ATP生物荧光检测法对重症监护室物体表面污染程度的评估价值

摘要

目的 探讨腺嘌呤核苷三磷酸(ATP)生物荧光检测法对重症监护室(ICU)物体表面污染程度的评估价值.方法 2016年1~12月期间 ICU内30组高频接触物体(每组包括床旁桌、监护仪、电脑键盘三种物体)被选为研究对象,每个物体在消毒前后均进行采样评测,每次采样时将物体表面均分为两处区域,分别通过 ATP生物荧光检测法和细菌培养计数法来评估物体表面污染程度,归为 ATP组和对照组.比较两组消毒前后的荧光检测值与菌落数,采用 Pearson相关分析同一个样品荧光检测值与菌落数的相关性,并对两者的合格率进行 Kappa一致性检验.结果 ①两组的呼吸机面板、床旁桌、电脑键盘消毒后的荧光检测值与菌落数均显著低于消毒前,差异均有统计学意义(t=8.107~26.393,均P<0.05).②Pearson分析结果表明无论是消毒前还是消毒后,呼吸机面板、床旁桌、电脑键盘的荧光检测值与菌落数之间均无显著相关性(r=0.199~0.338,均P>0.05).③消毒前后两组呼吸机面板、床旁桌、电脑键盘的检测合格率比较,差异均无统计学意义(χ2=0.000~1.404,均P>0.05).消毒前ATP组与对照组的合格率分别为0与8.9%,消毒后两组的合格率分别为86.7%与91.1%,一致性检测结果提示Kappa值=0.776(95%CI:0.575~0.978)>0.75,提示两者一致程度相当满意.结论 ATP生物荧光检测法能作为一种快速、简便的初筛方法,辅助细菌培养计数法评估 ICU内物体表面污染程度,应用效果令人满意,值得临床推广应用.%Objective To investigate the value of adenosine triphosphate(ATP)bioluminescence assay for assessing object surface contamination degree in intensive care unit(ICU).Methods 30 groups of high frequency contact object(including ventilator panel,bedside table and computer keyboard)in ICU from January to December 2016 were enrolled for the study. Each object was sampled and evaluated before and after disinfection,and their surface was divided into two areas,whose sur-face contamination degree was evaluated by ATP bioluminescence assay and bacterial culture method that were classified as ATP group and control group.The fluorescence detection value and colony number were compared between two groups be-fore and after disinfection.The correlation between the fluorescence detection value and colony number was analyzed by Pearson correlation in the same sample,and the Kappa consistency test was used for the qualification rates of two detections. Results ①The fluorescence detection value and colony number of ventilator panel,bedside table and computer keyboard af-ter disinfection in two groups were significantly lower than that before disinfection(t=8.107~26.393,all P<0.05).②Pearson analysis result showed that both before and after disinfection,the fluorescence detection value had no significant cor-relation with colony number of ventilator panel,bedside table and computer keyboard(r=0.199~0.338,all P>0.05).③There were no significant differences in the qualification rate between two groups of ventilator panel,bedside table and com-puter keyboard before and after disinfection(χ2=0.000~1.404,all P>0.05).The qualification rate before the disinfection of ATP group and control group were 0 and 8.9%,and that after disinfection were 86.7% and 91.1%,whose Kappa consis-tency test result showed that the Kappa value was 0.776(95%CI:0.575~0.978)>0.75,so the consistency was quite sat-isfied.Conclusion ATP bioluminescence assay could be used as a rapid and handy preliminary screening to assist bacterial culture method to evaluate the object surface contamination in ICU,and the result was satisfactory and it would be worthy of clinical application.