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PART1
医用中心吸引系统
临床应用与院感防控
医用中心吸引系统，在临床中主要是通过真空机组产生负压源，使得整个管道与终端系统在各个病房或手术室获得负压，通过吸引终端为患者提供负压源，利用一次性使用负压吸引器或吸引瓶建立患者与负压源连接联合使用。
在临床应用中大家较为熟悉的应该是在医院的负压病房医护工作人员为重症患者呼吸道实施吸痰术用于保证或者维持危重患者的有效通气功能。在实施吸痰术时，不仅是将患者体内痰液、分泌物引出至体外的过程，也是一个产生气溶胶的过程。
在疫情常态化的新形势下，为了保障患者安全的诊疗环境，对感染性医疗废液以及气溶胶的隔离防护成为了新的临床研究热点和加强科室管理的重要内容。
医用中心吸引系统的负压源是中心吸引站的真空泵机组，通过真空泵机组的抽吸使吸引管道内空气压力达到所需负压值，在手术室、抢救室、治疗室和各个病房的终端处产生吸力，提供医疗使用。
医用中心吸引系统（以下简称为吸引系统）按真空泵结构方式分为水环式、油环式、旋片式中心吸引站，真空泵使中心吸引系统产生负压源；真空泵应由两个或多个机组构成，分为工作机组与备用机组，保证工作不间断，同时，在特殊情况下，多个机组可以同时启动，以满足用户的需求；中心吸引系统由中心真空负压站、监测和报警系统、终端的管道分配系统及阀门组成；中心真空负压站是由真空泵机组、真空容器、管道、阀门、电控柜、过滤器、真空仪表和排污罐组成的独立操作间。
一、医用中心吸引系统的临床应用
医用中心吸引系统在临床中主要是通过真空机组产生负压源，使得整个管道与终端系统在各个病房或手术室获得负压，通过吸引终端为患者提供负压源，利用一次性使用负压吸引器或吸引瓶建立患者与负压源连接联合使用。
医用中心吸引系统，是急诊和手术中常规使用的患者治疗技术手段。如采用负压对患者呼吸道实施吸痰术用于保证或者维持危重患者的有效通气功能，为临床救治提供基础保证。在实施吸痰术时，不仅是将患者体内痰液、分泌物引出至体外的过程，也是一个产生气溶胶的过程。在疫情常态化的新形势下，为了保障患者安全的诊疗环境，对感染性医疗废液以及气溶胶的隔离防护成为了新的临床研究热点和加强科室管理的重要内容。
医院是各种病源微生物聚集的场所，医护人员在接触具有转染性的血液、体液、分泌物、排泄物等感染性液体，或接触因实施医疗行为而使用过的卫生材料和医用耗材时都可能造成感染。国内有研究显示护士职业暴露占所有职业类别的71.43%，是职业暴露的高发人群。职业暴露发生的科室以手术室和急诊为主。急诊中开放的伤口及伤口周围存在血液和液体，以及伤口部位的冲洗液对黏膜皮肤存在暴露风险。急诊收治的患者往往没有经过感染性疾病检查，或者未能及时获得患者的感染性疾病检查结果，接诊的医务人员接触到感染性引流液的风险更大，由此，为临床负压系统制定规范流程，以及为规避和控制感染风险选择更为合适的负压吸引系统及收集装置具有重要的临床意义，可以为患者提供更加优质的治疗，为医务人员提供更好的防护，提升医院感染控制措施。
医院感染防护的原则，不论是否有明显的血迹污染或是否接触非完整的皮肤与黏膜，接触上述物质者，必须采取防护措施。如无法消除风险，应当考虑用其他风险较小的方式取代，降低血液与皮肤直接接触风险。采取工程控制措施将工作场所的血源性病原体隔离或移开，包括机械、设施和设备。工程措施指采用某些措施和工具隔离或消除工作场所血源性病原体危害。
中心吸引系统为负压引流类治疗和护理操作提供动力源，通常要求与之配合使用的收集系统具有微生物过滤阀，用于对进入负压吸引系统的气体进行初级过滤。同时，由于患者体液、血液、伤口冲洗液、引流液等血源性液体属于感染性医疗废物，通常称为医疗引流液或医疗废液。近30年来，随着医学发展、新技术和新理念不断地推陈出新，对医疗废物的认知逐步完善，由于医疗废物对于人类健康、卫生挑战和环境危害等诸多影响，国际上各国对于感染性医疗废物的监管都趋于更加严格和细化。比如，美国联邦法律对医疗废物尤其是受到监管的感染性医疗废物（Regulated Medical Waste）在医疗机构内、外的包装和运输都有严格的要求，严格禁止以液体形式进行转运。
2003年，我国国务院令第380号正式发布了《医疗废物管理条例》，从国家法令的角度提出对医疗废物的监管要求。《条例》明确地方政府和医疗机构负有医疗废物管理的职责，同时将医疗废物分为：感染性废物、药物性废物、化学性废物、损伤性废物、放射性废物五类。同年8月，原卫生部发布了《医疗卫生机构医疗废物管理办法》，细化和明确包括感染性医疗废物在内的各种医疗废物的处置要求。
值得关注的是，在国内监管趋于更加专业化管理的同时，国际上循证医学提出了更多的指导性建议。2020年1月，AORN（Association of periOperative Registered Nurses）美国手术室注册护士协会批准最新的指南Guidelines for perioperative practice environmental cleaning推荐的医疗引流液（废液）处理方式有在引流液中添加凝固剂，以及使用较少人工操作、自动化程度较高的封闭吸引系统。该推荐有助于帮助医务人员减少与感染性引流液接触，为医务人员提供职业防护。
二、院感风险防范
1．末端吸引装置防范
使用密闭式负压吸引系统（如一次性负压吸引袋），取代非密闭式负压吸引系统（如吸引瓶），能有效防范临床使用感染风险。末端吸引装置应采用预置消毒液的一次性负压吸引袋，使用前根据其容积加入达到有效氯5 000～10 000mg/L的消毒液，使用后密闭封存，按感染性医疗废物处理。为减少消毒剂与操作人员直接接触及对环境影响，宜采用预置含氯消毒剂封闭负压收集袋。对无条件应用预置消毒剂负压吸引袋的情况，可采用后凝固负压吸引袋将引流液转化为固体形态，以降低引流液的流动性和扩散性。
2．医护人员操作防范
医护人员应做好自身防护，根据要求佩戴医用防护口罩，并按规定穿着防护服、护目镜/防护面屏、手套、鞋套等，确保急诊医务人员防护装备的安全性及规范性。如治疗和护理操作过程中发生喷溅污染防护装备、手套破损等应及时更换。在处理血液或其他潜在污染物质的过程中，应尽量避免喷、溅、洒落和飞扬或产生飞沫。
基于以上，医用中心吸引系统规范的操作流程和性能检测质量控制，也成为大家在疫情常态防控下重点关注的问题。更多详情，请联系洁净园购买《急救及生命支持类医疗设备质控管理指南》。
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话不多说，咱们直接进入主题：「高手是如何解决问题的」 你是否有过这样的体验：处理常规工作时，总能心平气和、按部就班地解决； 一旦遇到紧急、困难、新的问题时，就会习惯性地选择抱怨。 …
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推广引流就是通过付费或者免费的方式给店铺进行宣传推广，从而吸引消费者增加产品的曝光量。 第一：如果想要店铺有一定的销量，那么我们的店铺首先必须要有流量，所以，付费的引流推广是非常有…
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