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常婧, 党芸, 王春丽, 等. 过氧化氢定期消毒结合持续消毒对口腔综合治疗台水路污染控制的有效性观察[J]. 四川大学学报(医学版), 2024, 55(1): 217-223. DOI: 10.12182/20240160210
引用本文: 常婧, 党芸, 王春丽, 等. 过氧化氢定期消毒结合持续消毒对口腔综合治疗台水路污染控制的有效性观察[J]. 四川大学学报(医学版), 2024, 55(1): 217-223. DOI: 10.12182/20240160210
CHANG Jing, DANG Yun, WANG Chunli, et al. Effect of Using Hydrogen Peroxide for Periodic Disinfection Combined With Continuous Disinfection to Control Contamination in Dental Unit Waterline[J]. Journal of Sichuan University (Medical Sciences), 2024, 55(1): 217-223. DOI: 10.12182/20240160210
Citation: CHANG Jing, DANG Yun, WANG Chunli, et al. Effect of Using Hydrogen Peroxide for Periodic Disinfection Combined With Continuous Disinfection to Control Contamination in Dental Unit Waterline[J]. Journal of Sichuan University (Medical Sciences), 2024, 55(1): 217-223. DOI: 10.12182/20240160210

过氧化氢定期消毒结合持续消毒对口腔综合治疗台水路污染控制的有效性观察

Effect of Using Hydrogen Peroxide for Periodic Disinfection Combined With Continuous Disinfection to Control Contamination in Dental Unit Waterline

  • 摘要:
    目的 观察过氧化氢定期消毒结合持续消毒对国内口腔综合治疗台水路污染控制的有效性,为选择水路消毒措施提供参考依据。
    方法 采用便利抽样法选择某口腔专科医院4台口腔综合治疗台。采用每4周1次的定期消毒结合持续消毒的方式对口腔综合治疗台水路进行消毒(口腔综合治疗台停用超3 d则额外增加1次定期消毒)。定期消毒指利用口腔综合治疗台自带的水路消毒装置使过氧化氢复合消毒剂原液(质量体积比为1.4%的过氧化氢)在水路中充盈,浸泡消毒24 h后排空。持续消毒指以质量体积比0.014%过氧化氢溶液作为诊疗用水,并在开诊前用其冲洗水路2 min,每次诊疗结束后用其冲洗水路30 s。研究持续25周,定期消毒7次,其余诊疗时间进行持续消毒。第1次消毒当日未使用消毒液时(基线)和消毒期间采集高速牙科手机和三用枪出水口水样,细菌培养后计算菌落总数和合格率,水样菌落总数≤100 CFU/mL即为合格水样;第1次消毒当日未使用消毒液时(基线)、消毒25周后分别采集1台口腔综合治疗台的高速牙科手机供水管路各1 cm,扫描电镜下观察生物膜形态。
    结果 共采集水样352份,基线水样8份,菌落总数中位数为3140 CFU/mL,消毒后第1日诊疗用水菌落总数中位数为7.5 CFU/mL,消毒前后诊疗用水菌落总数差异有统计学意义(P=0.012);消毒后水样344份,三用枪和高速牙科手机水样菌落总数中位数为11 CFU/mL和11 CFU/mL,菌落总数差异无统计学意义;合格率分别为83.7%(144/172)和82.0%(141/172),合格率差异无统计学意义;消毒第1至9周期间,除第3周外,其余8周诊疗用水合格率均大于80%。在第14周至17周、第18至21周的2个定期消毒周期内,仅前2周合格率保持在80%以上,从第3周开始下降。扫描电镜下观察生物膜形态,基线的生物膜结构致密,有大量细菌混合;消毒25周后,生物膜结构疏松,未见大量细菌留存的连贯性特征。
    结论 过氧化氢定期消毒结合持续消毒的方式,可有效控制口腔综合治疗台水路污染,但需结合实际情况,进一步探讨定期消毒周期及持续消毒时过氧化氢浓度。

     

    Abstract:
    Objective To observe the effect of using hydrogen peroxide in periodic disinfection combining with continuous disinfection of dental unit waterlines and to provide references for the selection of waterway disinfection measures.
    Methods  A total of 4 dental units in a hospital of stomatology were selected through convenience sampling. The dental unit waterlines received periodic disinfection once every 4 weeks in addition to continuous disinfection (When the dental units were not used for more than 3 days, an additional periodic disinfection would be performed.). Periodic disinfection referred to filling up the waterlines with a disinfectant solution (1.4% hydrogen peroxide) by using the waterline disinfection device that came with the dental unit, immersing for 24 hours, and then emptying out the disinfectant solution. Continuous disinfection referred to using hydrogen peroxide at a concentration of 0.014% as dental treatment water and using it to flush the waterlines for 2 minutes before any dental treatment in the morning and to flush the waterlines for 30 seconds after each dental treatment. The study lasted for 25 weeks, with periodic disinfection being performed for 7 times and continuous disinfection carried out for the rest of the dental treatment time. During the 25 weeks, water samples were collected from air/water syringes and high-speed handpieces. Then, the water samples were incubated and the bacterial concentration and the qualification rates were calculated accordingly. When the bacterial concentration≤100 CFU/ mL, the water samples were considered to be qualified. Waterline tubes of 1 cm were collected before and after the 25 weeks of disinfection with hydrogen peroxide. Biofilms in the waterline tube were observed under scanning electron microscope.
    Results  A total of 352 water samples were collected. Eight water samples were collected before disinfection with hydrogen peroxide, with the median of bacterial concentration being 3140 CFU/mL. On the first day of disinfection with hydrogen peroxide, the median bacterial concentration in dental treatment water was 7.5 CFU/mL. There was a significant difference between the bacterial concentration of the water samples before the disinfection and that after the disinfection (P=0.012). A total of 344 water samples were collected after the disinfection, with the median bacterial concentrations for air/water syringes and high-speed handpieces being 11 CFU/mL and 11CFU/mL and the qualified rates being 83.7% and 82.0%, respectively. There was no significant difference in bacterial concentration or the qualification rates. During week 1 through week 9 of the disinfection, the qualification rates of the dental treatment water always exceeded 80% in 8 weeks, with week 3 being the exception. In the two four-week disinfection periods of week 14 through week 17 and week 18 through week 21, the qualification rate was maintained at above 80% for only the first two weeks and started to decrease from the third week. Biofilm morphology was observed under scanning electron microscope. Before the disinfection, the biofilm was found to be a dense structure and the mixture of a large number of bacteria. After 25 weeks of the disinfection, the biofilm structure appeared to be loose and did not show consistent characteristics of a large number of bacteria retained.
    Conclusion  Periodic disinfection combined with continuous disinfection using hydrogen peroxide can effectively control contamination in dental unit waterlines. But the cycles of periodic disinfection and the concentration of hydrogen peroxide for continuous disinfection should be further discussed according to the actual clinical situation.

     

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