,如辅助清洗用具被合理应用,能使清洗设备发挥更好的效能。目前我院的清洗消毒设备为一套半自动清洗机,厂家所提供的辅助清洗用具为U型架和清洗筐,医疗器械中90%以上为轴节类器械,由于U型架规格单一,只适用于少量轴节类器械上架清洗,大部分不适合上架的器械摆放于清洗筐中,极易造成器械磨擦、碰撞,导致器械损伤,刀刃变钝；打开轴节的器械会重新关闭,致使清洗不彻底；对清洗不干净器械再次进行清洗,浪费人力、物力和时间。镊子是属于非轴节类器械的一种,传统方法把镊子平铺放于清洗筐内,由于镊子没有被有效固定好,清洗过程中会出现镊子叠加在一起,造成镊子清洗不彻底,干燥效果欠佳等问题。氧气吸入疗法是临床上常用的护理技术操作之一,现代医院感染学资料表明,呼吸道感染比例占医院感染的首位,氧气湿化瓶污染与下呼吸首感染有着密切的联系。传统方法在氧气湿化瓶清洗、干燥过程中存在工作效率低,耗费人力；干燥效果欠佳,水珠残留,易致细菌生长；氧气湿化瓶内壁存在隐性污染等问题,针对上述存在问题,我们研制了系列器械清洗装载架,以提高工作效率,减少器械损耗,减少对工作人员职业伤害,节约人力,节约能源,提高器械清洗质量,以达到消毒、灭菌前的要求。
研究目的和意义
1、研制“一种医疗器械清洗架”、“一种镊子清洗装载架”、“一种氧气湿化瓶及内芯装载架”,探讨其在相关医疗器械清洗中的优势及价值。
2、通过系列器械清洗装载架的研制,促进消毒供应中心清洗质量的提高,预防院内感染的发生。
方法
1.“一种医疗器械清洗架”的设计及效果评价。
该医疗器械清洗架是用5mm不锈钢圆支制成,由支柱、环钩、架背、底座4个部件构成。
效果评价：将回收的1222件轴节类器械先按照器械来源,再按类型随机分为实验组和对照组,实验组器械615件,对照组器械607件。由固定的1名工作人员进行操作。实验组：应用自制的医疗器械清洗架,对照组：使用厂家提供的U型架和清洗筐,将适用于U型架的器械固定于U型架上,将不适用于U型架的器械直接放于清洗筐内。两组采取相同的清洗方法(1)冲洗：将回收器械用流动自来水冲洗,并用毛刷刷洗轴节及缝隙数次,用流动水进行冲洗。(2)洗涤、漂洗：实验组将医疗器械清洗架连同器械依次放于半自动清洗机各清洗槽中；对照组将清洗筐连同U型架和器械依次放于半自动清洗机各清洗槽,两组均进行以下清洗程序,预浸泡→超声清洗→漂洗→高温槽消毒→上润滑油→干燥槽烘干。对两组器械清洗效果及清洗合格所需时间进行比较。
2.“一种镊子清洗装载架”的设计及效果评价。
该镊子清洗装载架用3mm不锈钢圆支制外框,用1.5mm不锈钢圆相互纵横交错形成一层镊子托架,镊子托架包含多个直接搁置镊子的方格框。
效果评价：将回收的2000个镊子随机分为实验组和对照组,实验组1000个,对照组1000个,由固定的1名工作人员进行操作,实验组应用自制镊子清洗装载架装载镊子；对照组应用清洗筐采用平铺法装载镊子。两组采用相同的清洗方法(详见医疗器械清洗架清洗方法)。对两组装载镊子的时间及镊子清洗效果进行比较。
3.“一种氧气湿化瓶及内芯装载架”的设计及效果评价。
该氧气湿化瓶及内芯装载架是用4mm不锈钢圆支构成矩形上托架、矩形下托架,在上托架和下托架边侧设有以4mm不锈钢圆支构成的内芯托架。
效果评价：将回收的1200套氧气湿化瓶及内芯经含氯消毒液浸泡后随机分为实验组和对照组,实验组600套,对照组600套,由固定的1名工作人员进行操作,载器组用氧气湿化瓶及内芯装载架进行终末漂洗装载送鼓风干燥箱内进行干燥,对照组用传统方法装载进行干燥。对两组终末漂洗装载过程所需时间、干燥效果、氧气湿化瓶及内芯侧翻情况进行比较。
数据分析采用Excel 2003中文版、SPSS13.0统计软件进行统计处理。
结果
1.一种医疗器械清洗架。
轴节类器械在相同的预处理后,用医疗器械清洗架装载清洗效果明显优于用U型架和清洗筐装载清洗效果。实验组的合格率为97.88%,显著高于对照组85.33%(x2=62.8778,p=0.000),说明实验组的清洗效果更好。提高工作效率,器械清洗合格所需时间,实验组比对照组节省160分钟,优点如下。
1.1提高了清洗质量。使用本清洗架时,器械的轴节、咬合口被充分打开并固定,由于没有了清洗框铁丝的障碍,可以促进超声波的传递,有利于多酶或碱性清洗液充分接触器械各部位,彻底分解器械上的有机物；同时能彻底冲洗清洗液,避免清洗液残留,有效提高了清洗质量。
1.2减少了器械损耗。将器械放置于清洗架后,可避免器械在冲洗槽的摆动脱出；在同一清洗架上,锋利的器械与其它器械分类放置,减少了器械松脱、缺损、刀锋变钝等情况,减少了器械损耗,延长了器械的使用寿命。
1.3减少职业损伤。工作人员在取放器械时不需用手扶持清洗架,可双手进行上架操作,避免被锐利器械损伤的危险。同时由于锐利器械如剪刀的刀尖、刀刃摆放方向一致,在取出器械时,工作人员只需手持器械的轴节部位,就可同时将多个器械取出减少职业损伤。
1.4适用范围广泛。医疗器械清洗架的支柱间距依据常用器械大小设计,同时兼顾特殊器械的规格设置,器械可放于相邻的两条支柱上,或放于相隔一条或两条支柱的支柱上,适用于多种规格的器械。
1.5提高工作效率。本医疗器械清洗架,器械有序摆放,清洗完毕后易于快速进行质量检查核对数量,同时能够批量取出器械,安全高效。
2.一种镊子清洗装载架。
实验组与对照组的装载镊子时间差异不显著(t=0.195,P=0.846),两组在装载镊子时间上没有差别。实验组的合格率96.3%显著高于对照组的合格率87.9%(x2=48.489,P=0.000),说明实验组清洗效果更好,优点如下。
2.1提高清洗质量。镊子垂直插于清洗装载架上,镊子被充分暴露,没有被遮挡,清洗剂能接触到镊子的各个部位,有效提高清洗质量。
2.2提高干燥效果。镊子垂直放置,清洗剂由高向低流动,避免清洗剂的残留,提高干燥效果。2.3装载数量多。与平铺法相比,装载数量较多,每个镊子只占用两个相邻方格框,一个镊子装载架可装载约150个镊子,比平铺法装载量约增加100个,比重叠法装载量约增加50个。
3.一种氧气湿化瓶及内芯装载架
终末漂洗、装载氧气湿化瓶及内芯时间比较,载器组所需时间显著少于对照组(t=-18.557,P=0.000)；载器械组的干燥率94.7%显著高于对照组的干燥率82.8%(x2=42.074,P=0.000),说明载器组干燥效果更好。载器组的侧翻率0%显著低于对照组的侧翻率16%(x2=104.348,P=0.000),说明载器组的侧翻率较低,效果如下。
3.1固定及干燥效果好,干燥过程持续有效、稳定。氧气湿化瓶倒置于上下托架上,固定效果良好。由于重力的作用有利于氧气湿化瓶壁上残留水滴往下流,氧气湿化瓶开口向下,提高干燥速度。氧气湿化瓶固定于托架3上,能避免氧气湿化瓶侧翻,内芯倒放于装载架的内芯托架4上,干燥效果良好。
3.2提高工作效率。使用装载架后,装载架连同固定于氧气湿化瓶托架上的氧气湿化瓶及固定于内芯托架上的内芯直接放入干燥箱内进行干燥,干燥结束后将装载架直接取出,大大提高了工作效率
3.3装载量多,工作流程整体性好。装载架每次能摆放30套氧气湿化瓶(含内芯),装载数量较多,由于内芯细小容易丢失,而装载架既能装载氧气湿化瓶,又能装载内芯,能有效避免内芯的丢失,整体操作性好。
结论
“一种医疗器械清洗架”具有提高清洗质量；减少器械损耗；减少职业伤害；适用范围广；工作效率高的优点。“一种镊子清洗装载架”具有提高清洗质量；提高干燥效果；装载数量多的优势。“一种氧气湿化瓶及内芯装载架”具有固定及干燥效果好,干燥过程持续有效、稳定；提高工作效率；装载量多,工作流程整体性好的。本文研制3种器械清洗装载架,与传统方法相比,在清洗质量、干燥效果、工作效率方面有一定优势,具有推广应用价值,是医院消毒供应中心理想的辅助清洗用具。
BACKGROUND
The clean of medical equipment is an important part of the work in a disinfection and supply center, is also a key link before sterilization of medical instruments, which is related to the safety of medical treatment. Currently the disinfection equipment in my hospital is a semi-automatic washing machine, and the auxiliary cleaning equipments are the U-shape frames and cleaning baskets provided by manufacturers, more than 90% medical devices are axis section instruments, due to a single U-frame size, which is only fit for a few of axis section instruments, most of them are not suitable for display but in the washing basket which is very likely to make friction and collision between the instruments, resulting in instrument damage, blunt blade; open shaft section of the instrument will be re-closed, which will result in an not complete clean; Repeated clean would waste manpower, resource and time. Forceps are non-axial section instruments, which clean in traditional way need to be tiled or overlapped in basket. But in this way forceps have not been fixed effectively, the forceps would be overlapped each other which effected the progress of clean and the evaporation. Oxygen inhalation therapy is one of commonly used in clinical nursing skills. The data of modern hospital infection showed that the infection of respiratory was in the first place of the infections during hospital, respiratory infections are closely related to the pollution of oxygen humidifier bottles. In traditional way, the process of clean and evaporate the oxygen bottles has a series of problems, such as low-efficient and labor-intensive; dry not enough to inhibit the grow of bacterium; polluted recessively by oxygen wet bottle wall. To solve these problems, new cleaning equipment shelves were research to improve cleaning quality, ensure the quality of disinfection, reduce the loss of equipment, decrease occupational injuries to staff and improve efficiency.
Research Purpose
1. Develop "a kind of cleaning shelf for medical instruments", "a kind of loading shelf for forceps cleaning", "a kind of loading shelf for oxygen humidifier bottles and inner cores", and discuss their advantages and values in the cleaning process of relative medical instruments.
2. Development on series of loading shelves for instruments cleaning can improve the cleaning quality of disinfection and supply center, ensure the quality of disinfection and sterilization products, and avoid the inflection incurrence of the hospital.
Methods:
1. Evaluation for the design and effectiveness of "a kind of cleaning shelf for medical instruments".
The round support, made of 5mm stainless steel, is composed of support, ring hook, frame back and base.
Effectiveness evaluation:1222 pieces of cardo instruments can be randomly divided into experimental group and control group by instruments resource and then by the type, and there shall be 615pieces of instruments in experimental group and 607 pieces of instruments in control group. In experimental group, it is operated by one fixed operator, and the self-made shelf for medical instruments cleaning shall be used. In control group, the type U fixture and cleaning basket provided by the manufacturer shall be used, and the applicable instruments shall be fixed on the type U fixture, while the inapplicable instruments shall be directly put into the cleaning basket. The same cleaning methods shall be used for the two groups. (1) Flushing:the recycled instruments shall be washed by flowing water, brushed its cardo and slits for times by the hairbrush, and then washed by flowing water. (2) Cleaning and rinsing: the experimental group shall put the shelf for medical instruments cleaning and the instrument into each rinse tank of the semi-automatic cleaner; while the control group shall put the cleaning basket with type U fixture and the instruments into each rinse tank of the semi-automatic cleaner, and then the two groups shall start cleaning in accordance with the following procedures:presoaking for the ultrasonic cleaning→rinsing→disinfection for high temperature groove→soaking for lubrication oil→drying for the drying tank. The cleaning effectiveness and cleaning time of the two groups of instrument shall be compared.
2. Evaluation for the design and effectiveness of "a kind of shelf for forceps cleaning"
The frame is designed by 3mm stainless steel round support, and the forceps bracket including several grid quadrangles for laying up the forceps, is formed by 1.05 mm crisscrossing stainless round steels.
Effectiveness evaluation:the 2000 recycled forceps shall be randomly divided into experimental group and control group, and there shall be 1000 forceps in each group, operated by one fixed personnel. The experimental group shall load the forceps by self-made load shelf for forceps cleaning; while the control group shall load the forceps by tile mode. The same cleaning methods shall be used for the two groups (Details, please see cleaning methods for the cleaning shelves of medical instruments). Make comparisons for the time for loading forceps and the effectiveness of the forceps cleaning.
3. Evaluation for the design and effectiveness of "a kind of loading shelf for oxygen humidifier bottles and inner cores"
The rectangular upper and lower brackets are constructed by 4mm stainless steel round support, and the inner core bracket constructed by 4mm stainless steel round support, is designed at the side of the upper and lower brackets
Effectiveness evaluation:the 1200 recycled oxygen humidifier bottles and the inner cores socked in chlorine disinfect solution shall be randomly divided into loading group and control group, and there shall be 600 sets in each group, operated by one fixed personnel. The loading group shall make the end rinsing by oxygen humidifier bottles and loading shelves of the inner cores, and then drying in air dry oven. Make comparisons for the time for end rinsing and loading, drying effectiveness and the rollover of oxygen humidifier bottles and inner cores in the two groups.
The statistical process for data analysis shall use Excel 2003 Chinese version and statistical software SPSS13.0.
Results
1. A kind of cleaning shelves for medical instruments
After the same pre-processing of the cardo instruments, the cleaning effectiveness of the loading shelves for medical instruments cleaning is obviously better than the effectiveness of type U fixture and cleaning basket. The acceptability of the experimental group is 97.88%, obviously higher than 85.33% of the control group (x2=62.8778, p=0.000), and it shows that the cleaning effectiveness of the experimental group is much better. For improving work efficiency and cleaning time of the instruments, the experimental group has saved 160 minutes comparing to the control group. The advantages are as following:
1.1 Improvement for cleaning quality. While using the cleaning shelf, the instrument cardo and joints are completely opened and fixed. Without the prevention of the iron wire in the cleaning basket, the transmission of the ultrasonic wave can be promoted, and the multienzyme or alkaline washing liquid can contact with each parts of the instrument to completely decompose the organics; at the same time, the washing liquid can be completely washed to avoid residue of the washing liquid and improve the cleaning quality.
1.2 Having reduced instruments wear. Locating the instrument behind the cleaning shelf can avoid swing and pulling the instrument away the washing tank; at the same cleaning shelf, the sharp instruments and other instruments shall be located separately to avoid the instruments release, damages and loss, and blunting of the edge, instruments wear and extend the use life of the instruments.
1.3 Reducing occupational injury. The operator need not support the cleaning shelf by hands while picking and placing the instruments and can carry out shelving to reduce the risk of injury by sharp instruments. At the same time, because the sharp instruments, such as the points of scissors and knife edge, are placed with same direction, when picking the instruments, the operator can just support the cardo parts of the instruments and pick several instruments at one time to reduce the occupational injury.
1.4 Wide application scope. The support spacing of the shelf for medical instruments cleaning is designed in accordance with the size of normal instruments, taking account of the specifications of the specific instruments. The instruments can be placed adjacent two supports or each one or two supports, with application to instruments with various specifications.
1.5 Improvement for work efficiency. The instruments can be placed in order on the shelves for medical instruments cleaning, and it is easy to check the quality and quantity after cleaning and pick instruments by lot at one time with safety and high efficiency.
2. A kind of loading shelf for forceps cleaning
The difference of the loading time for experimental group and control group is not obvious (t=0.195, P=0.846), so there is no time difference between the two groups. The dryness factor 96.3% of experimental group is higher than the dryness factor 87.9%(x2=48.489, P=0.000) of experimental group, and it shows that the drying effectiveness of experimental group is much better. The advantages are as following:
2.1 Improvement for cleaning quality. The forceps are inserted vertically in the loading shelf for cleaning, with complete exposure of the forceps and without any shelter, in order that the cleaning agent can contact each part of the forceps to improve cleaning quality efficiently.
2.2 Improvement for drying effectiveness. As the forceps are placed vertically, the cleaning agent can flow from high to low to avoid the residue of the cleaning agent to improve drying effectiveness.
2.3 With much loading quantity. Comparing to the tile mode, the loading quantity is much more, and every forceps only occupies the two adjacent grid quadrangles. A forceps loading shelf can load about150 forceps, more 100 than the tile mode, and more 50 than overlap method.
3. A kind of loading shelf for oxygen humidifier bottles and inner cores
Comparing to the time for end rinsing, loading oxygen humidifier bottles and inner cores, time for the loading group is obviously less than the control group (t =-18.557, P=0.000); the dryness factor of the loading group is obviously higher than the dryness factor 82.8%(x2=42.074, P=0.000)of the control group, and it shows that the drying effectiveness of the loading group is much better. The rollover factor 0% of the loading group is obviously lower than the rollover factor 16%(x2= 104.348, P=0.000) of the control group, it shows that the rollover factor of the loading group is much lower. The effectiveness is as following:
3.1 Good fixing and drying effectiveness, and effective and stable drying process. The oxygen humidifier bottles are inverted on the upper and lower brackets and the fixed effect is good. As the action of the gravity is benefit for the flowing of the residue water on the wall of oxygen humidifier bottles and the openings f the bottles are downward, the drying speed can be improved. The oxygen humidifier bottles are fixed on the bracket 3, which can avoid the rollover of the oxygen humidifier bottles, and the inner cores are placed on the inner core bracket 4, which can keep good drying effectiveness.
3.2 Improvement for work efficiency. After using the loading shelves, the loading shelves, oxygen humidifier bottles on the brackets and the inner cores fixed on the inner core brackets shall be put into the drying oven for drying, and after the drying, the shelves can be picked out directly, which has greatly improved work efficiency.
3.3 With much loading quantity and good integrity for workflow. The loading shelf can only accommodate 30 oxygen humidifier bottles (including inner cores) each time. The loading quantity is much more, as the inner cores are tiny and can be lost easily, while the loading shelf can not only load the oxygen humidifier bottles, but also load the inner cores, which can avoid the loss of inner cores to keep good operation property.
Conclusion
"A kind of shelf for medical instruments cleaning" has the advantages of improving cleaning quality, decreasing the instruments damages, reducing the occupational injuries, wide application scope and high work efficiency. "A kind of loading shelf for forceps cleaning" has the advantages of improving cleaning quality and drying effectiveness, with great loading quantity. "A kind of loading shelf for oxygen humidifier bottles and inner cores has the advantages of good fixing and drying effectiveness, continuously effective and stable drying process, improving work efficiency, great loading quantity and good integrity for workflow. The three kinds of loading shelves for instruments cleaning researched in this paper, comparing to the traditional ways, have some specific advantages in cleaning quality, drying effectiveness and work efficiency, which are worthy to be popularized and utilized, and they are the ideal assistant cleaning tools for disinfection and supply center in hospital.
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[9]Anforderungen an die Hygiene bei der Aufberitung flexible Endoskope undendoskopischen Zusatzinstrumentariums.Empfehlung der Kommission furKrankenhaushygiene und Infektionspr vention beim Robert Koch- Instiut(RKI).Bundesgesundheitsbl Gesundheitsfosch Gesundheitsschutz. 2002,45(4):395-411
[10]LangenbergW,Rawws EAJ.Oudbier JH.Patient to patient transmission of Campylobacter pylori infection by fibroptic gastroduodenoscopy and biopsy.J Infect Dis,1990(161):507
[11]Kaczmarek PG,Moore RM Multi-state investigation of the actual disinfection/sterilization of endoscopes in health care facilities.Am.J.Med. 1992,61_922
[12]关于进一步加强医院感染管理工作的紧急通知.卫生部.1994-01-04
[13]朱士俊.现代医院感染学.北京：人民军医出版社,1998,3-68
[14]Parker R,Graves N,Griffin M.Socio-economic burden of hospital acquired infection.london PHIS,1999
[15]毛雅琴,葛洁芳,高雅文,等.消毒供应室的管理[J].中华医院感染学杂志,2000,10(6)：434
[16]王梅素,施杏梅.医用物品清洁灭菌中存在的问题与对策[J].中华医院感染学杂志,2004,14(6)：653-654
[17]张瑞明,程新莉,钱志云.多酶清洗剂去热原效果的研究.中华医院感染学杂志,2004,14(16)：1131-1132
[18]李思,贺吉群.有机物对低温等离子体灭菌效能影响的研究[J].中国医学工程,2006,14(3)：265
[19]Spach D;Silverstein F,Stamm W Transmission infection by gastrointestinal endoscopy and bronchoscopy.Anmals of Internal Medicine 1993,(118):117-128
[20]Bronowicki J.Patient-to-patient transmission of hepatitis C virus during colonoscopy.The New Engladn Jouranl of Medicine,1997(337):237-240
[21]戴梅君等.Journal of Qiqihar medical couege,2002,vol.23.NO.10
[22]徐忠春等.氧气湿化液的污染情况调查[J].预防医学情报杂 志,2002,18(6)：486-487
[23]孟建华等.吸氧湿化瓶的消毒及湿化液微生物污染调查[J].河南预防医学杂志,2000,11(3)：153-154
[24]Shi Lan Ping.Analyses on the contamination of humidified fiuid used in oxygen therapy and its countermeasures,Chinese nursingresearch. May,2005 VOL.19No.5A
[25]汪涛,余道军,蔡艺飞,等.氧气湿化瓶细菌学调查[J].中华医院感染学杂志,2005,15(5)：533-535.
[26]陶凤芹,景凤霞,陈桂玲等.浅谈氧气湿化瓶系统引起院内感染的预防措施[J].《中国保健》医学研究版,2008,16(9)：359
[27]于农,金欣,陈天宝等.输氧湿化瓶微生物污染及污染途径调查[J].现代护理,2008,2,14(4)：486-487
[28]刘金味,王建芳,杜倩.氧气湿化液污染引起肺部感染菌群调查[J].护理研究,2007,21(7)：1816-1817
[29]宋瑾,张玲,陈宇红.自制手术器械架在清洗消毒器械中的应用观察[J].中国消毒学杂志,2004,21(1)：55-56
[30]陈培玲,莫碧环,青志旺.自制器械架在超声清洗中的应用[J].中国实用护理杂志,2006,22(8)：49
[31]陈慧,黄浩.消毒供应中心医疗器械清洗架的设计与应用[J].护士进修杂志,2009,24(8)：676
[32]丁志红.湿化瓶干燥架的设计与应用[J].中国消毒学杂志,2007,24(3)：221
[33]卓龙彩,黄榕.自制湿化瓶沥水盘的应用[J].现代护理,2007,13(11)：1027
[34]张勤,张亿琴,沈常霞.医疗器械清洗质量的影响因素的检测方法.解放军护理杂志,2007,24(12B)：42-43.
[35]倪晓平,蒋辉等.杭州市医院医疗器械清洗质量监测分析[J].中华医院感染学杂志,2003,13(4)：350-351
[36]张红玲.超声清洗机洗涤效果分析[J].中华医院感染学杂志,2003,13(9)：847-848
[37]中华人民共和国卫生部.消毒技术规范[S].北京：中华人民共和国卫生部,2002.168
[38]吴可萍,于翠香,梁云霞,等.轴节类器械清洗方法的探讨[J].中国感染控制杂志,2008,7(1)：63-64.
[39]王华生,孙雪莹,梁树森.影响医疗器械清洗质量的因素[J].中华医院感染学杂志,2007,17(5)：553-554
[40]陈金波.医院消毒供应中心管理与质量控制指南.北京：中国卫生科技出版社,2006：100
[41]陶凤芹,陈桂玲,郑秀颖等.氧气湿化瓶清洁与消毒方法的临床探讨[J].《中国保健》医学研究版,2007,15(4)：40
[42]张淑音.氧气湿化瓶的消毒方法及效果观察[J].现代护理,2007,13(26)：2455-2456
[43]罗带姨.医用氧气湿化瓶消毒保存方法改进[J].中国消毒学杂志,2008,25(1)：91
[44]李勤,姚楠,杨瑞仪等.壁式供氧装置消毒效果研究[J].中华医院感染学杂志,2007,17(12)：1533-1534
[45]胡安荣,周琴琴,黄新明等.消毒后备用湿化瓶的干燥方法及存放时间探讨[J].中国实用护理杂志,2006,22(6)上旬版：48-49
[46]徐秀华.临床医院感染学(修订版)[M].长沙：湖南科学技术出版社.2005
[47]Wenzel R.医院内感染的预防和控制[M].4版.天津：天津科学技术翻译出版公司,2005：753
[48]宋慧.医院机械清洗热力消毒应用进展[J].中华护理杂志,2008,43(5)：475-478
[49]周颂华,王惠珍,冯瑞萍等.多功能器械清洗架在轴节类器械清洗中的应用研究[J].中国实用护理杂志,2010,26(2)中旬版：49-50
[2]Alvarado C.J Reichelderfer M.APIC guideline for infection prevention and control in flexible endoscopy. American Journal of Infection Control. 2008(28):138-155
[3]Casas J M.B.Bacteremia caused by digestive system endoscopy. Revista Espanola de Endoscopy 2001(33):1070-1080
[4]Nelson D B,Barkun AN,BlocKP,etal. Technology status evaluation report.Transmission of infection by gastrintestnal endoscopy. May2001. Gastrointes Endosc,2001,54(6):8-824
[5]Langenberg W,Rauws EA,Oudbier JH,et al.Patient-to-patient transmission of Campylobacter pylori infection by fiberoptic gastroduodenoscopy and biopsy.J Infect Dis,1990,161(13):507
[6]Bronowicki JP,Venard V,Botte C.et al.Patient-to-patient transmission of hepatitis C virus during colonoscopy, N Engl J Med,1997,337(4):40-237
[7]Bronchoscopy-related infections and pseudoinfections-New York 1996 and 1998.MMWR Morb Mortal Wkly Rep.1999,48(26):60-557
[8]Ramsey AH.Oemig TV.Davis JP,et al.Anoutbreak of bronchoscopy-retlated My cobacterium tuberculosis infections due to lack of bronchoscope leak testing.Chest,2002,12(3):81-976
[9]Anforderungen an die Hygiene bei der Aufberitung flexible Endoskope undendoskopischen Zusatzinstrumentariums.Empfehlung der Kommission furKrankenhaushygiene und Infektionspr vention beim Robert Koch- Instiut(RKI).Bundesgesundheitsbl Gesundheitsfosch Gesundheitsschutz. 2002,45(4):395-411
[10]LangenbergW,Rawws EAJ.Oudbier JH.Patient to patient transmission of Campylobacter pylori infection by fibroptic gastroduodenoscopy and biopsy.J Infect Dis,1990(161):507
[11]Kaczmarek PG,Moore RM Multi-state investigation of the actual disinfection/sterilization of endoscopes in health care facilities.Am.J.Med. 1992,61_922
[12]关于进一步加强医院感染管理工作的紧急通知.卫生部.1994-01-04
[13]朱士俊.现代医院感染学.北京：人民军医出版社,1998,3-68
[14]Parker R,Graves N,Griffin M.Socio-economic burden of hospital acquired infection.london PHIS,1999
[15]毛雅琴,葛洁芳,高雅文,等.消毒供应室的管理[J].中华医院感染学杂志,2000,10(6)：434
[16]王梅素,施杏梅.医用物品清洁灭菌中存在的问题与对策[J].中华医院感染学杂志,2004,14(6)：653-654
[17]张瑞明,程新莉,钱志云.多酶清洗剂去热原效果的研究.中华医院感染学杂志,2004,14(16)：1131-1132
[18]李思,贺吉群.有机物对低温等离子体灭菌效能影响的研究[J].中国医学工程,2006,14(3)：265
[19]Spach D;Silverstein F,Stamm W Transmission infection by gastrointestinal endoscopy and bronchoscopy.Anmals of Internal Medicine 1993,(118):117-128
[20]Bronowicki J.Patient-to-patient transmission of hepatitis C virus during colonoscopy.The New Engladn Jouranl of Medicine,1997(337):237-240
[21]戴梅君等.Journal of Qiqihar medical couege,2002,vol.23.NO.10
[22]徐忠春等.氧气湿化液的污染情况调查[J].预防医学情报杂 志,2002,18(6)：486-487
[23]孟建华等.吸氧湿化瓶的消毒及湿化液微生物污染调查[J].河南预防医学杂志,2000,11(3)：153-154
[24]Shi Lan Ping.Analyses on the contamination of humidified fiuid used in oxygen therapy and its countermeasures,Chinese nursingresearch. May,2005 VOL.19No.5A
[25]汪涛,余道军,蔡艺飞,等.氧气湿化瓶细菌学调查[J].中华医院感染学杂志,2005,15(5)：533-535.
[26]陶凤芹,景凤霞,陈桂玲等.浅谈氧气湿化瓶系统引起院内感染的预防措施[J].《中国保健》医学研究版,2008,16(9)：359
[27]于农,金欣,陈天宝等.输氧湿化瓶微生物污染及污染途径调查[J].现代护理,2008,2,14(4)：486-487
[28]刘金味,王建芳,杜倩.氧气湿化液污染引起肺部感染菌群调查[J].护理研究,2007,21(7)：1816-1817
[29]宋瑾,张玲,陈宇红.自制手术器械架在清洗消毒器械中的应用观察[J].中国消毒学杂志,2004,21(1)：55-56
[30]陈培玲,莫碧环,青志旺.自制器械架在超声清洗中的应用[J].中国实用护理杂志,2006,22(8)：49
[31]陈慧,黄浩.消毒供应中心医疗器械清洗架的设计与应用[J].护士进修杂志,2009,24(8)：676
[32]丁志红.湿化瓶干燥架的设计与应用[J].中国消毒学杂志,2007,24(3)：221
[33]卓龙彩,黄榕.自制湿化瓶沥水盘的应用[J].现代护理,2007,13(11)：1027
[34]张勤,张亿琴,沈常霞.医疗器械清洗质量的影响因素的检测方法.解放军护理杂志,2007,24(12B)：42-43.
[35]倪晓平,蒋辉等.杭州市医院医疗器械清洗质量监测分析[J].中华医院感染学杂志,2003,13(4)：350-351
[36]张红玲.超声清洗机洗涤效果分析[J].中华医院感染学杂志,2003,13(9)：847-848
[37]中华人民共和国卫生部.消毒技术规范[S].北京：中华人民共和国卫生部,2002.168
[38]吴可萍,于翠香,梁云霞,等.轴节类器械清洗方法的探讨[J].中国感染控制杂志,2008,7(1)：63-64.
[39]王华生,孙雪莹,梁树森.影响医疗器械清洗质量的因素[J].中华医院感染学杂志,2007,17(5)：553-554
[40]陈金波.医院消毒供应中心管理与质量控制指南.北京：中国卫生科技出版社,2006：100
[41]陶凤芹,陈桂玲,郑秀颖等.氧气湿化瓶清洁与消毒方法的临床探讨[J].《中国保健》医学研究版,2007,15(4)：40
[42]张淑音.氧气湿化瓶的消毒方法及效果观察[J].现代护理,2007,13(26)：2455-2456
[43]罗带姨.医用氧气湿化瓶消毒保存方法改进[J].中国消毒学杂志,2008,25(1)：91
[44]李勤,姚楠,杨瑞仪等.壁式供氧装置消毒效果研究[J].中华医院感染学杂志,2007,17(12)：1533-1534
[45]胡安荣,周琴琴,黄新明等.消毒后备用湿化瓶的干燥方法及存放时间探讨[J].中国实用护理杂志,2006,22(6)上旬版：48-49
[46]徐秀华.临床医院感染学(修订版)[M].长沙：湖南科学技术出版社.2005
[47]Wenzel R.医院内感染的预防和控制[M].4版.天津：天津科学技术翻译出版公司,2005：753
[48]宋慧.医院机械清洗热力消毒应用进展[J].中华护理杂志,2008,43(5)：475-478
[49]周颂华,王惠珍,冯瑞萍等.多功能器械清洗架在轴节类器械清洗中的应用研究[J].中国实用护理杂志,2010,26(2)中旬版：49-50
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