1 Instruments, equipment and materials
1. 1 instrument: ①YOP-4 photoelectron dust particle counter; ②FA- 1 multistage impact air microbial sampling; ③ Hot-bulb anemometer; ④ Room temperature meter; ⑤ Ventilation hygrometer; ⑥ Air pump; ⑦ Sound level meter.
1.2 equipment: ① air filter (homemade); ② Blower; ③ oscillator; ④ Low pressure aspirator; ⑤ Micro motor; ⑥ Low ozone ultraviolet lamp 20W× 2; ⑦ Lighting lamp; 8 automatic cutting machine for bottle caps of large and small medicine bottles; Pet-name ruby ampoule automatic cutting device; Attending ampoule fixing box; (1 1) safety bottle (homemade); (12) 2 medicine bottle fixing boxes (homemade); (13) Disposable bidirectional diverter and air inlet needle; (14) 2 sets of tangential negative pressure switch time limiters; B 15？ Foot-controlled negative pressure switch; B 16？ 2 sets of conventional disinfection switches.
1.3 material: steel plate, aluminum plate and stainless steel plate.
2 Combination and production
According to the procedure of liquid preparation, the above equipment and materials are combined together to make a purification workbench, as shown in the attached figure.
2. 1 purification project length 130 cm, width 60 cm, height 168 cm. The upper part is equipped with blower, air inlet, air duct (with built-in ultraviolet lamp), coarse filter, sound insulation material and high efficiency air filter. When the fan is working, outdoor air is sent out from the air supply outlet and enters the fan through the coarse filter, and sound insulation materials are added around the fan to reduce noise. The air after coarse filtration is sent to the air duct, disinfected by ultraviolet lamp, and then sent to the purification studio through high efficiency filter. At this point, the air has been sterilized and purified by filtering dust.
2.2 The purification studio is set on the left side of the workbench, with a space of 50 cm high, 90 cm long and 60 cm wide. There is ultraviolet light in the center of the top
Attached Figure Schematic diagram of intravenous intramuscular injection purification and liquid preparation workbench
1 air supply outlet
4 high efficiency filter
7 oscillator
10 negative pressure meter
13 liquid suction switch
16 disinfection switch
2 air supply pipeline
5 protective net
8 exhaust pipe
1 1 drug return switch
14 lighting switch
17 bottle opener
3 ultraviolet lamp observation window
6 protective door
9 main switch of power supply
12 oscillating switch
15 bottle opening switch
18 air outlet
A traveling lamp (controlled by a protective door), an illuminating lamp, a protective net (protecting a high-efficiency filter) and a hook 2. A plexiglass protective door (controlled by a timed disinfection switch and automatically closed after 45 minutes of routine automatic disinfection) is set right in front of the purification room, which has the functions of protection and timed disinfection for workers. A negative pressure tube of a medicine oscillator (adjustable timer), a safety bottle (consisting of a negative pressure air outlet, an air inlet and a liquid leakage hole, which has negative pressure function and can prevent liquid from flowing backwards), a bidirectional shunt, an air inlet needle, a medicine bottle fixing box and an ampoule fixing box are arranged inside.
2.3 Under the workbench, there are exhaust ducts, large and small medicine bottles and automatic ampoule cutting devices. Equipped with main power supply, blower, cutting flow negative pressure limit, oscillator timing, automatic cutting of large and small medicine bottles and ampoules and other switches and signal display lights.
3 Clinical application
3. 1 Powder preparation and suction: The operator holds the medicine bottle in his right hand and sends the bottle neck end into the protective cover in parallel. The bottle cap will automatically cut about 1 s, which will not affect the rubber plug. Put the medicine bottles into the bottle fixing boxes respectively, disinfect the bottle caps with iodophor spray, and after drying, insert the needle of the bidirectional suction diverter and the negative pressure needle of the bidirectional diverter into the medicine bottles respectively. The other end is inserted into the liquid bottle and the safety bottle respectively (to prevent the negative pressure from sucking the liquid into the negative pressure tube and then flowing back into the bottle, and if it is inhaled, it can be discharged through the leakage port). Turn on the timing switch for cutting off the negative pressure or the foot-controlled negative pressure switch, make the negative pressure in the medicine bottle flow into the medicine bottle for 2-3 s by the above operation method, turn off the negative pressure switch, pull out the needle, and fix the needle on the switch frame of the bidirectional shunt according to aseptic operation to prepare the next batch of similar drugs. Put the medicine bottle into a timing oscillator to oscillate, and then take it out and put it into the medicine bottle fixing box. After the medicine bottle is disinfected by iodophor spray, the liquid medicine is sucked into the infusion bottle by negative pressure, and then the disposable infusion needle is inserted and put on the infusion rack for later use. If it is intramuscular injection, you can directly extract the dissolved liquid medicine with an empty needle in the purification studio.
3.2 Suction of ampoule medicine: after the automatic ampoule cutter is turned on to cut the ampoule, it is disinfected, put into the limit holes of ampoule fixing boxes with different specifications, and then put into the holes of the fixing boxes. The liquid medicine in the ampoule bottle is pumped out by the medicine suction needle of the two-way shunt, and the slide plate below the ampoule box is pulled to the right, so that the empty ampoule automatically falls into the waste box. If the ampoule in the box is cleared, pull the sliding spring under the box to make it all fall into the waste storage box.
3.3 Removal of toxic gas: If it is necessary to remove toxic gas in the clean room, turn on the switch of the exhaust fan, and the harmful gas will be automatically discharged from the pipeline.
4 monitoring methods and results
4. 1 air monitoring: according to the requirements of GB 15982- 1995 [2]. During the operation of the clean room and the treatment room, samples are taken at the same time, and 1 sampling points are distributed in the four corners and the middle respectively, and the points in the four corners of the clean room are 10 cm away from the clean room wall. The four corners of the treatment room are away from the wall 100 cm, and the vertical height from each point to the ground is 100 cm. Sedimentation sampling, the plate was exposed in the purification room for 30 min, exposed in the treatment room for 5 min, and then cultured at 37℃ for 24 h to count the colonies.
4.2 Measurement of wind speed and dust concentration: 4 wind speed points and 5 dust concentration points, and the values are measured by YOP-4 photoelectron dust particle counter.
4.3 Monitoring results: The average total number of colonies in the purification studio is 3 cfu/cm3；; ; The total number of colonies in the treatment room was 67 1 cfu/cm3. It is suggested that the number of bacterial colonies in the purification studio is significantly lower than that in the treatment room.
The average wind speed at four points of the purification bench is 0.57 m/s, the average dust concentration in 0.3μm space is 5.4 particles /L, and the average dust concentration in 0.5μm space is 1.7 particles/L. ..
5 discussion
5. 1 Prevention of planktonic bacteria infection in the air: The number of planktonic bacteria in the air of treatment rooms in China is higher than that in advanced countries 10 ~ 200 times [1]; When preparing large infusion, a large number of planktonic bacteria in the air can pollute the liquid in the infusion bottle through various links, which is the main factor to increase the dilution pollution of injection [3]. Measures to prevent the pollution of large infusion, commonly used disinfection methods in hospitals include physical, chemical, natural ventilation, Chinese herbal medicine spray, vinegar, and reconstruction of treatment room [4 ~ 10]. According to the statistics of Mao Youling and others [10], the sterilization rate of 3% hydrogen peroxide spray is 85.6%; Lactic acid fumigation was 76.33%; The smoking rate of Atractylodes lancea was 90.75%, and the ultraviolet irradiation rate was 8 1.56%. However, the above disinfectants are corrosive, consume manpower, material resources and time, and have peculiar smell in the air. Through the research and combination, the liquid preparation workbench for intravenous muscle injection was trial-produced, which was used by more than 600 people in clinic. Safe and time-saving, it has many functions, such as automatic cutting of large and small bottle caps, sucking and pumping of liquid medicine, oscillation, automatic air purification, etc., which makes the liquid preparation scientific and sterile. It was confirmed by measurement that the average number of colonies in the purification studio was 3 cfu/m3 and that in the treatment room was 67 1 cfu/m3. The average dust concentration of 0.3μm is 5.4 /L, and that of 0.5μm is 1.7 /L, which is 99.5 1% lower than the 350 /L reported by Yang Yulan [9]. Compared with the measured value (500 cfu/m3), the number of colonies decreased by 99.4%.
5.2 Advantages: ① Automatically disinfect and purify the air, avoid polluted air from entering liquid bottles and medicine bottles, and ensure the sterility of drugs. (2) Ensure that the hollow needle is not contaminated during liquid absorption and drug extraction. ③ Quick mechanical cutting of medicine bottles and ampoules, and automatic oscillation of medicine, which lightens the complicated work of nurses and shortens the dispensing time. ④ The mechanical cutting of the bottle cap ensures the standardization of the sterilization area of the bottle cap. ⑤ One-time two-way shunt suction and pump medicine to prevent the invasion of pathogenic microorganisms during dispensing.
(This topic is supported by the Infection Monitoring Committee of Sichuan Provincial Health Department, Sichuan Provincial Science and Technology Commission, Sichuan Provincial Administration of Medicine, Director Deng Yunqing of the Nursing Department of the Second Affiliated Hospital of West China Medical University, Head Nurses Yu and Ding Chenghuai of the Provincial Post and Telecommunications Hospital, and Director of the Nursing Department of the Stomatological Hospital affiliated to West China Medical University. Thank you. )