Control of nosocomial infection -microbial contamination of in-use drugs and its preventive measures-

1.我们对10家医院输液袋中残留的192份在用混合和非混合的肠外营养液的微粒和微生物污染进行了检测。192种混合溶液中，药用玻璃瓶、塑料瓶和小瓶的平均用量(范围)分别为3.38支(1~13支)、0.79支(0~7支)和1.2支(0~8支)。≧1.3μm、≧5μm、≧10μm、≧50μm的平均颗粒数(范围)分别为960.9(30~9539)/ml、42.8(0~587)/ml、6.4(0~146)/ml、0.09(0~1)/ml。2.对10家医院76台超声雾化器药杯雾化溶液的微生物污染情况进行了评价。此外，还对护士进行了访谈调查，以评价这些超声波雾化器的消毒方法。76份雾化液样品中，11份(14.5%)的菌落形成单位(CFU)/ml为10-10-2，9份(11.8%)为10-10-10-5CFU/ml，主要污染物为洋葱伯克霍尔德氏菌、CDC gr.IVC-2、少毛鞘氨醇单胞菌等葡萄糖发酵杆菌。这些结果表明，超声波雾化器每隔24小时消毒是可取的。特别是，当使用不含防腐剂的雾化溶液时，24小时间隔的消毒是必不可少的。

1.We evaluated particulate and microbial contamination in a total of 192 samples of in-use admixed and unadmixed parenteral nutrition solutions remaining in infusion bags in 10 hospitals. The mean numbers (range) of drug glass ampoules, plastic ampoules, and vials used in a total of 192 admixed solutions were 3.38 (1-13), 0.79 (0-7), and 1.2 (0-8), respectively. The mean number of particles (range) contained in the 192 samples according to the particle size (diameter) was 960.9 (30-9539)/ml for particles ≧1.3μm, 42.8 (0-587)/ml for those ≧5μm, 6.4 (0-146)/ml for those ≧10μm, and 0.09 (0-1)/ml for those ≧50μm. On the other hand, none of the 199 samples showed bacteria or fungi/5ml residual solution. Measures against particulate contamination of admixed parenteral nutrition solutions are neccessary.2.We evaluated the microbial contamination of nebulization solutions in medication cups from a total of 76 ultrasonic nebulizers in use in 10 hospitals. In addition, an interview survey was given to nurses to evaluate the disinfection methods of these ultrasonic nebulizers. Of a total of 76 nebulization solution samples, 11 (14.5%) were contaminated with 10-10^2 colony-forming units (CFU)/ml and 9 (11.8%) with 10^3 - 10^5 CFU/ml. The major contaminants were glucose fermentative bacilli such as Burkholderia cepacia, CDC gr.IV C-2, and Sphingomonas paucimobilis. These results show that disinfection of ultrasonic nebulizers at 24-h intervals is desirable. In particular, when nebulization solutions not containing preservatives are used, disinfection at 24-h intervals is indispensable.