Liguori G, Spagnoli G, Agozzino E, Marinelli A, Signoriello G, Lucariello A, Albano L, Di Onofrio V, Cammarota B, Capozza G, Lombardi R, Marinelli P
Cattedra di Igiene ed Epidemiologia, Fac. di Scienze Motorie, Università degli Studi di Napoli "Parthenope".
Ann Ig. 2005 Sep-Oct;17(5):385-400.
The authors present an environmental microbiological monitoring programme carried out over a period of 15 months in 16 operating theatres performing specific types of surgery. The levels of microbial contamination of the air and of four of the most representative surfaces of the clean area were determined at 3 different times for each theatre, both before and during surgery. For the air assessment, the results obtained with three different samplers, Sed-3 Unit, SAS and RCS, were compared. The results were on the whole acceptable, but some poor conditions were detected during the theatres in use, especially in general surgery theatres; in some of these the floors showed levels of contamination consistently exceeding the reference limits. As the monitoring programme proceeded, the microbiological quality of the air and of the surfaces in the theatres notably improved. The three air samplers showed different conditions expressed with units of measure not always readily comparable. For active samplers, the bacterial load determined by RCS, although less variable, were always higher (even 2-3 fold) than those obtained with the SAS. Passive sampling takes longer but determines the real risk of infection for the patients; contemporary determination of the fall-out and the CFU/m3 helps to identify the occupational risks. Since the limit values established by the ISPESL guidelines for the operating theatres have been defined only for active samplers, there is urgent need for more exhaustive national guidelines to define similar values also for passive sampling. The Authors conclude stressing the importance of promoting continuing information-education programmes to heighten the awareness of all those involved in operating theatre activities.
作者介绍了一项在16个进行特定类型手术的手术室中开展的为期15个月的环境微生物监测计划。在每个手术室手术前和手术期间的3个不同时间点，测定了空气以及清洁区域4个最具代表性表面的微生物污染水平。对于空气评估，比较了使用三种不同采样器（Sed-3 Unit、SAS和RCS）获得的结果。总体而言，结果是可接受的，但在使用中的手术室检测到了一些较差的情况，尤其是在普通外科手术室；其中一些手术室的地板污染水平持续超过参考限值。随着监测计划的推进，手术室空气和表面的微生物质量显著改善。三种空气采样器显示出不同的情况，其测量单位并不总是易于比较。对于主动采样器，RCS测定的细菌载量虽然变化较小，但总是高于（甚至高出2至3倍）SAS获得的细菌载量。被动采样耗时更长，但能确定患者真正的感染风险；同时测定沉降物和每立方米菌落形成单位有助于识别职业风险。由于意大利国家职业卫生与安全研究所（ISPESL）指南为手术室设定的限值仅针对主动采样器，因此迫切需要更详尽的国家指南来为被动采样也定义类似的值。作者强调了促进持续的信息教育计划以提高所有参与手术室活动人员意识的重要性。
