Routine disinfection of patients' environmental surfaces. Myth or reality?
Routine disinfection of patients' environmental surfaces. Myth or reality?
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DOI：
10.1053/jhin.1999.0567
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发表时间：
1999-06-01
影响因子：
6.9
通讯作者：
Pittet, D
中科院分区：
文献类型：
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作者：
Dharan, S;Mourouga, P;Pittet, D
我们评估了在瑞士日内瓦大学医院的两翼医疗单位[北(N)和南(S)]的患者区域内，对未被生物液体污染的环境表面进行日常消毒的必要性。每周随机进行表面细菌学监测(N=1356个样本)。在S翼(对照组)，我们使用洗涤剂/消毒剂日常清洁地板和家具。在北翼，我们开始使用一种洗涤剂来清洗地板和家具；四周后的结果是，我们建议轮换使用洗涤剂，吸尘吸引一次性干拖把和消毒剂。在此期间，家具被一种活性氧基化合物清洗。清洁地板前后污染的平均差异为(细菌数量的平均减少和95%可信区间；CI95)：一次性拖把：92.7CFU/24厘米(2)(CI95；74-112)，活性氧基化合物111.1(90-133)，季铵化合物-0.6(-27-26)。单独使用洗涤剂与细菌菌落计数显著增加有关：平均增加103.6 cfu(CI9573-134)。季铵化合物不足以消毒浴室和厕所，但基于活性氧基的化合物是令人满意的。对于家具，使用消毒剂的两种方法都显著减少了细菌数量。由于洗涤剂受到污染，单独使用它进行清洁，我们实际上是在表面播撒细菌。我们对1117名患者进行了研究，在四个月的试验期间，我们观察到医院感染的发生率没有变化。总之，不加控制地对环境表面进行常规消毒并不一定会使患者感到安全，而且可能会在环境中播下潜在的病原体种子。
We have evaluated the need for daily disinfection of environmental surfaces not contaminated by biological fluids, in patient areas of a medical unit with two wings [North (N) and South (S)] at the University Hospitals of Geneva, Switzerland. Weekly bacteriological monitoring of surfaces was carried out at random (N = 1356 samples). In the S wing (control), we used detergent/disinfectant for daily cleaning of the floors and furniture. In the N wing we began by using a detergent for floors and furniture; after four weeks the results suggested changing to a rotation of detergent, dust attracting disposable dry mops and disinfectant. During this period the furniture was cleaned with an active oxygen-based compound. The average differences in contamination before and after cleaning floors were (mean reduction in bacterial counts and 95% confidence intervals; CI95): disposable mops: 92.7 cfu/24 cm(2) (CI95; 74-112), active oxygen based compound 111.1 (90-133), and quaternary ammonium compound -0.6 (-27-26). Use of detergent alone was associated with a significant increase in bacterial colony counts: on average by 103.6 cfu (CI95 73-134). The quaternary ammonium compound was inadequate for disinfecting bathrooms and toilets but the active oxygen based compound was satisfactory. For furniture, there was a significant reduction in bacterial counts with both the methods using disinfectants. As the detergent was contaminated, by using it alone for cleaning, we were actually seeding surfaces with bacteria.A total of 1117 patients was studied and we observed no change in the incidence of nosocomial infections during the four months of the trial. In conclusion, uncontrolled routine disinfection of environmental surfaces does not necessarily make it safe for the patient and could seed the environment with potential pathogens.