Health Sciences, Illinois State University, Normal, Illinois 61790, USA.
J Occup Environ Hyg. 2011 Feb;8(2):104-12. doi: 10.1080/15459624.2011.547453.
Fumigation of hospital rooms with high concentrations of toxic chemicals has been proposed to reduce microbial agents on hospital surfaces and to control infections. Chemical fumigation has been used effectively in other areas, such as building decontamination after bioterrorism events, in agriculture, and in residential structures. However, even in these situations, there have been incidents where fumigants have escaped, causing illness and death to exposed workers and the public. Before expanding the use of a potentially hazardous technology in areas where there are vulnerable individuals, it is important to fully weigh benefits and risks. This article reviews the effectiveness of fumigation as a method of inactivating microbes on environmental surfaces and in reducing patient infection rates against the potential risks. Peer-reviewed literature, consensus documents, and government reports were selected for review. Studies have demonstrated that fumigation can be effective in inactivating microbes on environmental surfaces. However, the current consensus of the infection control community is that the most important source of patient infection is direct contact with health care workers or when patients auto-infect themselves. Only one peer-reviewed, before-after study, at one hospital reported a significant reduction in infection rates following chemical fumigation. The limitations of this study were such that the authors acknowledged that they could not attribute the rate reduction to the fumigation intervention. A serious concern in the peer-reviewed literature is a lack of evidence of environmental monitoring of either occupational or non-occupational exposures during fumigation. Currently, there are neither consensus documents on safe fumigation exposure levels for vulnerable bedridden patients nor sampling methods with an acceptable limit of detection for this population. Until additional peer-reviewed studies are published, demonstrating significant reductions in patient infection rates following chemical fumigation and consensus guidance on the safe exposure levels and monitoring methods, chemical fumigation in health care should be conducted only in the most stringently controlled research settings.
对医院病房进行高浓度有毒化学物质熏蒸，以减少医院表面微生物，并控制感染，这种做法已被提议。化学熏蒸已在其他领域得到有效应用，如生物恐怖袭击事件后的建筑物净化、农业和住宅结构。然而，即使在这些情况下，也有过熏蒸剂逸出的事件，导致暴露于熏蒸剂的工人和公众生病和死亡。在将这种潜在危险技术扩展到有弱势群体的地区之前，充分权衡利弊非常重要。本文回顾了熏蒸作为一种灭活环境表面微生物和降低患者感染率的方法的有效性，同时评估了其潜在风险。本文选取同行评议文献、共识文件和政府报告进行综述。研究表明，熏蒸可以有效灭活环境表面的微生物。然而，感染控制界目前的共识是，患者感染的最重要来源是直接接触医护人员或患者自身感染。只有一项在一家医院进行的、经过同行评议的、前后对照研究报告称，在进行化学熏蒸后，感染率显著降低。由于该研究存在局限性，作者承认他们无法将感染率降低归因于熏蒸干预。在同行评议文献中，一个严重的问题是缺乏熏蒸过程中职业或非职业暴露的环境监测证据。目前，对于卧床不起的弱势患者，既没有关于安全熏蒸暴露水平的共识文件，也没有针对该人群可接受检测极限的采样方法。在发表更多经过同行评议的研究、证明化学熏蒸后患者感染率显著降低，以及针对安全暴露水平和监测方法的共识指南之前，医疗保健中的化学熏蒸应仅在最严格控制的研究环境中进行。
