【作者】 谢天；

【导师】 张宗久； 张阳德；

【作者基本信息】 中南大学 ， 生物医学工程， 2011， 博士

【摘要】 医院空气污染是引起院内人群感染的重要因素之一,医院环境空气质量的检测和控制正在日益引起人们的重视。传统的空气消毒方法,如紫外线灯照射、臭氧消毒、甲醛熏蒸等,只能对空气进行静态消毒,消毒后由于医护人员入内的活动致使室内空气中细菌的菌落数回升,造成空气的再次污染,故仅有暂时的消毒效果。此外,传统的空气消毒方法不具有除尘作用,而小粒径微生物粒子(即微生物气溶胶)在因空气传播引起的医院内感染上起着非常重要的作用,应是医院空气消毒的重点。随着医学科学技术的发展和医疗服务水平的不断提升,要求医院环境能在室内有人员活动的情况下保持空气的持续洁净,传统的消毒方法已不能满足当前的要求。如何对医院的空气进行安全有效地消毒净化,一直是医学界和消毒界所共同关注的重要问题。动态空气净化消毒是近年来提倡的新型空气净化消毒方法,主要包括空气净化机和层流空气净化系统的应用等,但是层流洁净技术因价格昂贵,维护较难,建造投入成本大,在我国现有的经济条件下,不能实现在基层医院的广泛应用。动态空气净化机可以对空气进行循环消毒净化,已成为众多研究者所关注的热点。自主研发的新型空气净化系统是采用高压静电除尘和TiO2光催化技术、活性碳吸附过滤等净化原理对空气进行消毒净化的一种新设备,克服了传统消毒方法的不足,应用前景较为广阔。但是,目前对其在医院环境中对应的作用效果、影响因素、动态作用的鉴定和评价方法等都缺乏深入研究。为了进一步了解新型空气净化系统的作用特点和规律,探讨其在医院环境对空气进行动态净化消毒的效果,进行了本项研究,主要内容包括以下三个方面：(1)医院环境空气质量检测筛选5家三级甲等医院的监护室病房,在设定时间下,采用手持式激光尘埃粒子计数器对空气中可吸入颗粒物和微生物的水平进行现场测定和分析,并对颗粒物采样进行扫描电镜的观察。(2)新型空气净化系统的净化效率检测选取3间20m2模拟现场空气实验室,随机分为A试验间(运行TA100空气净化机2h)、B试验间(运行自制高效空气净化机2h)和对照间(无空气净化机)进行测试,采用3511型压电天平式粉尘测定仪测量可吸入颗粒物降解率,FA-1式多级空气撞击式采样器测量白葡萄球菌杀灭率,应用4160型甲醛现场分析仪分析甲醛降解率。(3)新型空气净化系统应用于监护室的净化效果检测在某三级甲等医院,随机选取两间面积大小相同的监护室病房,其中一间安装有新型空气净化系统作为实验组,对空气进行动态循环净化,另外一间未安装空气净化系统的监护室作为空白对照组,采用手持式激光尘埃粒子计数器对空气中可吸入颗粒物的动态变化进行现场测定和分析。结果：(1)医院空气质量现状5家三级甲等医院空气中PM2.5的浓度值为260096.7±33097.39个/m3,PM10的浓度值为260980.5±33214.69315个/m3,PM2.5是PM10的主要组成部分；随着粒径增大,颗粒物数量减少。所调查的医院监护室内空气消毒监测总体合格率为70.42%。(2)新型空气净化系统的现场净化效果①TA100空气净化机开机1h和2h可吸入颗粒物降解率分别为47%和73.6%,自制高效空气净化机则分别为56%和77.8%,均显著高于对照组的0和3.4%(P<0.01),自制高效空气净化机颗粒物降解率优于TA100(P<0.05)；②TA100和自制高效空气净化机开机2h白葡萄球菌杀灭率分别为94.47%和99.97%,而对照组仅为55.83%,净化机组均优于对照组(P<0.01),但TA100和自制高效空气净化机无统计学差异(P>0.05)；③TA100和自制高效空气净化机开机2h甲醛降解率分别为74%和83%,显著高于对照组的7.5%(P<0.01),自制高效空气净化机降解率优于TA100(P<0.05)。(3)新型空气净化系统应用于监护室的净化效果应用自制高效空气净化机的监护室内空气中可吸入颗粒物PM10的浓度均值为197951个/m3,PM2.5的浓度均值为197440个/m3,均显著低于对照组(P<0.05),在监测的任一时刻,实验组可吸入颗粒物浓度水平较对照组低。本研究结果提示,医院环境空气质量存在一定问题,传统的空气净化消毒方法已不能满足现代医学的要求,此新型空气净化系统具有较高的净化效率,对医院监护室内空气中可吸入颗粒物具有较高的动态清除作用,同时对多种粒径范围的尘埃粒子均有去除作用,除尘粒子谱广。本研究结果为进一步研究医院环境室内空气中微生物气溶胶的分布规律提供了翔实的基础资料,对于有效控制医院感染,规范和促进动态空气净化消毒器的发展具有重要的意义,为政府开展医院感染和消毒管理工作提供了重要的科学依据。更多还原

【Abstract】 It is considered that air pollution is a major cause of in-hospital infections. People more and more think highly of the detection and control of air quality of hospital environment. Conventional way of disinfection such as ultraviolet lamp irradiation, ozone disinfection, and formaldehyde fumigation can only provide static disinfection. It is temporarily effective because repollution will happen due to medical staff’s interior activity. Moreover, conventional air disinfection way does not have the function of dust removal. Microbial aerosol plays an important role in air transmitted hospital infection, and it is the key point of hospital air disinfection. As the development of medical scientific technology and the level of medical treatment is improving, it is required that continous air cleaning is kept under the condition of interior activities of medical staff. So convetinal air disinfection method can not meet the need of modern medicine. How to acquire safe and effiective disinfection and purification for hospital air is always a problem of common interest for the medical circle and disinfection circle.Dynamic air purification and disinfection method is promoted recent years. It includes air purification machine, laminar flow air purification system, et al. But laminar flow air purification technology can not be widely used in primary hospitals now due to its expensive price, difficulty in maintaining, and large construction cost. Air purification machine can provide circulative air disinfection and purification, and it becomes a topic of interest for many researchers. The independent research and development new type of air purification system overcomes disadvantages of convetional disinfection method by using purification principles such as high voltage electrostatic, TiO2photocatalysis technology, and adsorption filtration by activated carbon and it has a wide application prospect. But deep research on the identification and evaluation method for its action effect, influence factors, and dynamic functioning in the hospital environment is needed.Inorder to further understand the action characteristics and rules of the new type of air purification system, and explore the effect of air dynamic disinfetion and purification in hospital environment, we developed this research. It mainly includes three parts as follows:(1) Detection of air quality in hospital environmentFive intensive care units were selected as the study objects and then the degradation rates of inhalable particles and Staphylococcus were detected and analyzed by laser-dust counter. Then particles were observed by Scanning Electron Microscope.(2) Detection of efficacy of new type of air purification systemThree air simulated cabins was selected as the study objects and were randomly divided into3groups, group A (TA100air purifier for2hours), group B (high effective air purifier for2hours), and blank control group C (no air purifier). And then the degradation rates of inhalable particles were measured with laser aerosol particle counter, Staphylococcus was measured with Anderson sampler, and formaldehyde of each group was measured with spectrophotometer.(3) Detection of efficacy of new type of air purification system in intensive care unitTwo intensive care units with the same area in some Grade A Class Three hospital were selected as the study objects and were randomly divided into2groups, study group (air purifier is on), and blank control group (no air purifier). And then the dynamic degradation rates of inhalable particles was measured and analyzed with laser aerosol particle counter.RESULTS:(1) Present situation of air quality in hospitalThe concentration of PM2.5and PM10in5Grade A Class Three hospitals is260096.7±33097.39/m3,260980.5±33214.69315/m3respectively. PM2.5is the main component of PM10. The amount of particles decreased with the increase of their grain size. The total qualified rate of air disinfection monitoring in hospital intensive care unit was70.42%.(2) Situational effect of the new type of air purification system①The1h degradation rate and2h degradation rate for inhalable particles using TA100air purification equipment was47%and73.6%respectively. The rates of the self-made effective air purification equipment were56%,77.8%respectively. Both of them were significantly higher than0,3.4%of the blank control group (P<0.01). The degradation rate of the self-made effective air purification equipment was superior to that of TA100(P<0.05).②The2h degradation rates of Staphylococcus of TA100and the self-made effective air purification equipment were94.47%and99.99%respectively. Both were significantly higher than that of blank control group which was55.83%(P<0.01). But there was no statistical difference between TA100and the self-made effective air purification equipment (P>0.05)③The2h degradation rates of formaldehyde of TA100and the self-made effective air purification equipment were74%and83%respectively. Both were significantly higher than7.5%of blank control group (P<0.01). The degradation rate of the self-made effective air purification equipment was superior to that of TA100(P<0.05).(3) Purification efficacy of the new type of air purification system in intensive care unitThe mean concentration of PM10and PM2.5(high effective air purifer was on) was197951/m3and197440/m3respectively. Both of them were significantly lower than blank control group (P<0.05). The concentration of inhalable particles of study group was lower than blank control group at any monitoring moment.This study revealed that qualiy of ambient air in selected hospital was disturbing. Traditional methods could not provide a satisfactory quality of air to meet the requirement in high-ranking hospital. The dynamic air disinfection system domenstrated a high efficacy in air purification and in processing ambient particulate matters.This study has provided basic materials for the further study of the distribution rules of the microbial aerosols of the air inside the hospital rooms and has offered scientific grounds for the administration.更多还原