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Article(id=1241759334456168458, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241759317016252418, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202404030, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1711987200000, receivedDateStr=2024-04-02, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773988096107, onlineDateStr=2026-03-20, pubDate=1727193600000, pubDateStr=2024-09-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773988096107, onlineIssueDateStr=2026-03-20, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773988096107, creator=13701087609, updateTime=1773988096107, updator=13701087609, issue=Issue{id=1241759317016252418, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='18', pageStart='3265', pageEnd='3456', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773988091898, creator=13701087609, updateTime=1773991617194, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241774103024174010, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241759317016252418, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241774103024174011, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241759317016252418, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=3302, endPage=3306, ext={EN=ArticleExt(id=1241759335144034322, articleId=1241759334456168458, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Environmental survelliance multiple respiratory viruses of medical institutions in Changsha City, 2023, columnId=null, journalTitle=Modern Preventive Medicine, columnName=null, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the epidemiologic profile of contamination by multiple respiratory viruses (including influenza virus, rhinovirus, adenovirus, and respiratory syncytial virus) in the environments of medical institutions in Changsha City in 2023, aiming to provide scientific evidence for the formulation of infection control measures.

Methods

A total of 663 environmental samples were collected from 11 medical institutions in Changsha City, encompassing various types such as air, desktops, countertops, trash cans, power switches, door handles, elevator buttons, faucets in washrooms, water dispensers, and other surface swab samples. RT-PCR technology was employed to conduct nucleic acid testing for multiple respiratory viruses. The overall positive rates of respiratory viruses among different types of medical institutions, surveillance areas, and environmental samples were comparatively analyzed.

Results

The study revealed that the overall positive rate of nucleic acids for multiple respiratory viruses in the medical institution environments of Changsha City in 2023 was 10.41%, and the positive rates for influenza virus, rhinovirus, adenovirus, and respiratory syncytial virus were 0.90%, 5.28%, 3.77%, and 0.45%, respectively. Among the different types of medical institutions, general hospitals exhibited the highest positive rate of multiple respiratory viruses, reaching 15.22%, while specialized hospitals and other medical institutions (including welfare hospitals and physical examination institutions) had positive rates of 10.71% and 2.61%, respectively. In terms of surveillance areas, outpatient diagnosis and treatment areas demonstrated the highest overall positive rate of multiple respiratory viruses, standing at 12.50%, while public areas and inpatient wards exhibited lower positive rates. Additionally, swab samples collected from desktops, countertops, and trash cans showed the highest overall positive rate of multiple respiratory viruses, accounting for 15.45%. Samples from other sources, including faucets and water dispensers in washrooms, power switches, elevator buttons, door handles, and air samples, also exhibited varying degrees of positive rates. Statistical analysis demonstrated significant differences in the overall positive rates of multiple respiratory viruses among different types of medical institutions, surveillance areas, and environmental samples (P<0.05).

Conclusion

The presence of multiple respiratory viruses in the environments of medical institutions in Changsha City in 2023 suggests the urgent need for enhanced epidemiologic surveillance and disinfection measures to effectively prevent and control nosocomial infections.

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目的

了解2023年长沙市医疗机构环境中多种呼吸道病毒（流感病毒、鼻病毒、腺病毒、呼吸道合胞病毒）的污染情况，为防控医院感染措施的制定提供依据。

方法

采集长沙市11家医疗机构环境样本(包括空气、桌面、台面、垃圾桶、电源开关、门把手、电梯按键、洗漱间水龙头及饮水机等物表涂抹)共计 663份，利用RT-PCR开展多种呼吸道病毒核酸检测，比较不同类型医疗机构、监测区域和环境样本多种呼吸道病毒总体阳性率差异。

结果

2023年长沙市医疗机构环境中多种呼吸道病毒核酸总体阳性率为10.41%，其中流感病毒、鼻病毒、腺病毒和呼吸道合胞病毒的阳性率分别为0.90%、5.28%、3.77%和0.45%。不同类型医疗机构中，综合医院多种呼吸道病毒阳性率最高（15.22%），专科医院和其他医疗机构（福利医院和体检机构）阳性率分别为10.71%和2.61%。不同类型监测区域中，门诊诊疗区域的多种呼吸道病毒总体阳性率最高（12.50%），公共区域和住院病房阳性率分别为9.78%和5.51%。不同类型样本中，桌面、台面及垃圾桶等涂抹样本多种呼吸道病毒总体阳性率最高（15.45%），洗漱间水龙头和饮水机涂抹、电源开关、电梯按键及门把手等涂抹和空气样本多种呼吸道病毒阳性率分别为10.96%、9.83%和2.94%。不同类型医疗机构、监测区域和环境样本多种呼吸道病毒总体阳性率差异均有统计学意义(P<0.05)。

结论

2023年长沙市医疗机构环境中存在多种呼吸道病毒污染，需要进一步加强环境监测和消毒。

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张如胜，E-mail：
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扶会媛（1991—），女，硕士，主管技师，研究方向：微生物检测

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扶会媛（1991—），女，硕士，主管技师，研究方向：微生物检测

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Nucleic Acid Testing Results for Multiple Respiratory Viruses in the environment of Different Types of Medical Institutions

, figureFileSmall=null, figureFileBig=null, tableContent=
监测项目综合医院专科医院其他医疗机构χ2值P值
样本数
(n)		阳性数
(n)		阳性率
(%)		样本数
(n)		阳性数
(n)		阳性率
(%)		样本数
(n)		阳性数
(n)		阳性率
(%)
流感病毒23031.3028010.3615321.311.8930.386
鼻病毒230187.83280176.0715300.0016.188<0.001
腺病毒230125.22280113.9315321.314.0250.127
呼吸道合胞病毒23020.8728010.3615300.001.2840.610
合计2303515.222803010.7115342.6124.216<0.001
), ArticleFig(id=1241759362490897043, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759334456168458, language=CN, label=表1, caption=

不同类型医疗机构环境中多种呼吸道病毒核酸检测结果

, figureFileSmall=null, figureFileBig=null, tableContent=
监测项目综合医院专科医院其他医疗机构χ2值P值
样本数
(n)		阳性数
(n)		阳性率
(%)		样本数
(n)		阳性数
(n)		阳性率
(%)		样本数
(n)		阳性数
(n)		阳性率
(%)
流感病毒23031.3028010.3615321.311.8930.386
鼻病毒230187.83280176.0715300.0016.188<0.001
腺病毒230125.22280113.9315321.314.0250.127
呼吸道合胞病毒23020.8728010.3615300.001.2840.610
合计2303515.222803010.7115342.6124.216<0.001
), ArticleFig(id=1241759362633503393, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759334456168458, language=EN, label=Table 2, caption=

Nucleic Acid Testing Results for Multiple Respiratory Viruses inthe environment of Different Types of Monitoring Areas

, figureFileSmall=null, figureFileBig=null, tableContent=
监测项目门诊诊疗区域公共区域住院病房χ2值P值
样本数
(n)		阳性数
(n)		阳性率
(%)		样本数
(n)		阳性数
(n)		阳性率
(%)		样本数
(n)		阳性数
(n)		阳性率
(%)
流感病毒35210.2818452.7212700.006.8920.016
鼻病毒352257.1018452.7212753.944.9640.084
腺病毒352174.8318463.2612721.572.6470.262
呼吸道合胞病毒35210.2818421.0912700.001.9020.283
合计3524412.50184189.7812775.5116.4410.017
), ArticleFig(id=1241759362742555308, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759334456168458, language=CN, label=表2, caption=

不同类型监测区域环境中多种呼吸道病毒核酸检测结果

, figureFileSmall=null, figureFileBig=null, tableContent=
监测项目门诊诊疗区域公共区域住院病房χ2值P值
样本数
(n)		阳性数
(n)		阳性率
(%)		样本数
(n)		阳性数
(n)		阳性率
(%)		样本数
(n)		阳性数
(n)		阳性率
(%)
流感病毒35210.2818452.7212700.006.8920.016
鼻病毒352257.1018452.7212753.944.9640.084
腺病毒352174.8318463.2612721.572.6470.262
呼吸道合胞病毒35210.2818421.0912700.001.9020.283
合计3524412.50184189.7812775.5116.4410.017
), ArticleFig(id=1241759362876773047, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759334456168458, language=EN, label=Table 3, caption=

Nucleic Acid Testing Results for Multiple Respiratory Viruses in Different Types of Environmental Samples

, figureFileSmall=null, figureFileBig=null, tableContent=
监测项目空气桌面、台面及垃圾桶等涂抹电源开关、电梯按键及门把手等涂抹洗漱间水龙头和饮水机等涂抹χ2值P值
样本数
(n)		阳性数
(n)		阳性率
(%)		样本数
(n)		阳性数
(n)		阳性率
(%)		样本数
(n)		阳性数
(n)		阳性率
(%)		样本数
(n)		阳性数
(n)		阳性率
(%)
流感病毒13610.7422031.3623410.437311.373.6290.267
鼻病毒13600.00220209.0923493.857368.2214.7480.001
腺病毒13632.2122094.09234125.137311.371.3990.719
呼吸道合胞病毒13600.0022020.9123410.437300.004.5100.102
合计13642.942203415.45234239.8373810.9623.8430.006
), ArticleFig(id=1241759364311225032, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759334456168458, language=CN, label=表3, caption=

不同类型环境样本多种呼吸道病毒核酸检测结果

, figureFileSmall=null, figureFileBig=null, tableContent=
监测项目空气桌面、台面及垃圾桶等涂抹电源开关、电梯按键及门把手等涂抹洗漱间水龙头和饮水机等涂抹χ2值P值
样本数
(n)		阳性数
(n)		阳性率
(%)		样本数
(n)		阳性数
(n)		阳性率
(%)		样本数
(n)		阳性数
(n)		阳性率
(%)		样本数
(n)		阳性数
(n)		阳性率
(%)
流感病毒13610.7422031.3623410.437311.373.6290.267
鼻病毒13600.00220209.0923493.857368.2214.7480.001
腺病毒13632.2122094.09234125.137311.371.3990.719
呼吸道合胞病毒13600.0022020.9123410.437300.004.5100.102
合计13642.942203415.45234239.8373810.9623.8430.006
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2023年长沙市医疗机构环境中多种呼吸道病毒监测分析
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扶会媛 1 , 胡慧琪 2 , 彭佳熠 2 , 罗璨 1 , 陈建勇 1 , 张如胜 1
现代预防医学 | 环境与职业卫生 2024,51(18): 3302-3306
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现代预防医学 | 环境与职业卫生 2024, 51(18): 3302-3306
2023年长沙市医疗机构环境中多种呼吸道病毒监测分析
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扶会媛1, 胡慧琪2, 彭佳熠2, 罗璨1, 陈建勇1, 张如胜1
作者信息
  • 1.长沙市疾病预防控制中心，湖南 长沙 410007
  • 2.南华大学公共卫生学院

    • 扶会媛（1991—），女，硕士，主管技师，研究方向：微生物检测

通讯作者:

张如胜，E-mail：
Environmental survelliance multiple respiratory viruses of medical institutions in Changsha City, 2023
Hui-yuan FU1, Hui-qi HU2, Jia-yi PENG2, Can LUO1, Jian-yong CHEN1, Ru-sheng ZHANG1
Affiliations
  • Changsha Center for Disease Control and Prevention, Changsha, Hunan 410007, China
出版时间: 2024-09-25 doi: 10.20043/j.cnki.MPM.202404030
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摘要
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目的

了解2023年长沙市医疗机构环境中多种呼吸道病毒（流感病毒、鼻病毒、腺病毒、呼吸道合胞病毒）的污染情况，为防控医院感染措施的制定提供依据。

方法

采集长沙市11家医疗机构环境样本(包括空气、桌面、台面、垃圾桶、电源开关、门把手、电梯按键、洗漱间水龙头及饮水机等物表涂抹)共计 663份，利用RT-PCR开展多种呼吸道病毒核酸检测，比较不同类型医疗机构、监测区域和环境样本多种呼吸道病毒总体阳性率差异。

结果

2023年长沙市医疗机构环境中多种呼吸道病毒核酸总体阳性率为10.41%，其中流感病毒、鼻病毒、腺病毒和呼吸道合胞病毒的阳性率分别为0.90%、5.28%、3.77%和0.45%。不同类型医疗机构中，综合医院多种呼吸道病毒阳性率最高（15.22%），专科医院和其他医疗机构（福利医院和体检机构）阳性率分别为10.71%和2.61%。不同类型监测区域中，门诊诊疗区域的多种呼吸道病毒总体阳性率最高（12.50%），公共区域和住院病房阳性率分别为9.78%和5.51%。不同类型样本中，桌面、台面及垃圾桶等涂抹样本多种呼吸道病毒总体阳性率最高（15.45%），洗漱间水龙头和饮水机涂抹、电源开关、电梯按键及门把手等涂抹和空气样本多种呼吸道病毒阳性率分别为10.96%、9.83%和2.94%。不同类型医疗机构、监测区域和环境样本多种呼吸道病毒总体阳性率差异均有统计学意义(P<0.05)。

结论

2023年长沙市医疗机构环境中存在多种呼吸道病毒污染，需要进一步加强环境监测和消毒。

医疗机构  /  环境样本  /  核酸检测  /  阳性率
Objective

To investigate the epidemiologic profile of contamination by multiple respiratory viruses (including influenza virus, rhinovirus, adenovirus, and respiratory syncytial virus) in the environments of medical institutions in Changsha City in 2023, aiming to provide scientific evidence for the formulation of infection control measures.

Methods

A total of 663 environmental samples were collected from 11 medical institutions in Changsha City, encompassing various types such as air, desktops, countertops, trash cans, power switches, door handles, elevator buttons, faucets in washrooms, water dispensers, and other surface swab samples. RT-PCR technology was employed to conduct nucleic acid testing for multiple respiratory viruses. The overall positive rates of respiratory viruses among different types of medical institutions, surveillance areas, and environmental samples were comparatively analyzed.

Results

The study revealed that the overall positive rate of nucleic acids for multiple respiratory viruses in the medical institution environments of Changsha City in 2023 was 10.41%, and the positive rates for influenza virus, rhinovirus, adenovirus, and respiratory syncytial virus were 0.90%, 5.28%, 3.77%, and 0.45%, respectively. Among the different types of medical institutions, general hospitals exhibited the highest positive rate of multiple respiratory viruses, reaching 15.22%, while specialized hospitals and other medical institutions (including welfare hospitals and physical examination institutions) had positive rates of 10.71% and 2.61%, respectively. In terms of surveillance areas, outpatient diagnosis and treatment areas demonstrated the highest overall positive rate of multiple respiratory viruses, standing at 12.50%, while public areas and inpatient wards exhibited lower positive rates. Additionally, swab samples collected from desktops, countertops, and trash cans showed the highest overall positive rate of multiple respiratory viruses, accounting for 15.45%. Samples from other sources, including faucets and water dispensers in washrooms, power switches, elevator buttons, door handles, and air samples, also exhibited varying degrees of positive rates. Statistical analysis demonstrated significant differences in the overall positive rates of multiple respiratory viruses among different types of medical institutions, surveillance areas, and environmental samples (P<0.05).

Conclusion

The presence of multiple respiratory viruses in the environments of medical institutions in Changsha City in 2023 suggests the urgent need for enhanced epidemiologic surveillance and disinfection measures to effectively prevent and control nosocomial infections.

Medical institutions  /  Environmental samples  /  Nucleic acid testing  /  Positive rate
扶会媛, 胡慧琪, 彭佳熠, 罗璨, 陈建勇, 张如胜. 2023年长沙市医疗机构环境中多种呼吸道病毒监测分析. 现代预防医学, 2024 , 51 (18) : 3302 -3306 . DOI: 10.20043/j.cnki.MPM.202404030
Hui-yuan FU, Hui-qi HU, Jia-yi PENG, Can LUO, Jian-yong CHEN, Ru-sheng ZHANG. Environmental survelliance multiple respiratory viruses of medical institutions in Changsha City, 2023[J]. Modern Preventive Medicine, 2024 , 51 (18) : 3302 -3306 . DOI: 10.20043/j.cnki.MPM.202404030
正文
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呼吸道病毒（Respiratory virus）是指能侵犯呼吸道并且可以导致呼吸道病变或者以呼吸道途径感染而引起呼吸道之外组织器官病变的病毒[1]。前者如流感病毒（Influenzaviruses,Flu）、鼻病毒（Human rhinovirus,HRV）、腺病毒（Adenovirus,AdV）、呼吸道合胞病毒（Respiratory syncytial virus,RSV）、人冠状病毒（Human coronavirus,hCoV）等；后者如麻疹病毒、风疹病毒、腮腺炎病毒等。呼吸道病毒多数在空气中以气溶胶和飞沫的形式进行传播，传染性强，人群普遍易感，感染者的主要表现为发热、流鼻涕、咳嗽等[2]。2014年一项医院感染横断面的调查中显示，医院感染现患率为2.67%，其中下呼吸道医院感染占比最高（47.53%），高于泌尿道（11.56%）和手术部位（10.41%）的医院感染[3]。大部分呼吸道传染病传播快、范围广、防控难度高，如果不及时采取防控措施，容易造成大规模的爆发流行，给社会公共卫生造成巨大压力[4]。
患者在医疗机构就诊过程中容易将病原体污染到诊疗场所环境中，从而引发医院感染的发生。英国一项研究对甲型H1N1流感患者所在的区域进行空气采样，检测发现空气标本中流感病毒核酸有阳性，表明患者感染病毒能进一步扩散到环境中[5]。中国台湾研究发现[6]，流感患者发生与空气质量高低有密切关联。根据佛山市医院儿科门诊环境中呼吸道病原微生物的一项调查研究显示，儿科环境物表、手表面及空气滤膜340份样本，分别检测出了流感病毒、呼吸道合胞病毒、鼻病毒，呼吸道阳性样本36份，阳性率为10.39%，由此可见，医院的环境中存在着呼吸道致病微生物的污染[7]。如果不及时加强医疗机构环境监测和消毒，容易造成医院感染率上升、爆发流行等[8]。另外流感病毒也是我国最常见的医院感染病原体[9]。
目前，综合医院患者集中，病人免疫力下降，易感人群数量大，承受着更大的流行风险，这些因素都可能导致呼吸道病毒院内传播和交叉感染[10]。医疗机构院感部门开展医院感染相关细菌耐药监测的研究报道较多[11]，根据《医院消毒卫生标准》（GB15982-2012），疾病预防控制部门日常主要针对医疗机构各类环境空气、物体表面及医务人员手开展菌落总数监测，暂未开展医疗机构环境中呼吸道病毒的日常监测。为了解辖区医疗机构环境中多种呼吸道病毒的污染情况，为医疗机构诊疗场所环境消毒和感染控制措施的制定提供依据。本研究开展了2023年长沙市医疗机构环境中流感病毒、鼻病毒、腺病毒及呼吸道合胞病毒多种呼吸道病毒分子监测研究，现报告如下。
1　材料与方法
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1.1　监测点选择
本研究根据2023年长沙市医院消毒日常监测方案，选取11家医疗机构（其中综合医院3家、专科医院4家、福利医院和体检机构等其他医疗机构4家）开展环境中流感病毒、鼻病毒、腺病毒、呼吸道合胞病毒多种呼吸道病毒监测。每家医疗机构选择门诊诊疗区域、住院病房和公共区域（洗漱间、走廊等）等人员流动频繁的区域作为监测采样区域，然后在不同监测采样区域开展空气及高频接触物体表面涂抹样本采集。
1.2　样本采集
2023年共采集11家医疗机构环境样本663份，其中空气样本136份、高频接触物体表面涂抹样本527份。空气样本采集：选择人员流动频繁的不同监测区域作为空气采样点，使用便携式生物气溶胶采样器（北京鼎蓝科技有限公司，型号：WA-400Ⅱ）和非灭活型病毒采样管（北京友康生物科技股份有限公司，货号：MT0301-2）在每个采样点采集10 min，采样过程中需保持采样器进风口距地面1.5 m左右，将空气样本自动收集到3.5 mL采样液中，具体采集方法参照仪器使用说明书，每个采样区域采集2~3份空气样本。物体表面涂抹样本采集：用蘸有采样液的带有聚丙烯纤维头的拭子反复涂抹擦拭高频接触部位至少5次以上，每个监测采样区域的高频接触物表每次至少采集1份涂抹样本。样本采集后在4 ℃条件下4 h内运送至长沙市疾病预防控制中心实验室，用于核酸检测的空气和其他环境样本应当尽快进行检测。
1.3　核酸检测
利用病毒DNA/RNA提取试剂盒（环境样本专用）（西安天隆科技有限公司，货号：T810）对医疗机构环境样本开展核酸提取，吸取400 μL充分混匀后的环境样本加至裂解液中，利用磁珠法核酸提取仪（西安天隆科技有限公司，型号：GeneRotex 96）自动提取样本核酸，流感病毒甲、乙型双重核酸检测试剂盒（深圳生科原生物技术公司）、鼻病毒核酸检测试剂盒、腺病毒核酸检测试剂盒及呼吸道合胞病毒核酸检测试剂盒（深圳市梓健生物有限公司）对提取的环境样本核酸在Applied Biosystems QuantStudio 5 Q5荧光定量PCR仪（Applied biosystems Thermofisher）进行核酸扩增，扩增条件及结果判定参照试剂盒说明书。
1.4　数据分析
将数据导入Excel 2019软件进行整理，采用SPSS 27.0软件进行统计分析，不同类型的医疗机构、监测区域和环境样本阳性率比较采用精确χ2检验，以P<0.05为差异有统计学意义。
2　结果
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2.1　医疗机构环境中多种呼吸道病毒核酸检测总体情况
2023年共采集长沙市11家医疗机构环境样本663份，共检出多种呼吸道病毒核酸阳性样本69份（总体阳性率为10.41%），其中流感病毒6份（阳性率为0.90%）、鼻病毒35份（阳性率为5.28%）、腺病毒25份（阳性率为3.77%）、呼吸道合胞病毒3份（阳性率为0.45%）。其中鼻病毒阳性率最高，多种呼吸道病毒的检出情况具有统计学意义（χ2=44.370，P<0.001）。
2.2　不同类型医疗机构环境中多种呼吸道病毒检出情况
不同类型医疗机构环境检测结果显示：综合医院多种呼吸道病毒总体阳性率最高（15.22%），其次为专科医院（10.71%），再次为其他医疗机构（2.61%），不同类型医疗机构环境中多种呼吸道病毒总体阳性率差异有统计学意义（χ2=24.216，P<0.001），见表1。
2.3　不同类型监测区域环境中多种呼吸道病毒检出情况
不同类型监测区域结果显示：门诊诊疗区域的多种呼吸道病毒总体核酸阳性率最高（12.5%）、其次为公共区域（9.78%）、再次为住院病房（5.51%）。医疗机构不同类型监测区域环境中多种呼吸道病毒总体阳性率差异有统计学意义（χ2=16.441，P=0.017），见表2。
2.4　不同类型环境样本多种呼吸道病毒核酸检测情况
环境样本检测结果显示：桌面、台面及垃圾桶等涂抹样本多种呼吸道病毒总体核酸阳性率最高（15.45%）、其次为洗漱间水龙头和饮水机等涂抹样本（10.96%）、再次为电源开关、电梯按键及门把手等涂抹样本（9.83%）和空气样本（2.94%）。不同类型环境样本多种呼吸道病毒核酸总体阳性率差异有统计学意义（χ2=23.843，P=0.006）。见表3。
3　讨论
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全国医院感染横断面调查显示，2014年我国医院感染现患率为2.67%[3]，2018年为3.12%[13]。医院感染给患者和医院带来较大的经济损失，有研究指出，医院感染直接导致患者住院费用增加13 839元[14]。感染控制是医疗机构、重点场所预防呼吸道传染病和阻断传播最有效的手段之一[15]。开展医院感染病原体监测是防控医院感染发生的重要措施之一，例如新冠肺炎防控期间，部分地区开展了医疗机构诊疗环境新冠病毒分子监测[16]，为新冠肺炎医院感染防控提供了依据。如在新冠疫情前后，湖南省一家综合三甲医院通过对住院儿童呼吸道合胞病毒感染情况进行分析发现，疫情防控初期，RSV感染降低，放开后出现波动小高峰[17]。在后疫情时代，本研究开展医疗机构环境中多种呼吸道病毒分子监测，对医院感染措施制定具有一定的指导意义。
本研究显示，2023年长沙市医疗机构环境中多种呼吸道病毒核酸总体阳性率为10.41%，其中鼻病毒在四种呼吸道病毒中阳性率最高（5.28%），这与银川市下呼吸道感染的1项研究报道结果相似[18]。根据湖南省发热呼吸道症候群监测研究结果显示，各个年龄段的病原构成具有统计学差异，在2012—2014年监测的8种病毒中，阳性检出率47.45%，AdV检出率最高，其次分别为RSV、Flu、HRV、hCoV、副流感病毒（ParainfluenzaVirus,PIV）、人偏肺病毒（Human metapneumovirus,HMPV）、人博卡病毒（Bocavirus,hBoV）[19]。在不同类型监测区域中，门诊诊疗区域鼻病毒的阳性率为7.10%，在不同类型环境样本中，鼻病毒在桌面、台面及垃圾桶等涂抹样中阳性率最高，提示鼻病毒在医疗机构环境中可能更容易流行和传播，提醒患者就医时应做好个人防护措施，佩戴口罩，注意手卫生。
综合医院是重要医疗资源，医疗配套设施齐全是各类疾病患者就医的首选。本研究显示，综合医院环境中多种呼吸道病毒总体阳性率最高（15.22%），原因可能与综合医院感染多种呼吸道病毒的就诊患者数量相比其他类型医疗机构（体检机构、福利医院和专科医院）多，就医群体复杂，导致了环境中多种呼吸道病毒污染增加。在2011—2012年一项湖南省急性呼吸道感染研究中[20]，通过对流感哨点医院监测样本发现，病毒感染率为35.8%，流感的感染率最高，其次为鼻病毒、腺病毒、呼吸道合胞病毒。检验结果提示需要引起综合医院院感部门的密切关注，在患者就诊中应严格进行预检分诊，防控呼吸道病毒医院感染的发生。
门诊诊疗区域人流量大，人员复杂，门诊大厅一般设有挂号、咨询、缴费等业务，是患者就医的第一站，本研究显示门诊诊疗区域多种呼吸道病毒核酸阳性率最高（12.50%），在长沙市长沙县地区门诊一项研究显示[21]，患者病原体检出率52.93%，主要的呼吸道病原体依次为FluB、HRV、FluA、RSV、ADV和肺炎支原体（M.Pneumonia, MP），提示门诊诊疗区域多种呼吸道病毒的污染较为常见，导致交叉污染、互相传染的概率增加，提醒医疗机构院感部门应严格执行医院环境消毒措施，必要时增加对门诊诊疗区域的环境清洁消毒频次。
既往研究显示，2020年疫情早期，从171份武汉火神山医院病区环境样本中检出1份床栏涂抹样本阳性,阳性率为0.58%[22]。本研究显示桌面、台面及垃圾桶等涂抹样本多种呼吸道病毒核酸阳性率最高（15.45%），如医生诊室办公桌面，挂号窗口台面、护士站台面这些地方都是患者就医的高频接触点，不同的人反复接触，容易发生交叉污染，提示对于高频接触的桌面、台面及垃圾桶表面应该加强消毒，必要时增加消毒频次，避免反复触摸导致交叉污染；其次是洗漱间水龙头及饮水机涂抹样本核酸阳性率较高（10.96%），原因可能与感染者在洗漱间洗漱时，感染者手上污染的病毒在开关水龙头时造成交叉污染，提示在医院消毒措施中应增加电梯按键、洗漱间等公用设备设施和门把手等高频接触物表部位的消毒频次，重点增加洗漱间水龙头表面的消毒频次或使用感应式水龙头（避免接触）。另外本研究从医疗机构空气样本中检出多种呼吸道病毒，进一步说明医疗机构诊疗场所应确保有效通风换气及空气消毒效果，特别是在通风不良,且与感染病例有关联的环境使用空调通风系统时，其卫生质量、运行管理、卫生学评价和清洗消毒等应符合《公共场所集中空调通风系统卫生规范》（WS394）、《公共场所集中空调通风系统卫生学评价规范》（WS/T395）和《公共场所集中空调通风系统清洗消毒规范》（WS/T396）的要求，避免引起医疗机构呼吸道病毒的气溶胶传播。
总之，医疗机构应构建“预防为主、防治结合”的医院感染防控管理制度，落实门急诊预检分诊制度，做好患者分流和医院感染措施宣传，与此同时，各医疗机构还应增加诊疗区域环境通风和消毒频次，督促医务人员做好个人防护和手卫生，降低呼吸道病毒医院感染发生的风险[23]。
基金
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  • 湖南省自然科学基金(2023JJ60399)
  • 湖南省卫生健康委科研计划课题(202212064269)
文献
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2024年第51卷第18期
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doi: 10.20043/j.cnki.MPM.202404030
  • 接收时间：2024-04-02
  • 首发时间：2026-03-20
  • 出版时间：2024-09-25
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  • 收稿日期：2024-04-02
基金
湖南省自然科学基金(2023JJ60399)
湖南省卫生健康委科研计划课题(202212064269)
作者信息
    1.长沙市疾病预防控制中心，湖南 长沙 410007
    2.南华大学公共卫生学院

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2种不同金属材料的力学参数
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Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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