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发表于 2010-4-27 12:47:52
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本帖最后由 米克 于 2010-4-29 11:26 编辑
院感专家一般都不是很了解透析机的工作原理，所以多数都支持每次消毒我非常理解。制定规程的临床专家也未必懂透析机的工作原理所以才会制定出来这样的条款。但是“美国医疗器械促进会（AAMI）”是美国医疗器械安全性确认的权威机构，在该组织和美国CDC的文件里明确说明的是[每天]消毒。
CDC的原文如下：
Recommendations for Preventing Transmission of Infections Among Chronic Hemodialysis Patients
Vol. 50 / No. RR-5 MMWR 16
Internal Pathways of Hemodialysis Machines.
In single-pass hemodialysis machines,the internal fluid pathways are not subject to contamination with blood. If a dialyzerleak occurs, dialysis fluid might become contaminated with blood, but this contaminated fluid is discarded through a drain and does not return to the dialysis machine to contaminate predialyzer surfaces. For dialysis machines that use a dialysate recirculating system (e.g., some ultrafiltration control machines and those that regenerate the
dialysate), a blood leak in a dialyzer could contaminate the internal pathways of the machine, which could in turn contaminate the dialysis fluid of subsequent patients (192 ). However, procedures normally practiced after each use (i.e., draining the dialysis fluid and rinsing and disinfecting the machine) will reduce the level of contamination
to below infectious levels. In addition, an intact dialyzer membrane will not allow passage of bacteria or viruses (24 ).
Vol. 50 / No. RR-5 MMWR 23
Published methods should be used to clean and disinfect the water treatment and distribution system and the internal circuits of the dialysis machine, as well as to reprocess dialyzers for reuse (see Suggested Readings). These methods are designed to control bacterial contamination, but will also eliminate blood borne viruses. For single-pass machines, perform rinsing and disinfection procedures at the beginning or end of the day. For batch recirculating machines, drain, rinse, and disinfect after each use. Follow the same methods for cleaning and disinfection if a blood leak has occurred, regardless of the type of dialysis machine used. Routine bacteriologic assays of water and dialysis fluids should be performed according to the recommendations of the Association for the Advancement of Medical Instrumentation (see Suggested Readings).
下面是翻译后的文字：
防止慢性血液透析病人感染传播的推荐
对于单向通道的血液透析机，内部的液体管道不可能够被血液污染。如果透析器发生破膜，透析废液可能被血液污染，但是污染的液体通过下游管道排水被丢弃掉了，不可能返回透析机上游管道来污染透析器。对于使用透析液再循环系统的透析机（比如一些超滤控制型机器，透析液被重复使用）透析器发生漏血时能够污染透析机的内部管道,可以使下一个病人的透析液被污染。尽管，每次使用后进行常规的程序（排掉透析废液，冲洗和消毒机器）可以降低污染的水平到感染级别以下。此外，一个完整的透析膜是不能使细菌或病毒通过的。
常规的方法可以用来清洁和消毒水处理和循环管道以及透析机的内部回路，也可以用来复用透析器。这些方法被用于控制细菌污染，同时也可以清除血源性病毒。 对于[单向通道水路透析机]，在[每天]开始和结束时执行冲洗和消毒程序。对于[再循环水路的透析机]，[每次]使用后排液，冲洗和消毒。如果发生漏血，遵照相同的方法清洗和消毒。
不论是什么型号的透析机，根据AAMI的要求，要执行透析用水和透析液的常规细菌学检测。
目前我们国内使用的透析机都是单通道的血液透析机
欧洲的规程里也没有要求每次对机器内部管道进行消毒，而是要求每次对床单元和机器表面进行消毒。
我们有个别专家不知是不是为了说明自己正确而有意误读欧洲的操作规程。
[h2]评分[/h2]
参与人数 2 +20
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理由
xiaolongnv
+ 10
科学的态度
柳莹依
+ 10
有理有据，值得提倡。
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楼主: dearhang
