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歐洲國家醫院手術室氣環境控制標準

19-05-24

OUZHOUGUOJIAYIYUANSHOUSHUSHIQIHUANJINGKONGZHIBIAOZHUN

醫院的環境控制除了舒適性要求以外,更要滿足醫療過程與感染控制要求,以及降低投資與運行費用。盡管各國醫院相關標準表述不一,但醫院環境控制的宗旨是一致的。醫院是多種病原與易感人群高度集合、混雜的一個特殊場所,醫院無菌室無塵車間,各國標準始終對院內感染予以極大的重視。醫院最難于控制的是氣溶膠傳染與手術部位感染(surgical site infection)。

JINNIANLAIGANRANKONGZHICHUXIANXINGUANNIAN,GEGUOBIAOZHUNZHONGTICHULEXIANGYINGDEJISHUCUOSHI,JIANGDILEYIYUANTOUZIYUYUNXINGFEIYONG。BIZHEZAIWENXIAN[1]ZHONGJIESHAOLE《YIYUANNUANTONGKONGDIAOSHEJIYUYUNXINGZHINAN(CAOAN)》 (Guidelines(draft): Designing and OperatingHeating, Ventilation and Air Conditioning in Hospi-tals),GAICAOANSHIYOUDEGUOYILIAOWEISHENGXIEHUIDGKH,RUISHIYILIAOWEISHENGXIEHUISGSHHEAODILIWEISHENG、WEISHENGWUJIYUFANGYIXUEHUI8GHMPSANJIAZHUANYEJIGOUZHICHI,BAOKUOWEISHENGWUXUE、WEISHENGXUEHEGONGCHENGXUEDENGDUOXUEKEDENUANTONGKONGDIAOGONGZUOZUZHIDINGQICAODEZHIDAOYIYUANHEWAIKEMENZHENNEIKONGDIAOXITONGSHEJI、JIANZAO、ANZHUANGHEYUNXINGDEJISHUGUIFAN。

2002 NIANZAIBOLINYIHUANGYEXINGSHIGONGBULEDISANGAOBINGKANDENGZAI2002NIAN《WEISHENGYUYILIAO》ZAZHI(Hygiene und Medizin)SHANG[2], GONGGONGZHONGPINGLUN。GAIZHINANBUSHIYAOTIDAIGUOJIAJISHUDAOZE,ZHISHIZUOWEIXIANGYINGZHINANHUOBIAOZHUNXIUDINGJICHU,ZAISHIJIANZHONGBEIYINYONG,SIKAOYUYUANYOUDEZHUNZEHUOGUIFANZHONGBUYIZHIDEFANGMIAN。HOULAIHELANWEISHENGSHESHIWEIYUANHUINBHFYECANJIACIXIANGGONGZUO。YOUYUPINGLUNFANKUIYIJIANXIANGZUO,NANYIDACHENGYIZHIYIJIAN,SUOYIZHIJINGAIZHINANSHANGWEIXINGCHENGZHENGSHIWENBEN。 YOUYUDANGSHIQIWANGGAIZHINANZUOWEIOUZHOUYIYUANBIAOZHUNZHIDINGDEJICHU,YINCIWOGUOYIXIEYIYUANYIJIXIANGGUANDESHEJIYUAN、GONGCHENGGONGSIWUCHENGGAIZHINANWEIOUZHOUYIYUANBIAOZHUN,BINGDUICIGANXINGQU,YOUYUZILIAOLAIYUAN、FANYIHUOLIJIESHANGDEZHONGZHONGWENTI,ZAOCHENGLEYIXIEWUJIE,SHENZHIZAISHEJIYUSHIGONGSHANGCHUXIANYIXIEBUTUODEZUOFA。WEICIBENWENGENJUDUONIANDEJISHUJILEIJIUXIANGGUANDEOUZHOUGEBIAOZHUNZUOYIJIESHAO。 

 1.OUZHOUGUOJIAYIYUANDEXIANGGUANBIAOZHUN OUZHOUBIAOZHUNYINGYOUOUZHOUBIAOZHUNWEIYUANHUI(Europen Cmmitte for Sandardizatin)FUZEZHIDING HUOZUZHIBIANXIE。WEICIFUZEJIANZHUTONGFENGDEOUZHOUBIAOZHUNWEIYUANHUI156JISHUWEIYUANHUI(Tehnical Committee),JIANCHENGCEN/TC 156,TEDITONGYICHENGLI13GONGZUOZU(Working Group)ZHUANMENFUZEZHIDINGYIYUANTONGFENGBIAOZHUN。OUZHOUBIAOZHUNCHUANTONGSHEJIDEFANWEISHIOUZHOUDALU,DEGUOBIAOZHUNYINGXIANGJIAODA,YINGGUOBIAOZHUN3]HEELUOSIBIAOZHUN[4YINGXIANGJIAOXIAO,YIYOULINGWENXUSHU,BENWENBUZUOJIESHAO。DEGUOBIAOZHUNCAOANWANGWANGYIHUANGYEXINGSHIGONGBU,ERZHENGSHIBIAOZHUNYIBAIYEXINGSHIBANBU。 GUOQUOUZHOUYIYUANFANGMIANDETONGFENGKONGDIAOBIAOZHUNZHUYAOCANZHAODEGUOBIAOZHUNDIN1946《TONGFENGYUKONGDIAO》DI4BUFEN“YIYUANTONGFENGKONGDIAO”,DUICIBIZHEZAIWENXIAN[5]ZHONGYIZUOLEJIESHAO。

自DIN1946第4部分1989 年頒布以來,在1999年3月就開始修訂,于2005年4月頒布了修訂草案第-稿,于2007 年7月頒布修訂草案第二稿。但幾次修訂結果并不令人滿意。因此許多國家或組織公布或修訂了自己的準則、指南或標準。醫院標準往往將手術部作為其闡述的重點。 在2000年,羅伯特科赫研究所發表了關于衛生學的新準則[6]。從醫療角度出發,對醫療環境控制提出了要求,特別對用在手術室的HVAC系統提出以下要求,奠定了基本原則。 

足球比分网  (1)DANXIANGLIUTONGFENGFANGSHIDUIYUYOUGAOGANRANFENGXIANWUJUNSHOUSHUJIERENSHIBIYAODE。

 (2)SONGFENGTIANHUACHICUNYINGYIJUSHOUSHUJIERENLEIXINGERDING。TONGCHANG,SHOUSHUTAIYUQIXIEZHUOYINGGAISHOUDAOBAOHU。

(3) IJIFANGJIAN(DIN1946-4GUIDING)YINGGAIJIANZAISHOUSHUBULI。 SHANGSHUDEYOUDEGUO、RUISHI、AODILISANGUOYILIAOWEISHENGXIEHUIQICAODE《YIYUANWEISHENGZHINAN(CAOAN)》 SHIYU2002NIANGONGBUDE,

GAIZHINANYOURUXIATEDIAN: (1)RENWEIJIANG“KONGDIAOXITONGZUOWEISONGFENGWURANYUAN”SHIZAILINIANSHANGTUPO,ZHIYOUZHEYANGCAINENGCHEDIJIEJUESHINEIXUANFUJUNDUISHUHOUGANRANDEYINGXIANG。

 (2)TICHULE“HEFENGKONGDIAO”(gentle air conditioning)GAINIAN,YIDISU、WENDING、SHUSHIDEQILIUJINXINGKONGDIAO,KAOSHINEILENG(RE)FUSHEMIANHUANRELAIJIANGDISONGFENGLIANG,ZHEYANGSONGFENGLIANGKEJIANGDAOJINYONGYUGONGYANG、JIANGSHI、CHUYIWEIHEWURANWU,HUOZAITEDINGQUYUFANGZHIGANRANDEFENGLIANG。BUJINTIGAOSHUSHIDU,ERQIEHUANJIANGDITOUZIYUYUNXINGFEIYONG。 aGONGBEIYUGUANYIZHIGUANJIEZHIHUANSHOUSHU,KONGQIBUSHINENGYINQIJU 

 (3)LINCHUANGHEWEISHENGWUXUEYANJIUBIAOMING,DUIYUFEIQIGUANYIZHI、GUANJIEZHIHUANSHOUSHU,KONGQIBUSHINENGYINQIJUBUSHUHOUGANRANDEWEISHENGWUZISHENGDESHIYIHUANJINGYINSU,YICILILUNKEJIANGDIDUIYIBANSHOUSHUSHI HUANJINGKONGZHIYAOQIU。

 (4)TICHU“WEICHIDONGTAIBAOHUQUYU”LINIAN,YONGJINGGAOXIAOGUOLVDEJIEJING、WUJUNDANXIANGLIUQILIU(CHUFENGTUANLIUDU<5%)LONGZHAOZHUSHOUSHUTAIHEQIXIEZHUOZHOUWEIDESHOUSHUQUYU(JIBAOHUQUYU),YAOQIUBAOHUQUYUMIANJIWEI2. 8mX2.8m。YUSHINEIQITAQUYUFENLIKAILAI,JIDONGTAIBAOHU,JIANGSHUHOUGANRANJIANGDIDAOZUIDI。BUZAIQIANGDIAOSHOUSHUSHIYUZHOUWEIHUANJINGDEGELI。 FAGUO2003NIANBANBULE《YILIAOSHESHIJIEJINGSHIJIXIANGYINGSHOUKONGHUANJING》NF S90-351,JIANYIYILIAOXUQIUYINGYUXIANGYINGQUYUDEYAOQIUZHI。 QIZHONGYIGEXIANZHUTEDIANSHITICHULE“FENGXIAN”DEGAINIAN。TONGCHANGJIANGSHOUSHUSHIDINGWEI4JIWEIXIANQU,ZHEYUYIXUEKEJIFAZHANSHUIPINGYOUGUAN。QIZHONGYIGEZHONGYAOXIJIESHIFENGXIANDEJIEDINGBINGBUSHIGENJUSHOUSHULEIXING,ERSHIGENJUZHILIAOGUOCHENG(ZHILIAOGUOCHENGDEFUZACHENGDUHECHIXUSHIJIANDENG)HEHUANZHEDESHENTIZHUANGKUANG。KAOLVDAODESHOUSHUBAOKUOWAISHANG、YANKE、XINXUEGUANHESHENJINGWAIKEDENG。WEICISHOUXIANYINGDUISHOUSHUGUOCHENGYUHUANZHEZHUANGTAIJINXINGFENGXIANPINGGU(JIANBIAO2-24), YIQUEDINGSHOUSHUHUANJINGYAOQIU(RUJIEJINGDUJIBIE)。 

FAGUOBIAOZHUNNF S90-351TUIJIANDEDI4LEIFENGXIANQUYIXIEZHUNZERUXIA:

 (1)三級過濾系統:空氣處理機進風最低為F6 (過濾效率為70%~80%),出風為F7 (過濾效率為80%~ 90%)而送風末端為H3 (過濾效率為995%; 凈化工程公司

(2)DADAOISO14644-1BIAOZHUNDE5JI(JIYUANMEIGUOFS209BIAOZHUNDE100JI);

足球比分网 (3)SONGFENGTIANHUA、DANXIANGLIU;

足球比分网  (4)SHINEIHUANQICISHUDAYU50CI/h。 XIBANYA2000NIANBANBU《YIYUANKONGDIAO》UNE100713.SHOUSHUSHIFENLEIRUTONGDEGUOBIAOZHUNDIN1946-4, JIANGYILIAOKESHIFENWEILIANGJI,SHOUSHUSHIWEI1JI,ZAIFENWEI1AHE1BLIANGJI,

要求如下: (1) 三級過濾,由F6 (過濾效率為70%~80%), F9 (過濾效率>95%)和H13(過濾效率為99. 95%)或H14 (過濾效率為99.995 %)三級組成; (2)高效過濾送風天花,1A手術室為單向流,1B 手術室足球比分网為單向流或非單向流;(3)均是100%的新風; (4)室內換氣次數大于30次/h。 

 ZAIOUZHOUDALUZUIZAOJIANGKONGQIJIEJINGJISHUYINRENDAOYIYUANHUANJINGKONGZHISHIRUISHI,CENGYINQIBUSHAOZHENGYIYUFEIYI,DANRUISHIJIANCHIKAIZHANDALIANGDELILUNYANJIUYUSHIJIYINGYONG。ZAICIJICHUSHANG,CONG1997NIAN1YUE22RIRUISHIKAISHIBIANXIESWKI 99-30BIAOZHUN《YIYUANGONGRE、TONGFENGYUKONGQIDIAOJIEXITONG》,YU2001NIANGONGBUDIYIGAOCAOAN,YU2002NIANGONGBUZUIHOUXIUDINGWENBEN,2003NIAN5YUEZHENGSHIBANBU。JIANYUGAIBIAOZHUNZAISHIJIANZHONGCHENGGONGYINGYONG,DEGUOGONGCHENGSHIXIEHUIVDICANZHAORUISHIGAIBIAOZHUNBIANXIELEVDI2167 《YIYUANJIANZHUSHESHI》DI1BUFEN“NUANTONGKONGDIAO”,YU2004NIAN12YUEGONGBUCAOAN,YUSWKI 99-3BIAOZHUNDEZHENGWENJIBENSHANGSHIYIZHIDE。QIJIANYUDEGUOBIAOZHUNDIN1946DISIBUFENBUDUANGOUTONG、XIEDIAO,ZHONGYUZAI2007NIAN8YUEYIBAIYEXINGSHIZHENGSHIBANBU。2005 NIAN9YUEBANBUDEAODILIBIAOZHUN《YIYUANSHESHITONGFENGKONGDIAOSHEBEI,ANZHUANG、YUNXINGHEJISHUYUWEISHENGKONGZHI》ONORM H 6020JIBENSHANGYESHIZHEYISILU 。 YINSHANGSHUYOUDEGUO、RUISHIHEAODILISANGUOYILIAOWEISHENGJIGOUBIANXIEDESUOWEIOUZHOUYIYUANBIAOZHUNSHANGWEITONGGUO,ERDIN1946DI4BUFENXIUDINGYOUBULIXIANG,YIJIANJIAODA,YINCIVDI2167《YIYUANJIANZHUSHESHI》DI1BUFEN“NUANTONGKONGDIAO”ZHENGSHIBANBUHOUBUDUANBEIYINYONG,HENKUAICHENGWEIOUZHOUDALUYIYUANJIANSHEDEYIJU,BINGQIEQIYINGXIANGLIYUELAIYUEDA,BINGYOUKENENGCHENGWEIOUZHOUBIAOZHUN,GUBENWENJIANGZAIXIAWENZHONGDIANJIESHAOVDI2167。

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