比较移动换药车3种不同消毒流程的效果。

选取北京大学第一医院整形烧伤外科病房换药室1辆移动换药车，分别采取3种不同消毒流程进行消毒。流程A：于每天早晨换药前、中午换药后和下午换药后彻底消毒换药车。流程B：每天早晨换药前、下午换药后彻底消毒换药车。流程C：每天早晨换药前、下午换药后彻底消毒换药车，同时增加换药车每次移动前(出换药单元前)用相同方法消毒换药车关键部位，即车顶、车把手和抽屉把手。每天分别于早晨消毒处理后、中午换药后消毒前和下午换药后消毒前采集样本。比较3种消毒流程下移动换药车的样本合格率和无菌落样本检出率。3种不同消毒流程下的样本合格率和无菌落样本检出率及两两比较均采用卡方检验。

3种消毒流程换药前样本合格率均为100.00%。流程A中午和下午换药后消毒前样本合格率分别为98.85%和100.00%，流程C中午和下午换药后消毒前样本合格率均为100.00%，与流程B(中午和下午换药后消毒前的样本合格率均为86.67%)比较差异均有统计学意义(χ²＝6.653、8.219、10.227、6.610，P值均小于0.05)。流程A和流程C之间差异无统计学意义(P>0.05)。3组消毒流程换药前无菌落标本检出率均高于90%，差异无统计学意义(χ²＝3.87，P＝0.14)。中午换药后消毒前和下午换药后消毒前无菌落标本检出率均有统计学差异(χ²＝37.58，30.38，P值均小于0.05)。中午和下午换药后消毒前流程C的无菌落标本检出率分别为100.00%和97.92%，均高于流程A(62.07%和48.33%)和流程B(60.00和66.67%)，差异均有统计学意义(χ²＝35.726、31.443、32.143、12.952，P值均小于0.05)。中午和下午换药后消毒前流程A和流程B的无菌落标本检出率差异均无统计学意义(χ²＝0.023、1.616，P值均大于0.05)。

每天早晨换药前、下午换药后彻底消毒换药车，同时增加换药车每次移动前关键部位的消毒，可以达到3者中最优的消毒效果。

To compare the effect of three disinfection processes of mobile dressing change trolly.

A mobile dressing change cart was selected from the dressing change room in the plastic and burn surgery ward, and three disinfection processes were respectively adopted for disinfection. Process A: disinfect the dressing change cart every morning, after dressing change at noon and after dressing change in the afternoon. Process B: disinfect the dressing change cart thoroughly before dressing in the morning and after dressing in the afternoon. Process C: disinfect the dressing cart thoroughly before dressing change in the morning and after dressing change in the afternoon, meanwhile, the key parts of the dressing change cart, including the roof, cart handle and drawer handle, should be disinfected in the same way before each movement of the dressing change cart( before leaving the dressing change unit). Samples were collected daily after disinfection in the morning, before disinfection at noon and in the afternoon. The sample qualification rate and detection rate of colony-free samples were compared under three disinfection processes. The sample qualification rete and detection rate of colony-free samples in three disinfection processes as well as the difference between two groups were compared by chi-square test.

The qualification rate of samples before dressing change under the three disinfection processes was 100%. The qualified rate of samples were 98.85% and 100.00% at noon and in the afternoon respectively after dressing change for process A, while the qualified rate of samples were both 100.00% at noon and in the afternoon for process C, and there were statistically significant differences when compared with prcess B(χ²=6.653, 8.219, 10.227, 6.610; P<0.05). There was no statistically significant difference between process A and process C(P>0.05). As for the detection rate of colony-free samples, there was no statistically significant difference between three groups before disinfection(P>0.05). There were statistically significant differences between three groups at noon and afternoon(χ²=37.58, 30.38; P<0.05). A further comparison between two groups showed that , the detection rate of colony-free samples in process C was 100.00% at noon and 97.92% in the afternoon, which was higher than that in both process A(62.07% and 48.33%) and process B(60.00% and 66.67%), there were statistically significant differences(χ²=35.726, 31.443, 32.143, 12.952; P<0.05). There was no statistically significant difference between process A and precess B(χ²=0.023, 1.616; P>0.05).

The best disinfection effect can be achieved by thoroughly disinfection the dressing change cart before dressing change in the morning and after dressing change in the afternoon, and at the same time increasing disinfection of key parts before each movement of the dressing change cart.