正(zheng)確(que)認(ren)識潔凈技術對感染的控制(zhi)

        1 在各種解決醫院感染的對策中，避免手術中的感染被認為是整體治療過程中為重要的關鍵環節[1]。從長遠的觀點看，抗生素的作用隨著劑量的增加而逐漸降低具效用，即病患出現抗藥性。抗生素的不合理使用，嚴重威脅著廣大人民群眾的身體健康和生命安全。濫用抗生素，既破壞了人體內的微生態平衡，損害了健康，又使耐藥細菌日益增多。國家食品藥品監督管理局日前做出規定：從2004年7月1日起，范圍內所有零售藥店必須憑執業醫師處方，才能銷售未列入非處方藥藥品目錄的各種抗菌藥物[2]。由于潔凈手術室在防止感染方面有著一定的作用，因此，建立潔凈手術室成為必然的趨勢。近些年來，隨著我國國民經濟的發展、國家綜合實力的增強、人民生活水準的逐步提高，一些別的醫院都建造了潔凈手術室。目前，建造潔凈手術室的熱潮已發展到中、小型醫院，并將建立潔凈手術室視為提高醫療質量，避免醫院感染的必要措施之一。但是，在新建醫院以及醫院改造過程中，大量的潔凈手術室工程不斷上馬，并形成醫院之間相互攀比、提高醫院形象的趨勢，這樣的現象即增加了醫院建造的初投資又浪費了人力、物力資源。

　　2、潔凈技術在(zai)控制感染方(fang)面的(de)(de)(de)作(zuo)用空(kong)(kong)(kong)氣(qi)(qi)中(zhong)浮(fu)游(you)的(de)(de)(de)細(xi)菌(jun)(jun)(jun)，大(da)(da)(da)多數(shu)都粘附在(zai)灰(hui)(hui)塵(chen)(chen)載體(ti)上(shang)，并以(yi)塵(chen)(chen)埃中(zhong)的(de)(de)(de)水分(fen)及(ji)營養維持其生命，很少單獨存在(zai)。一(yi)般情(qing)況(kuang)下(xia)，空(kong)(kong)(kong)氣(qi)(qi)中(zhong)的(de)(de)(de)浮(fu)游(you)菌(jun)(jun)(jun)濃度與大(da)(da)(da)氣(qi)(qi)中(zhong)≥0.5μm的(de)(de)(de)灰(hui)(hui)塵(chen)(chen)粒子(zi)在(zai)數(shu)量上(shang)大(da)(da)(da)約(yue)有1∶10萬的(de)(de)(de)關系[3]。也(ye)就是(shi)說，空(kong)(kong)(kong)氣(qi)(qi)中(zhong)灰(hui)(hui)塵(chen)(chen)量大(da)(da)(da)，細(xi)菌(jun)(jun)(jun)濃度就會相(xiang)應的(de)(de)(de)大(da)(da)(da)一(yi)些。據天津(jin)大(da)(da)(da)學對(dui)醫院(yuan)、辦公室(shi)以(yi)及(ji)室(shi)外大(da)(da)(da)氣(qi)(qi)的(de)(de)(de)含塵(chen)(chen)和(he)含菌(jun)(jun)(jun)濃度同(tong)時(shi)對(dui)比采樣測(ce)定[4]，結果證(zheng)明(ming)(ming)：空(kong)(kong)(kong)氣(qi)(qi)中(zhong)浮(fu)游(you)菌(jun)(jun)(jun)的(de)(de)(de)含量及(ji)其變化(hua)規律與≥3～5μm的(de)(de)(de)塵(chen)(chen)粒變化(hua)規律具有相(xiang)關性。天津(jin)大(da)(da)(da)學自1983年起所進(jin)行(xing)的(de)(de)(de)一(yi)系列空(kong)(kong)(kong)氣(qi)(qi)過(guo)(guo)(guo)濾(lv)(lv)(lv)器(qi)細(xi)菌(jun)(jun)(jun)過(guo)(guo)(guo)濾(lv)(lv)(lv)效率試驗，也(ye)證(zheng)明(ming)(ming)空(kong)(kong)(kong)氣(qi)(qi)過(guo)(guo)(guo)濾(lv)(lv)(lv)器(qi)對(dui)細(xi)菌(jun)(jun)(jun)有良好的(de)(de)(de)過(guo)(guo)(guo)濾(lv)(lv)(lv)效果[4]。通過(guo)(guo)(guo)對(dui)細(xi)菌(jun)(jun)(jun)及(ji)灰(hui)(hui)塵(chen)(chen)進(jin)行(xing)了過(guo)(guo)(guo)濾(lv)(lv)(lv)效率實(shi)測(ce)比較(jiao)，可以(yi)得出以(yi)下(xia)三個(ge)結論[3]： 1、細(xi)菌(jun)(jun)(jun)粒子(zi)過(guo)(guo)(guo)濾(lv)(lv)(lv)效率與大(da)(da)(da)氣(qi)(qi)塵(chen)(chen)中(zhong)4～5μm粒子(zi)的(de)(de)(de)過(guo)(guo)(guo)濾(lv)(lv)(lv)效率大(da)(da)(da)致相(xiang)同(tong)，即細(xi)菌(jun)(jun)(jun)等(deng)效直(zhi)徑為4～5μm; 2、過(guo)(guo)(guo)濾(lv)(lv)(lv)材(cai)料如對(dui)1.5μm粒子(zi)過(guo)(guo)(guo)濾(lv)(lv)(lv)效率為，則過(guo)(guo)(guo)濾(lv)(lv)(lv)后(hou)檢測(ce)不(bu)出細(xi)菌(jun)(jun)(jun)存在(zai);

　　3、在生物(wu)凈化中盲目追求過濾(lv)器的(de)(de)率是不經(jing)濟的(de)(de)，因生物(wu)粒子一(yi)般較(jiao)大(da)(da)，則過濾(lv)效(xiao)(xiao)率會較(jiao)高(gao)。表1列舉了天津大(da)(da)學測(ce)試的(de)(de)幾(ji)種(zhong)國(guo)產濾(lv)材(cai)的(de)(de)濾(lv)塵濾(lv)菌效(xiao)(xiao)率。

　　為(wei)減少術(shu)后感染(ran)率(lv)，在手(shou)術(shu)室(shi)內(nei)浮游菌(jun)與感染(ran)率(lv)的(de)(de)(de)關系方面也做了(le)大量的(de)(de)(de)。瑞士和英國的(de)(de)(de)人員對6000例股(gu)關節置換手(shou)術(shu)進行了(le)統計，結(jie)果顯(xian)示：當空氣中(zhong)的(de)(de)(de)細菌(jun)濃度(du)從(cong)(cong)(cong)400個(ge)/m3降至5個(ge)/m3時，感染(ran)率(lv)大致可(ke)以(yi)從(cong)(cong)(cong)4%降低(di)至1%[3]。世界的(de)(de)(de)矯(jiao)形科專家J. Charnley在Wrightington醫(yi)(yi)院進行了(le)十(shi)多(duo)年的(de)(de)(de)連續，為(wei)潔(jie)凈技(ji)術(shu)了(le)一(yi)些重(zhong)要的(de)(de)(de)例證和數據。 Charnley醫(yi)(yi)生(sheng)整(zheng)理的(de)(de)(de)不同手(shou)術(shu)環境(jing)下手(shou)術(shu)感染(ran)率(lv)。可(ke)以(yi)看出：潔(jie)凈技(ji)術(shu)降低(di)了(le)手(shou)術(shu)環境(jing)中(zhong)的(de)(de)(de)菌(jun)濃，將(jiang)手(shou)術(shu)感染(ran)率(lv)從(cong)(cong)(cong)8.9%降到0.5%。以(yi)上數據都說明(ming)：潔(jie)凈技(ji)術(shu)在控制醫(yi)(yi)院內(nei)感染(ran)方面，確實有著一(yi)定的(de)(de)(de)作用。

　　3、目前存在的問(wen)題根據不同部門對防(fang)止感染擴散(san)的不同環境要求，以(yi)(yi)及醫(yi)院空調(diao)系統(tong)運行管(guan)理的經驗，歐美以(yi)(yi)及日本(ben)等國(guo)家的醫(yi)院管(guan)理規(gui)范對空調(diao)系統(tong)的過(guo)濾器(qi)配(pei)置都給予了規(gui)定(ding)。以(yi)(yi)美國(guo)為例，其綜合醫(yi)院對空調(diao)通風系統(tong)的過(guo)濾器(qi)配(pei)置如下表。

　　在美國，諸(zhu)如骨髓、等要(yao)求潔(jie)凈度較(jiao)高的手術(shu)，其要(yao)求的潔(jie)凈室末端過濾器效率(lv)為99.97%(DOP測試)。與之不同(tong)的是，對于這(zhe)些手術(shu)我(wo)國只(zhi)在潔(jie)凈度上做出了在手術(shu)區達到百(bai)級要(yao)求的規定，

　　美(mei)國經(jing)過(guo)(guo)大(da)(da)(da)量的(de)(de)(de)(de)(de)(de)(de)(de)(de)調(diao)(diao)查統計(ji)[8]，都不能說明平行流手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)中(zhong)(zhong)的(de)(de)(de)(de)(de)(de)(de)(de)(de)手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)感(gan)染(ran)(ran)(ran)(ran)(ran)(ran)(ran)(ran)率(lv)一(yi)(yi)定比亂流潔(jie)(jie)(jie)凈(jing)(jing)(jing)(jing)(jing)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)要(yao)(yao)低得多(duo)(duo)，或者說在(zai)(zai)統計(ji)數(shu)字(zi)上得不出(chu)差異(yi)。而文獻[9]也指(zhi)出(chu)：只有(you)(you)(you)當空氣中(zhong)(zhong)懸(xuan)浮菌(jun)(jun)(jun)濃度(du)達到(dao)707～1767個(ge)(ge)(ge)/m3，空氣途徑的(de)(de)(de)(de)(de)(de)(de)(de)(de)污(wu)染(ran)(ran)(ran)(ran)(ran)(ran)(ran)(ran)才(cai)容易引(yin)起術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)后(hou)(hou)感(gan)染(ran)(ran)(ran)(ran)(ran)(ran)(ran)(ran)，如(ru)(ru)引(yin)起敗血(xue)癥(zheng)等(deng)。當室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)內懸(xuan)浮菌(jun)(jun)(jun)濃度(du)低于(yu)180個(ge)(ge)(ge)/m3時，感(gan)染(ran)(ran)(ran)(ran)(ran)(ran)(ran)(ran)危險降低到(dao)很小的(de)(de)(de)(de)(de)(de)(de)(de)(de)程(cheng)(cheng)度(du)，如(ru)(ru)再下降到(dao)40個(ge)(ge)(ge)/m3閾值以(yi)下，尚(shang)無(wu)(wu)(wu)充分證(zheng)(zheng)據證(zheng)(zheng)明空氣凈(jing)(jing)(jing)(jing)(jing)化對降低術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)后(hou)(hou)感(gan)染(ran)(ran)(ran)(ran)(ran)(ran)(ran)(ran)率(lv)有(you)(you)(you)明顯作用(yong)或明顯相關性(xing)(xing)。由此可以(yi)看(kan)出(chu)我國在(zai)(zai)手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)潔(jie)(jie)(jie)凈(jing)(jing)(jing)(jing)(jing)度(du)方(fang)面(mian)(mian)要(yao)(yao)求(qiu)較(jiao)為(wei)(wei)嚴格。目(mu)前(qian)，許多(duo)(duo)醫(yi)(yi)(yi)(yi)(yi)(yi)院(yuan)潔(jie)(jie)(jie)凈(jing)(jing)(jing)(jing)(jing)手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)的(de)(de)(de)(de)(de)(de)(de)(de)(de)設計(ji)在(zai)(zai)很大(da)(da)(da)程(cheng)(cheng)度(du)上受(shou)到(dao)工業潔(jie)(jie)(jie)凈(jing)(jing)(jing)(jing)(jing)技(ji)(ji)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)的(de)(de)(de)(de)(de)(de)(de)(de)(de)影響，片(pian)面(mian)(mian)強(qiang)調(diao)(diao)凈(jing)(jing)(jing)(jing)(jing)化、依賴大(da)(da)(da)風量或濫用(yong)層流技(ji)(ji)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)等(deng)，造成(cheng)潔(jie)(jie)(jie)凈(jing)(jing)(jing)(jing)(jing)手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)部(bu)投資和運(yun)行費用(yong)過(guo)(guo)大(da)(da)(da)。潔(jie)(jie)(jie)凈(jing)(jing)(jing)(jing)(jing)技(ji)(ji)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)只是一(yi)(yi)種保(bao)(bao)障(zhang)(zhang)手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)段(duan)，而無(wu)(wu)(wu)菌(jun)(jun)(jun)程(cheng)(cheng)度(du)才(cai)是控(kong)(kong)(kong)制(zhi)(zhi)(zhi)的(de)(de)(de)(de)(de)(de)(de)(de)(de)目(mu)的(de)(de)(de)(de)(de)(de)(de)(de)(de)和結果(guo);應(ying)(ying)(ying)該強(qiang)調(diao)(diao)手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)細(xi)菌(jun)(jun)(jun)控(kong)(kong)(kong)制(zhi)(zhi)(zhi)的(de)(de)(de)(de)(de)(de)(de)(de)(de)綜合措(cuo)施(shi)(shi)，強(qiang)調(diao)(diao)全過(guo)(guo)程(cheng)(cheng)控(kong)(kong)(kong)制(zhi)(zhi)(zhi)以(yi)及(ji)完(wan)善(shan)的(de)(de)(de)(de)(de)(de)(de)(de)(de)保(bao)(bao)證(zheng)(zheng)體(ti)(ti)系，以(yi)真正有(you)(you)(you)效(xiao)(xiao)(xiao)地消(xiao)(xiao)除(chu)交叉感(gan)染(ran)(ran)(ran)(ran)(ran)(ran)(ran)(ran)的(de)(de)(de)(de)(de)(de)(de)(de)(de)隱患(huan)。如(ru)(ru)文獻[10]所述：龍巖(yan)市(shi)*醫(yi)(yi)(yi)(yi)(yi)(yi)院(yuan)屬于(yu)三(san)(san)級(ji)(ji)乙(yi)等(deng)醫(yi)(yi)(yi)(yi)(yi)(yi)院(yuan)，其(qi)新(xin)建(jian)(jian)(jian)的(de)(de)(de)(de)(de)(de)(de)(de)(de)手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)部(bu)建(jian)(jian)(jian)筑面(mian)(mian)積(ji)為(wei)(wei)1500m2，Ⅰ級(ji)(ji)手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)兩間(jian)(jian)，Ⅱ級(ji)(ji)手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)三(san)(san)間(jian)(jian)，Ⅲ級(ji)(ji)手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)三(san)(san)間(jian)(jian)共八間(jian)(jian)手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)。天津(jin)市(shi)第三(san)(san)中(zhong)(zhong)心醫(yi)(yi)(yi)(yi)(yi)(yi)院(yuan)屬于(yu)綜合性(xing)(xing)三(san)(san)級(ji)(ji)甲等(deng)醫(yi)(yi)(yi)(yi)(yi)(yi)院(yuan)，共建(jian)(jian)(jian)有(you)(you)(you)十(shi)四(si)間(jian)(jian)手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)組(zu)成(cheng)，其(qi)中(zhong)(zhong)Ⅰ級(ji)(ji)手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)一(yi)(yi)間(jian)(jian)，Ⅱ級(ji)(ji)手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)三(san)(san)間(jian)(jian)，III級(ji)(ji)手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)十(shi)間(jian)(jian)。而廣東(dong)省人民醫(yi)(yi)(yi)(yi)(yi)(yi)院(yuan)(綜合性(xing)(xing)三(san)(san)級(ji)(ji)甲等(deng)醫(yi)(yi)(yi)(yi)(yi)(yi)院(yuan))的(de)(de)(de)(de)(de)(de)(de)(de)(de)手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)數(shu)目(mu)更(geng)是驚(jing)人，其(qi)手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)面(mian)(mian)積(ji)達3800m2，由二(er)十(shi)一(yi)(yi)個(ge)(ge)(ge)手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)間(jian)(jian)組(zu)成(cheng)，其(qi)中(zhong)(zhong)Ⅰ級(ji)(ji)手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)兩間(jian)(jian)，Ⅱ級(ji)(ji)與III級(ji)(ji)可轉換的(de)(de)(de)(de)(de)(de)(de)(de)(de)手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)有(you)(you)(you)八間(jian)(jian)，III級(ji)(ji)手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)有(you)(you)(you)十(shi)一(yi)(yi)間(jian)(jian)[11]。其(qi)手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)的(de)(de)(de)(de)(de)(de)(de)(de)(de)投資約2000萬(wan)(wan)元(yuan)，號稱：吸收世界醫(yi)(yi)(yi)(yi)(yi)(yi)院(yuan)手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)的(de)(de)(de)(de)(de)(de)(de)(de)(de)精(jing)華，被稱作迄今為(wei)(wei)止我國、現(xian)代化的(de)(de)(de)(de)(de)(de)(de)(de)(de)手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)[11]。如(ru)(ru)以(yi)上列(lie)舉，目(mu)前(qian)各地醫(yi)(yi)(yi)(yi)(yi)(yi)院(yuan)在(zai)(zai)建(jian)(jian)(jian)造潔(jie)(jie)(jie)凈(jing)(jing)(jing)(jing)(jing)手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)方(fang)面(mian)(mian)大(da)(da)(da)多(duo)(duo)追求(qiu)別、大(da)(da)(da)數(shu)量，這些(xie)現(xian)象反應(ying)(ying)(ying)出(chu)有(you)(you)(you)關人員(yuan)對潔(jie)(jie)(jie)凈(jing)(jing)(jing)(jing)(jing)手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)的(de)(de)(de)(de)(de)(de)(de)(de)(de)作用(yong)認識不夠。術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)后(hou)(hou)感(gan)染(ran)(ran)(ran)(ran)(ran)(ran)(ran)(ran)一(yi)(yi)般由直接接觸(chu)、自身感(gan)染(ran)(ran)(ran)(ran)(ran)(ran)(ran)(ran)及(ji)空氣污(wu)染(ran)(ran)(ran)(ran)(ran)(ran)(ran)(ran)三(san)(san)種途徑引(yin)起。潔(jie)(jie)(jie)凈(jing)(jing)(jing)(jing)(jing)技(ji)(ji)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)解決的(de)(de)(de)(de)(de)(de)(de)(de)(de)是空氣污(wu)染(ran)(ran)(ran)(ran)(ran)(ran)(ran)(ran)問題，明確了這一(yi)(yi)點，對解決控(kong)(kong)(kong)制(zhi)(zhi)(zhi)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)后(hou)(hou)感(gan)染(ran)(ran)(ran)(ran)(ran)(ran)(ran)(ran)問題有(you)(you)(you)著較(jiao)為(wei)(wei)重(zhong)要(yao)(yao)的(de)(de)(de)(de)(de)(de)(de)(de)(de)意(yi)義。建(jian)(jian)(jian)造潔(jie)(jie)(jie)凈(jing)(jing)(jing)(jing)(jing)手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)只是一(yi)(yi)種保(bao)(bao)障(zhang)(zhang)手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)段(duan)，無(wu)(wu)(wu)菌(jun)(jun)(jun)程(cheng)(cheng)度(du)才(cai)是控(kong)(kong)(kong)制(zhi)(zhi)(zhi)的(de)(de)(de)(de)(de)(de)(de)(de)(de)目(mu)的(de)(de)(de)(de)(de)(de)(de)(de)(de)和結果(guo)的(de)(de)(de)(de)(de)(de)(de)(de)(de)體(ti)(ti)現(xian);應(ying)(ying)(ying)該強(qiang)調(diao)(diao)手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)細(xi)菌(jun)(jun)(jun)控(kong)(kong)(kong)制(zhi)(zhi)(zhi)的(de)(de)(de)(de)(de)(de)(de)(de)(de)綜合措(cuo)施(shi)(shi)，強(qiang)調(diao)(diao)全過(guo)(guo)程(cheng)(cheng)控(kong)(kong)(kong)制(zhi)(zhi)(zhi)以(yi)及(ji)完(wan)善(shan)的(de)(de)(de)(de)(de)(de)(de)(de)(de)保(bao)(bao)證(zheng)(zheng)體(ti)(ti)系，以(yi)真正有(you)(you)(you)效(xiao)(xiao)(xiao)地消(xiao)(xiao)除(chu)交叉感(gan)染(ran)(ran)(ran)(ran)(ran)(ran)(ran)(ran)的(de)(de)(de)(de)(de)(de)(de)(de)(de)隱患(huan)。許多(duo)(duo)美(mei)國醫(yi)(yi)(yi)(yi)(yi)(yi)學專(zhuan)家(jia)不提(ti)倡手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)采(cai)(cai)用(yong)單向(xiang)流。對高潔(jie)(jie)(jie)凈(jing)(jing)(jing)(jing)(jing)度(du)手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)的(de)(de)(de)(de)(de)(de)(de)(de)(de)實用(yong)效(xiao)(xiao)(xiao)果(guo)存有(you)(you)(you)疑問的(de)(de)(de)(de)(de)(de)(de)(de)(de)，包括曾任美(mei)科協會(hui)手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)環境(jing)委員(yuan)會(hui)的(de)(de)(de)(de)(de)(de)(de)(de)(de)委員(yuan)長，他引(yin)用(yong)美(mei)國四(si)個(ge)(ge)(ge)醫(yi)(yi)(yi)(yi)(yi)(yi)院(yuan)在(zai)(zai)僅(jin)(jin)(jin)有(you)(you)(you)普通空調(diao)(diao)通風的(de)(de)(de)(de)(de)(de)(de)(de)(de)手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)中(zhong)(zhong)進行的(de)(de)(de)(de)(de)(de)(de)(de)(de)股關節全置(zhi)換手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)的(de)(de)(de)(de)(de)(de)(de)(de)(de)創(chuang)(chuang)(chuang)口(kou)深部(bu)感(gan)染(ran)(ran)(ran)(ran)(ran)(ran)(ran)(ran)率(lv)來(lai)證(zheng)(zheng)明他的(de)(de)(de)(de)(de)(de)(de)(de)(de)論(lun)點，如(ru)(ru)下表。股關節全置(zhi)換手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)的(de)(de)(de)(de)(de)(de)(de)(de)(de)創(chuang)(chuang)(chuang)口(kou)深部(bu)感(gan)染(ran)(ran)(ran)(ran)(ran)(ran)(ran)(ran)率(lv) (Laufman) 表5 外(wai)科醫(yi)(yi)(yi)(yi)(yi)(yi)生(sheng) 手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)數(shu) 觀察期間(jian)(jian) 抗生(sheng)物(wu)質 感(gan)染(ran)(ran)(ran)(ran)(ran)(ran)(ran)(ran)率(lv) Coventry Mayo 2012 9～30個(ge)(ge)(ge)月(yue)(yue) 使(shi)用(yong) 0.6% Stauffer& Johnston(Jawa) 550 29個(ge)(ge)(ge)月(yue)(yue) 使(shi)用(yong) 0.18% Stinchfield (New York) 460 32個(ge)(ge)(ge)月(yue)(yue) - 0.8% Murroy (San Francisco) 600 18～42個(ge)(ge)(ge)月(yue)(yue) - 0.8% 合計(ji) 3622 9～42個(ge)(ge)(ge)月(yue)(yue) - 0.45% 2000年10月(yue)(yue)，我國*部(bu)《醫(yi)(yi)(yi)(yi)(yi)(yi)院(yuan)潔(jie)(jie)(jie)凈(jing)(jing)(jing)(jing)(jing)手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)部(bu)建(jian)(jian)(jian)設標(biao)(biao)準》頒布(bu)實施(shi)(shi)。《標(biao)(biao)準》著重(zhong)手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)作為(wei)(wei)生(sheng)物(wu)潔(jie)(jie)(jie)凈(jing)(jing)(jing)(jing)(jing)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)的(de)(de)(de)(de)(de)(de)(de)(de)(de)特性(xing)(xing)，以(yi)控(kong)(kong)(kong)制(zhi)(zhi)(zhi)有(you)(you)(you)生(sheng)命(ming)微(wei)粒(li)為(wei)(wei)目(mu)標(biao)(biao)，降低術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)后(hou)(hou)感(gan)染(ran)(ran)(ran)(ran)(ran)(ran)(ran)(ran)應(ying)(ying)(ying)是一(yi)(yi)個(ge)(ge)(ge)全過(guo)(guo)程(cheng)(cheng)的(de)(de)(de)(de)(de)(de)(de)(de)(de)控(kong)(kong)(kong)制(zhi)(zhi)(zhi)，減少交叉感(gan)染(ran)(ran)(ran)(ran)(ran)(ran)(ran)(ran)風險必須采(cai)(cai)取綜合措(cuo)施(shi)(shi)。《標(biao)(biao)準》提(ti)出(chu)[12]：潔(jie)(jie)(jie)凈(jing)(jing)(jing)(jing)(jing)手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)污(wu)染(ran)(ran)(ran)(ran)(ran)(ran)(ran)(ran)控(kong)(kong)(kong)制(zhi)(zhi)(zhi)應(ying)(ying)(ying)采(cai)(cai)用(yong)細(xi)菌(jun)(jun)(jun)控(kong)(kong)(kong)制(zhi)(zhi)(zhi)的(de)(de)(de)(de)(de)(de)(de)(de)(de)綜合措(cuo)施(shi)(shi)，建(jian)(jian)(jian)立一(yi)(yi)個(ge)(ge)(ge)無(wu)(wu)(wu)菌(jun)(jun)(jun)環境(jing)的(de)(de)(de)(de)(de)(de)(de)(de)(de)保(bao)(bao)障(zhang)(zhang)體(ti)(ti)系，實施(shi)(shi)一(yi)(yi)個(ge)(ge)(ge)全過(guo)(guo)程(cheng)(cheng)控(kong)(kong)(kong)制(zhi)(zhi)(zhi)的(de)(de)(de)(de)(de)(de)(de)(de)(de)理念(nian)，而不是僅(jin)(jin)(jin)僅(jin)(jin)(jin)為(wei)(wei)了達到(dao)手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)內潔(jie)(jie)(jie)凈(jing)(jing)(jing)(jing)(jing)、無(wu)(wu)(wu)菌(jun)(jun)(jun)等(deng)某項指(zhi)標(biao)(biao)。 4、建(jian)(jian)(jian)議文獻[13]提(ti)出(chu)：各級(ji)(ji)醫(yi)(yi)(yi)(yi)(yi)(yi)院(yuan)應(ying)(ying)(ying)以(yi)萬(wan)(wan)級(ji)(ji)和十(shi)萬(wan)(wan)級(ji)(ji)潔(jie)(jie)(jie)凈(jing)(jing)(jing)(jing)(jing)手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)為(wei)(wei)主，大(da)(da)(da)型醫(yi)(yi)(yi)(yi)(yi)(yi)院(yuan)百級(ji)(ji)手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)一(yi)(yi)般不要(yao)(yao)過(guo)(guo)二(er)間(jian)(jian)。一(yi)(yi)般來(lai)說，一(yi)(yi)個(ge)(ge)(ge)三(san)(san)級(ji)(ji)甲等(deng)綜合性(xing)(xing)醫(yi)(yi)(yi)(yi)(yi)(yi)院(yuan)潔(jie)(jie)(jie)凈(jing)(jing)(jing)(jing)(jing)手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)數(shu)量應(ying)(ying)(ying)為(wei)(wei)十(shi)至十(shi)二(er)間(jian)(jian)為(wei)(wei)宜;一(yi)(yi)個(ge)(ge)(ge)二(er)級(ji)(ji)甲等(deng)綜合性(xing)(xing)醫(yi)(yi)(yi)(yi)(yi)(yi)院(yuan)潔(jie)(jie)(jie)凈(jing)(jing)(jing)(jing)(jing)手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)數(shu)量應(ying)(ying)(ying)為(wei)(wei)六至八間(jian)(jian)為(wei)(wei)宜。經(jing)調(diao)(diao)查，手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)傷口(kou)的(de)(de)(de)(de)(de)(de)(de)(de)(de)比例情況大(da)(da)(da)致如(ru)(ru)下[14]： 1、清潔(jie)(jie)(jie)傷口(kou)：1%～5%，非感(gan)染(ran)(ran)(ran)(ran)(ran)(ran)(ran)(ran)性(xing)(xing)手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)創(chuang)(chuang)(chuang)傷; 2、清潔(jie)(jie)(jie)-污(wu)染(ran)(ran)(ran)(ran)(ran)(ran)(ran)(ran)傷口(kou)：3%～11%，呼吸道(dao)、消(xiao)(xiao)化道(dao)、生(sheng)殖泌尿道(dao)手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(有(you)(you)(you)控(kong)(kong)(kong)制(zhi)(zhi)(zhi)的(de)(de)(de)(de)(de)(de)(de)(de)(de)); 3、污(wu)染(ran)(ran)(ran)(ran)(ran)(ran)(ran)(ran)傷口(kou)：10%～17%，開(kai)放、新(xin)迫、意(yi)外(wai)事故創(chuang)(chuang)(chuang)傷、手(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)(shou)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)中(zhong)(zhong)無(wu)(wu)(wu)菌(jun)(jun)(jun)技(ji)(ji)術(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)(shu)受(shou)破壞等(deng);

　　4、污穢或感染口(kou)傷：>27%，陳舊(jiu)性創(chuang)傷或已是感染的(de)(de)(de)(de)臟器貫穿。由以(yi)(yi)上的(de)(de)(de)(de)數據比(bi)例可(ke)以(yi)(yi)看出：需要高(gao)潔(jie)(jie)凈的(de)(de)(de)(de)手(shou)術(shu)所(suo)占(zhan)的(de)(de)(de)(de)比(bi)例較小，而(er)感染性傷口(kou)所(suo)占(zhan)比(bi)例較大，即：高(gao)潔(jie)(jie)凈手(shou)術(shu)室(shi)的(de)(de)(de)(de)使用率(lv)較低，而(er)低潔(jie)(jie)凈的(de)(de)(de)(de)手(shou)術(shu)室(shi)使用率(lv)較高(gao)。因(yin)此，在手(shou)術(shu)室(shi)的(de)(de)(de)(de)新(xin)建或改造過(guo)程中，不應只強調手(shou)術(shu)室(shi)的(de)(de)(de)(de)數目(mu)和，應考慮各種因(yin)素以(yi)(yi)確定合適(shi)的(de)(de)(de)(de)手(shou)術(shu)室(shi)數量和。潔(jie)(jie)凈手(shou)術(shu)室(shi)的(de)(de)(de)(de)數量不宜過(guo)多，應該(gai)注重提高(gao)潔(jie)(jie)凈手(shou)術(shu)室(shi)的(de)(de)(de)(de)使用率(lv)。