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Efficiency of Some Disinfectants (Cidex, Deconex, and Creolin) Against E.Coli

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Efficiency of Some Disinfectants (Cidex, Deconex, and Creolin) Against E.Coli Efficiency of Some Disinfectants (Cidex, Deconex, and Creolin) against E.coli 1 Mohammad Ali Zazouli , 2 Mahmoud Homayoun nasab Langroodi , 3 Mohammad Ahanjan , 4 Jamshid Yazdani Cherati , 5 Masoomeh Islamifar 1 Associate Professor, Department of Environmental Health Engineering, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran 2 MSc Student in Environmental Health Engineering, Student Research Committee, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran 3 Assistant Professor, Department Microbiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran 4 Assistant Professor, Department of Biostatistics, Health Sciences Research Centre, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran 5 MSc in Microbiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran (Received January 6, 2014 ; Accepted February 21, 2014) Abstract Background and purpose: Appropriate and efficient disinfection is an important aspect of hospital infections control. The aim of this study was to investigate the effects of common disinfectants used for Escherichia coli bacteria separated from two teaching hospitals in Sari, 2014. Materials and methods: Escherichia coli were taken from different wards in Zare and BouAli hospitals. E.Coli was identified by standard plant methods, differential test and biochemical isolation. Deconex plus53, Creolin and Cidex were used as disinfectants in various concentrations. Their effects were determined by Standard disc diffusion method. Data was analyzed using regression in Minitab V.17. Results: A total of 120 samples were investigated of which 48 (40%) were found contaminated and 15 (13%) of these isolates were positive for E.coli. The most effective disinfectants against E.coli were Cidex 2%, deconex Plus53 2%, and Creolin 3.5%, respectively. Conclusion: Performing pretests is necessary for choosing the most appropriate disinfectant and increasing its efficacy. Also, it is important to consider common infectious bacteria in hospitals and effective factors on disinfectants such as concentration and time. Keywords: Disinfectants, Nosocomial infections, Deconex 53plus, Cidex, Creolin, Escherichia coli J Mazandaran Univ Med Sci 2015; 25(122): 137-146 (Persian). 137 ﭘﮋوﻫﺸﻲ ﻣـﺠـــﻠـــــﻪ داﻧـﺸــــﮕﺎه ﻋــــﻠــــﻮم ﭘـــﺰﺷـــﻜــــﻲ ﻣــﺎزﻧـــــﺪران دوره ﺑﻴﺴﺖ و ﭼﻬﺎرم ﺷﻤﺎره 122 اﺳﻔﻨﺪ ﺳﺎل 1393 (146 137-) ﺑﺮرﺳﻲ اﺛﺮ ﮔﻨﺪزداﻫﺎ (ﺳﺎﻳﺪﻛﺲ، دﻛﻮﻧﻜﺲ، ﻛﺮﺋﻮﻟﻴﻦ) ﺑﺮ ﺑﺎﻛﺘﺮي اﺷﺮﺷﻴﺎﻛﻠﻲ ﻣﺤﻤﺪﻋﻠﻲ ززوﻟﻲ1 ﻣﺤﻤﻮد ﻫﻤﺎﻳﻮن ﻧﺴﺐ ﻟﻨﮕﺮودي2 ﻣﺤﻤﺪ آﻫﻨﺠﺎن3 ﺟﻤﺸﻴﺪ ﻳﺰداﻧﻲ ﭼﺮاﺗﻲ4 ﻣﻌﺼﻮﻣﻪ اﺳﻼﻣﻲ ﻓﺮ5 ﭼﻜﻴﺪه ﺳﺎﺑﻘﻪ و ﻫﺪف: ﮔﻨﺪزداﻳﻲ ﻣﻨﺎﺳﺐ و ﻛﺎرآﻣﺪ از ﭘﺎﻳﻪ ﻫﺎي ﻣﻬﻢ ﻛﻨﺘﺮل ﻋﻔﻮﻧﺖ ﻫﺎي ﺑﻴﻤﺎرﺳﺘﺎﻧﻲ اﺳﺖ. اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺑﻪ ﻣﻨﻈـﻮر ﺗﻌﻴﻴﻦ اﺛﺮ ﮔﻨﺪزداﻫﺎي راﻳﺞ ﺑﺮ ﺑﺎﻛﺘﺮي اﺷﺮﻳﺸﻴﺎﻛﻠﻲ ﺟﺪا ﺷﺪه از ﻣﺤﻴﻂ ﻫﺎي ﻣﺨﺘﻠـﻒ دو ﺑﻴﻤﺎرﺳـﺘﺎن آﻣﻮزﺷـﻲ ﺷـﻬﺮ ﺳـﺎري در ﺳﺎل 1393 اﻧﺠﺎم ﮔﺮدﻳﺪ. ﻣﻮاد وروش ﻫﺎ: در اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺑﺎﻛﺘﺮي اﺷﺮﻳﺸﻴﺎﻛﻠﻲ از ﺑﺨﺶﻫﺎي ﻣﺨﺘﻠﻒ ﺑﻴﻤﺎرﺳﺘﺎنﻫﺎي زارع و ﺑﻮﻋﻠﻲﺳﻴﻨﺎ ﺑـﺎ ا ﺳـﺘﻔﺎده از روش ﻫﺎي ﻛﺸﺖ اﺳﺘﺎﻧﺪارد و ﺗﺴﺖ ﻫﺎي اﻓﺘﺮاﻗﻲ و ﺑﻴﻮﺷﻴﻤﻴﺎﻳﻲ اﻳﺰوﻟﻪ و ﺷﻨﺎﺳﺎﻳﻲ ﮔﺮدﻳﺪ. ﮔﻨﺪزداﻫﺎي ﻣـﻮرد اﺳـﺘﻔﺎده ﺷـﺎﻣﻞ دﻛﻮﻧﻜﺲ53 ﭘﻼس، ﻛﺮﺋﻮﻟﻴﻦ و ﺳﺎﻳﺪﻛﺲ (ﮔﻠﻮﺗﺎرآﻟﺪﺋﻴﺪ) در ﻏﻠﻈﺖ ﻫﺎي ﻣﺨﺘﻠﻒ ﺑﻮدﻧـﺪ ﻛـﻪ اﺛـﺮ آن ﻫـﺎ ﺑـﺎ اﺳـﺘﻔﺎده از روش اﺳﺘﺎﻧﺪارد دﻳﺴﻚ دﻳﻔﻴﻮژن ﺗﻌﻴﻴﻦ ﺷﺪ. دادهﻫﺎ ﺑﺎ اﺳﺘﻔﺎده از ﻧﺮماﻓﺰار minitab17 و رﮔﺮﺳﻴﻮن ﻣﻮرد ﺗﺠﺰﻳﻪ و ﺗﺤﻠﻴﻞ ﻗﺮارﮔﺮﻓﺖ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﻧﺘﺎﻳﺞ اﻳﻦ ﺗﺤﻘﻴﻖ ﻧﺸﺎن داد ﻛﻪ از 120 ﻧﻤﻮﻧﻪ، 48 ﻣﻮرد (40 درﺻﺪ) ﻛﺸﺖ ﻣﺜﺒﺖ ﺑﻪ دﺳﺖ آﻣﺪ ﻛـﻪ 15 ﻧﻤﻮﻧـﻪ از آنﻫﺎ (13درﺻﺪ) آﻟﻮدﮔﻲ ﺑﻪ اﺷﺮﻳﺸﻴﺎ ﻛﻠﻲ را ﻧﺸﺎن داد. ﻣﻮﺛﺮﺗﺮﻳﻦ ﮔﻨـﺪزداﻫﺎ ﺑـﺮ روي ﺳـﻮﻳﻪ ﻫـﺎي اﺷﺮﻳﺸـﻴﺎﻛﻠﻲ ﺟـﺪا ﺷـﺪه ﺑـﻪ ﺗﺮﺗﻴﺐ ﺳﺎﻳﺪﻛﺲ (2 درﺻﺪ)، دﻛﻮﻧﻜﺲ53 ﭘﻼس (2 درﺻﺪ) و ﺿﻌﻴﻒﺗﺮﻳﻦ آنﻫﺎ ﻛﺮﺋﻮﻟﻴﻦ (5/3 درﺻﺪ) ﺑﻮد. اﺳﺘﻨﺘﺎج: اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﻧﺸﺎن داد ﻛﻪ اﻧﺠﺎم ﭘﻴﺶ ﺗﺴﺖ ﺟﻬﺖ اﻧﺘﺨﺎب ﮔﻨﺪزدا و اﻓﺰاﻳﺶ ﻛﺎراﻳﻲ ﻓﺮاﻳﻨﺪ ﮔﻨﺪزداﻳﻲ، ﺗﻮﺟـﻪ ﺑـﻪ ﺑﺎﻛﺘﺮيﻫﺎي راﻳﺞ ﻋﻔﻮﻧﺖزا در ﻫﺮ ﺑﻴﻤﺎرﺳﺘﺎن و ﻋﻮاﻣﻞ ﺗﺎﺛﻴﺮﮔﺬار ﺑﺮ ﮔﻨﺪزداﻳﻲ ﻣﺎﻧﻨﺪ ﻏﻠﻈﺖ و زﻣﺎن ﺿﺮوري ﻣﻲﺑﺎﺷﺪ. واژه ﻫﺎي ﻛﻠﻴﺪي: ﮔﻨﺪزداﻫﺎ، ﻋﻔﻮﻧﺖ ﺑﻴﻤﺎرﺳﺘﺎﻧﻲ، دﻛﻮﻧﻜﺲ53ﭘﻼس، ﺳﺎﻳﺪﻛﺲ، ﻛﺮﺋﻮﻟﻴﻦ، اﺷﺮﻳﺸﻴﺎﻛﻠﻲ ﻣﻘﺪﻣﻪ ﻋﻔﻮﻧــﺖﻫــﺎي ﺑﻴﻤﺎرﺳــﺘﺎﻧﻲ ﻳﻜــﻲ از ﻣﺸــﻜﻼت راﻳــﺞ ﺑﻪ ﻋﻔﻮﻧﺘﻲ اﻃﻼق ﻣﻲ ﺷﻮد ﻛﻪ 48 ﺳـﺎﻋﺖ ﭘـﺲ از ﺑﺴـﺘﺮي ﺑﻴﻤﺎرﺳﺘﺎنﻫﺎ و ﻣﺮاﻛﺰ درﻣﺎﻧﻲ اﺳﺖ ﻛـﻪ ﻣﻮﺟـﺐ اﻓـﺰ اﻳﺶ ﺷﺪن ﺑﻴﻤﺎر آﺷـﻜﺎر ﺷـﻮد، ﺑﻴﻤـﺎر در ﮔﺬﺷـﺘﻪ ﺑـﻪ آن ﻣﺒـﺘﻼ ﺑﺎر ﺑﻴﻤﺎريﻫـﺎ در ﺳـﻄﺢ ﺟﺎﻣﻌـﻪ و ﻣـﺮگ و ﻣﻴـﺮ ﺑﻴﻤـﺎران ﻧﺒﻮده و ﻳﺎ در زﻣﺎن ﭘـﺬﻳﺮش در دوره ﻧﻬﻔﺘـﻪ ﺑﻴﻤـﺎري ﻗـﺮار ﺑﺴﺘﺮي در ﺑﻴﻤﺎرﺳﺘﺎنﻫﺎ ﻣﻲﺷﻮد. ﻋﻔﻮﻧﺖﻫﺎي ﺑﻴﻤﺎرﺳـﺘﺎﻧﻲ ﻧﺪاﺷﺘﻪ ﺑﺎﺷﺪ. اﻳﻦ ﻣﻘﺎﻟﻪ ﺣﺎﺻﻞ ﻃﺮح ﺗﺤﻘﻴﻘﺎﺗﻲ ﺷﻤﺎره 1032 اﺳﺖ ﻛﻪ ﺗﻮﺳﻂ ﻣﻌﺎوﻧﺖ ﺗﺤﻘﻴﻘﺎت و ﻓﻨﺎوري داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﻣﺎزﻧﺪران ﺗﺎﻣﻴﻦ ﺷﺪه اﺳﺖ. ﻣﻮﻟﻒ ﻣﺴﺌﻮل: ﻣﺤﻤﻮد ﻫﻤﺎﻳﻮن ﻧﺴﺐ ﻟﻨﮕﺮودي - ﻓﺮﻳﺪوﻧﻜﻨﺎر: ﺟﻨﺐ ﺟﺎم ﺟﻢ، ﻣﺴﻜﻦ ﻣﻬﺮ اﺣﻴﺎﮔﺮان، ﻓﺎز 3، ﺑﻠﻮك 2، ﻃﺒﻘﻪ 2، واﺣﺪ Email: [email protected] 1 1. داﻧﺸﻴﺎر، ﮔﺮوه ﻣﻬﻨﺪﺳﻲ ﺑﻬﺪاﺷﺖ ﻣﺤﻴﻂ، داﻧﺸﻜﺪه ﺑﻬﺪاﺷﺖ، داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﻣﺎزﻧﺪران، ﺳﺎري، اﻳﺮان 2. داﻧﺸﺠﻮي ﻛﺎرﺷﻨﺎﺳﻲ ارﺷﺪ ﻣﻬﻨﺪﺳﻲ ﺑﻬﺪاﺷﺖ ﻣﺤﻴﻂ، ﻛﻤﻴﺘﻪ ﺗﺤﻘﻴﻘﺎت داﻧﺸﺠﻮﻳﻲ، داﻧﺸﻜﺪه ﺑﻬﺪاﺷﺖ، داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﻣﺎزﻧﺪران، ﺳﺎري، اﻳﺮان 3. اﺳﺘﺎدﻳﺎر، ﮔﺮوه ﻣﻴﻜﺮوﺑﻴﻮﻟﻮژي، داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ، داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﻣﺎزﻧﺪران، ﺳﺎري، اﻳﺮان 4. اﺳﺘﺎدﻳﺎر، ﮔﺮوه آﻣﺎر زﻳﺴﺘﻲ، ﻣﺮﻛﺰ ﺗﺤﻘﻴﻘﺎت ﻋﻠﻮم ﺑﻬﺪاﺷﺘﻲ، داﻧﺸﻜﺪه ﺑﻬﺪاﺷﺖ، داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﻣﺎزﻧﺪران، ﺳﺎري، اﻳﺮان 5. ﻛﺎرﺷﻨﺎس ارﺷﺪ ﻣﻴﻜﺮوﺑﻴﻮﻟﻮژي، داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ، داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﻣﺎزﻧﺪران، ﺳﺎري، اﻳﺮان ﺗﺎرﻳﺦ درﻳﺎﻓﺖ : 16/10/1393 ﺗﺎرﻳﺦ ارﺟﺎع ﺟﻬﺖ اﺻﻼﺣﺎت : 5/11/1393 ﺗﺎرﻳﺦ ﺗﺼﻮﻳﺐ : 1393/12/2 138 ﻣﺠﻠﻪ داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﻣﺎزﻧﺪران دوره ﺑﻴﺴﺖ و ﭼﻬﺎرم ، ﺷﻤﺎره 122 ، اﺳﻔﻨﺪ 1393 ﭘﮋوﻫﺸﻲ ﻣﺤﻤﺪ ﻫﻤﺎﻳﻮن ﻧﺴﺐ ﻟﻨﮕﺮودي و ﻫﻤﻜﺎران در اﻳﻦ ﻣﻴﺎن، ﻋﻔﻮﻧﺖ ﻣﺤﻞ زﺧﻢ ﺟﺮاﺣﻲ 25 درﺻﺪ ﻣﻮاﻗــﻊ اﻧﺘﺨــﺎب ﻧﺎﻣﻨﺎﺳــﺐ ﮔﻨــﺪزداﻫﺎ، ﻓﻴﺰﻳــﻚ ﻧﺎﻣﻨﺎﺳــﺐ از ﻛﻞ ﻋﻔﻮﻧﺖﻫﺎي ﺑﻴﻤﺎرﺳﺘﺎﻧﻲ را ﺷﺎﻣﻞ ﻣﻲﺷﻮد ﻛﻪ ﺳﻬﻢ ﻣﺤﻴﻂ، ﻋﺪم آﻣﻮزش و ﻧﺎآﮔـﺎﻫﻲ ﭘﺮﺳـﻨﻞ، ﺳـﺒﺐ ﻛـﺎﻫﺶ ﻗﺎﺑــﻞ ﻣﻼﺣﻈــﻪاي در اﻓــﺰاﻳﺶ ﺑــﺎر اﻗﺘﺼــﺎدي ﻧﺎﺷــﻲ از ﺗﺎﺛﻴﺮ ﮔﻨﺪزدا ﻫﺎ ﺷﺪه ﻛﻪ ﺑﻪ ﺣﺬف ﻧـﺎﻣﻄﻠﻮب ﭘـﺎﺗﻮژن ﻫـﺎي ﻋﻮارض ﻋﻔﻮﻧﺖ را دارد. ﺑﻪ ﻃﻮريﻛﻪ آﻟﻮدﮔﻲ ﻣﻴﻜﺮوﺑـﻲ ﻣﺤﻴﻄﻲ و در ﻧﻬﺎﻳﺖ اﻓﺰاﻳﺶ اﺣﺘﻤﺎل اﻳﺠـﺎد ﻋﻔﻮﻧـﺖ ﻫـﺎي اﺗﺎقﻫﺎي ﻋﻤﻞ، زاﻳﻤﺎن، ﺑﺨﺶﻫﺎي ﺳﻮﺧﺘﮕﻲ، ﭘﺎﻧﺴـﻤﺎن و ﺑﻴﻤﺎرﺳــﺘﺎﻧﻲ ﻣﻨﺠــﺮ ﻣــﻲﺷــﻮد(5). ﺷــﻨﺎﺧﺖ راهﻫــﺎي اﻧﺘﻘــﺎل ﺗﺰرﻳﻘﺎت ﻳﻜﻲ از ﻣ ﻬﻢﺗﺮﻳﻦ ﻋﻮاﻣﻞ زﻣﻴﻨﻪﺳﺎز ﻋﻔﻮﻧـﺖ ﻫـﺎي ﻋﻔﻮﻧﺖ ﻣﻲ ﺗﻮاﻧﺪ ﺑﻪ ﺟﻠﻮﮔﻴﺮي از اﻳﺠﺎداﻳﻦ ﭼﺮﺧﻪ ﻛﻤـﻚ ﺑﻴﻤﺎرﺳﺘﺎﻧﻲ ﻫﺴﺘﻨﺪ(2،1). ﻋﻔﻮﻧﺖ ﻫـﺎي ﺑﻴﻤﺎرﺳـﺘﺎﻧﻲ ﻣﺸـﻜﻞ ﻛﻨﺪ. ﺑﻪ ﻃﻮر ﻛﻠﻲ 5 راه اﺻﻠﻲ در اﻧﺘﻘﺎل ﻣﻴﻜﺮوارﮔﺎﻧﻴﺴﻢ ﻫـﺎ ﻋﻤﺪه ﭘﺰﺷﻜﻲ ﻣﺪرن و از ﻋﻠﻞ ﺷﺎﻳﻊ و ﻣﻬﻢ اﻓﺰاﻳﺶ ﻃـﻮل ﻋﺒﺎرﺗﻨﺪ از: ﺗﻤـﺎس، ذرات ﻣﻌﻠـﻖ، ﻫـﻮا، ﻋﺎﻣـﻞ ﻣﺸـﺘﺮك و ﻣﺪت ﺑﺴﺘﺮي، ﻫﺰﻳﻨﻪ ﻫﺎي ﺑﻴﻤﺎرﺳﺘﺎن و ﻣﺮگ و ﻣﻴﺮ ﺑﻴﻤﺎران ﻧﺎﻗﻠﻴﻦ. از اﻳﻦ ﻣﻴﺎن، ﺗﻤﺎس ﻣﻬﻤﺘﺮﻳﻦ آن ﻫﺎ ﻣﻲ ﺑﺎﺷﺪ ﻛـﻪ ﺑـﺎ اﺳﺖ(2). ﺑﺮ اﺳﺎس آﻣﺎر اﻋﻼم ﺷﺪه، ﺳﺎﻻﻧﻪ دو ﻣﻴﻠﻴـﻮن ﻣـﻮرد اﺗﺨــﺎذ ﻳــﻚ ﺳﻴﺎﺳــﺖ ﮔﻨــﺪزداﻳﻲ ﻣﻨﺎﺳــﺐ از اﻧﺘﻘــﺎل اﻳــﻦ ﻋﻔﻮﻧﺖ ﻫﺎي ﺑﻴﻤﺎرﺳﺘﺎﻧﻲ در آﻣﺮﻳﻜﺎ ﺑﻪ وﻗﻮع ﻣﻲﭘﻴﻮﻧﺪد ﻛﻪ ﻋﻮاﻣﻞ ﺑﺎ اﻳﻦ روش ﺟﻠﻮﮔﻴﺮي ﻧﻤﻮده و ﺑﺮوز ﻋﻔﻮﻧﺖ ﻫـﺎي ﻣﻨﺠﺮ ﺑﻪ اﻓﺰاﻳﺶ ﺑﻴﻤﺎري، ﻣﺮگ و ﻣﻴـﺮ، ﻫﺰﻳﻨـﻪ ﻫـﺎ و ﻃـﻮل ﺑﻴﻤﺎرﺳﺘﺎﻧﻲ را ﺗـﺎ ﺣـﺪ زﻳـﺎدي ﻛـﺎﻫﺶ داد(2). ﻣﻴـﺰان اﻳـﻦ ﻣﺪت ﺑﺴﺘﺮي ﺑﻴﻤﺎران در ﺑﻴﻤﺎرﺳﺘﺎن ﻣﻲﮔﺮدد. ﻣﻴﺰان ﻣﺮگ ﻋﻔﻮﻧﺖ ﻫﺎ درﺳﺎل 1379 در اﻳﺮان از 9/1درﺻﺪ ﺗﺎ ﺑـﻴﺶ از و ﻣﻴﺮ ﺑﻪ دﻧﺒﺎل اﻧﻮاع ﻋﻔﻮﻧﺖ ﺑﻴﻤﺎرﺳﺘﺎﻧﻲ از 8/14درﺻﺪ ﺗـﺎ 25درﺻﺪ ﮔﺰارش ﺷﺪه اﺳﺖ(6). ﺗﻮﺟﻪ ﺑـﻪ اﻧﺘﻘـﺎل ﻋﻮاﻣـﻞ 71درﺻﺪ ﻣﺘﻐﻴﺮ ﺑﻮده اﺳﺖ. ﺑﺮ اﺳﺎس ﮔﺰارش (آﻣـﺎري در ﻋﻔﻮﻧﻲ از ﻃﺮﻳـﻖ ﺗﻤـﺎس ﺑـﻪ ﻋﻨـﻮان ﻣﻬـﻢ ﺗـﺮﻳﻦ راه، ﻧﻘـﺶ اﻣﺮﻳﻜﺎ) در ﺳﺎل 1995، ﻋﻔﻮﻧﺖﻫﺎي ﺑﻴﻤﺎرﺳﺘﺎﻧﻲ در ﻫـﺮ 6 ﮔﻨﺪزداﻳﻲ را ﺑـﻪ ﻋﻨـﻮان ﻣﻬـﻢ ﺗـﺮﻳﻦ راهﻛـﺎر ﭘﻴﺸـﮕﻴﺮي از دﻗﻴﻘﻪ ﻣﻮﺟﺐ ﻣﺮگ ﻳﻚ ﻧﻔﺮ در آﻣﺮﻳﻜﺎ ﻣﻲ ﺷـﻮد (3). اﻳـﻦ اﻳﺠﺎد ﻋﻔﻮﻧﺖ ﺑﻴﻤﺎرﺳﺘﺎﻧﻲ ﺑﺴـﻴﺎر ﺑـﺎ اﻫﻤﻴـﺖ ﻧﻤـﻮده اﺳـﺖ رﻗﻢ درﻛﺸﻮرﻫﺎي در ﺣﺎل ﺗﻮﺳﻌﻪ ﺑﻴﺶﺗﺮ اﺳﺖ و ﺳﺎﻻﻧﻪ 2 ﻋﻮاﻣﻞ زﻳﺎدي در ﻣﻮﻓﻘﻴﺖ ﻳﻚ ﻓﺮاﻳﻨﺪ ﮔﻨﺪزداﻳﻲ ﺗﺎﺛﻴﺮﮔﺬار ﺗﺎ 4 ﻣﻴﻠﻴﻮن ﻣﻮرد ﻋﻔﻮﻧﺖ ﻫﺎي ﺑﻴﻤﺎرﺳﺘﺎﻧﻲ در اﻳﻦ ﻛﺸﻮرﻫﺎ اﺳﺖ ﻛﻪ ﺑـﻲ ﺗـﻮﺟﻬﻲ ﺑـﻪ آن ﻫـﺎ ﻣـﻲ ﺗﻮاﻧـﺪ ﺳـﺒﺐ ﻛـﺎﻫﺶ رخ ﻣﻲ دﻫﺪ، ﺗﺎ آنﺟﺎ ﻛﻪ ﻳﺎزدﻫﻤﻴﻦ ﻋﻠﺖ ﻣﺮگ و ﻣﻴـﺮ در ﻛﺎراﻳﻲ اﻳﻦ ﻓﺮاﻳﻨﺪ ﺷﻮد. ﺗﻮﺟﻪ ﺑـﻪ اﭘﻴـﺪﻳﻤﻲ ﻋﻔﻮﻧـﺖ ﻫـﺎي ﺟﻬﺎن و ﭘﻨﺠﻤﻴﻦ ﻋﻠﻞ ﻣﺮگ و ﻣﻴﺮ در ﺑﻴﻤﺎرﺳﺘﺎنﻫـﺎ اﺳـﺖ . ﺑﻴﻤﺎرﺳﺘﺎﻧﻲ و ﻋﻮاﻣﻞ ﻏﺎﻟﺐ ﻋﻔﻮﻧﺖ زا درﻛﻨﺎر ﺧﺼﻮﺻﻴﺎت درﻣﺎن ﻋﻔﻮﻧﺖ ﻫﺎي ﺑﻴﻤﺎرﺳﺘﺎﻧﻲ ﻧﻴـﺰ ﺑﺴـﺘﻪ ﺑـﻪ ﻧـﻮع ﻋﻔﻮﻧـﺖ ﻓﻴﺰﻳﻜﻲ و ﺷﻴﻤﻴﺎﻳﻲ ﻣﺤﻴﻂ و ﺗﺮﻛﻴﺒﺎت ﮔﻨﺪزدا در اﻧﺘﺨﺎب ﻫﺰﻳﻨﻪاي زﻳﺎدي را ﺑﺮ ﺟﺎﻣﻌﻪ ﺗﺤﻤﻴﻞ ﻣﻲﻛﻨﺪ و ﻃﻮل ﻣﺪت و ﻛﺎرﺑﺮد اﻳﻦ ﺗﺮﻛﻴﺒﺎت ﻧﻘﺶ ﻣﻬﻤﻲ دارد. ﺑﻨﺎﺑﺮاﻳﻦ ﺑﺎ ﺗﻮﺟﻪ ﺑﺴﺘﺮي ﺷﺪن ﺑﻴﻤﺎران در ﺑﻴﻤﺎرﺳﺘﺎن از 1 ﺗﺎ30 روز ﺑﺴﺘﻪ ﺑـﻪ ﺑﻪ ﻣﻄﺎﻟﺐ ﺑﺎﻻ و ﻣﺸﻜﻼت ﻧﺎﺷﻲ از ﻋﻔﻮﻧﺖ ﻫﺎي ﺑﻴﻤﺎرﺳـﺘﺎﻧﻲ ﻧﻮع ﻋﻔﻮﻧﺖ اﻓﺰاﻳﺶ ﻣﻲدﻫﺪ(3، 4). و ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ اﻳﻦ ﻛﻪ ﻫـﻴﭻ ﻳـﻚ از ﮔﻨـﺪزداﻫﺎ ﺑـﺮاي ﺗﻤـﺎم ﻳﻜﻲ از ﻋﻮاﻣﻞ ﻣﻬﻢ ﮔﺴﺘﺮش ﻋﻔﻮﻧﺖﻫـﺎي ﺑﻴﻤﺎرﺳـﺘﺎﻧﻲ ﻧﻴﺎزﻫﺎي ﻣﺨﺘﻠﻒ ﮔﻨﺪزداﺋﻲ ﻣﻨﺎﺳﺐ ﻧﻴﺴﺘﻨﺪ و از ﻃﺮﻓﻲ ﭼـﻮن ﻋـــﺪم اﺳـــﺘﻔﺎده ﺻـــﺤﻴﺢ از ﮔﻨـــﺪزداﻫﺎ اﺳـــﺖ. اﺳـــﺘﻔﺎده در ﻣﺤﻴﻂ ﻫﺎي درﻣﺎﻧﻲ اﻧﺘﺨـﺎب ﻧـﻮع ﻣـﺎده ﮔﻨـﺪزدا داراي از ﻣﺤﻠــﻮلﻫــﺎي ﺿــﺪﻋﻔﻮﻧﻲ ﻛﻨﻨــﺪه ﻣــﻮﺛﺮ و ﺑــﻲﺧﻄــﺮ و ﺑــﺎ اﻫﻤﻴﺖ ﻣﻲ ﺑﺎﺷﺪ. ﻟﺰوم اﻧﺠـﺎم ﺗﺤﻘﻴـﻖ ﺑـﺮاي ﺗﻌﻴـﻴﻦ اﺛـﺮات ﺣﺪاﻗﻞ آﺳﻴﺐ ﺑﻪ وﺳﺎﻳﻞ و ﭘﺮﺳﻨﻞ ﻳﻜﻲ از اﺻـﻮل اﺳﺎﺳـﻲ ﺿﺪﻋﻔﻮﻧﻲ ﻛﻨﻨﺪﮔﻲ ﮔﻨﺪزداﻫﺎي ﻣﺨﺘﻠـﻒ ﺟﻬـﺖ اﻧﺘﺨـﺎب ﺿﺪﻋﻔﻮﻧﻲﻛﺮدن ﻣﻲﺑﺎﺷﺪ(1 ،4). ﺷـﻨﺎﺧﺖ ﻣﺒـﺎﻧﻲ و اﺻـﻮل ﮔﻨﺪزداﻫﺎي ﻣﻨﺎﺳﺐ ﻻزم و ﺿﺮوري اﺳﺖ. ﻟـﺬا ﻫـﺪف از ﮔﻨــﺪزداﻳﻲ و آﮔــﺎﻫﻲ از ﻣﺎﻫﻴــﺖ ﮔﻨــﺪزدا و ﻓﺎﻛﺘﻮرﻫــﺎي اﻳﻦ ﺗﺤﻘﻴـﻖ، ﺑﺮرﺳـﻲ اﺛـﺮ ﮔﻨـﺪزداﻫﺎي راﻳـﺞ ﺑـﺮ ﺑـﺎﻛﺘﺮي ﺗﺎﺛﻴﺮﮔﺬار ﺑﺮ ﻛﺎراﻳﻲ آن ﻧﻘﺶ ﻛﻠﻴـﺪي در ﻣﻮﻓﻘﻴـﺖ ﻳـﻚ اﺷﺮﺷﻴﺎﻛﻠﻲ ﺟﺪا ﺷﺪه از ﺑﻴﻤﺎرﺳﺘﺎن ﻫﺎي آﻣﻮزﺷﻲ در ﺷـﻬﺮ ﮔﻨﺪزداﻳﻲ ﻳﺎ اﺳﺘﺮﻳﻠﻴﺰاﺳـﻴﻮﻧﺪارد . ﻣﺘﺎﺳـﻔﺎﻧﻪ در ﺑﺴـﻴﺎري از ﺳﺎري در ﺳﺎل 1393 ﻣﻲﺑﺎﺷﺪ. ﻣﺠﻠﻪ داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﻣﺎزﻧﺪران دوره ﺑﻴﺴﺖ و ﭼﻬﺎرم ، ﺷﻤﺎره 122 ، اﺳﻔﻨﺪ 1393 139 ﻣﻮاد و روشﻫﺎ ﺑﺨﺶﻫـﺎي ﺑﻴﻤﺎرﺳـﺘﺎن داﺷـﺘﻪ اﻧـﺪاﻧﺠﺎم ﺷـﺪ . ﺑﻌـﺪ از ﻫـﺮ ﻧﻤﻮﻧﻪﺑﺮداري ﻣﺤﺘﻮﻳﺎت ﺳﻮاپ ﻣـﻮرد اﺳـﺘﻔﺎده در ﻳـﻚ ﮔﻨﺪزداﻫﺎي ﻣﻮرد ﻣﻄﺎﻟﻌﻪ ﻟﻮﻟــﻪ آزﻣــﺎﻳﺶ ﺣــﺎوي10 ﻣﻴﻠــﻲﻟﻴﺘــﺮ ﻣﺤــﻴﻂﻛﺸــﺖ ﻣــﺎﻳﻊ ﻣــﻮاد ﮔﻨــﺪزداﻫﺎي ﻣــﻮرد ﻣﻄﺎﻟﻌــﻪ ﻋﺒــﺎرت ﺑﻮدﻧــﺪ از : (ﺑﺮاث) ﺗﺨﻠﻴﻪ ﺷﺪ و ﺑﻪ آزﻣﺎﻳﺸﮕﺎه ﻣﻨﺘﻘـﻞ و در اﻧﻜﻮﺑـﺎﺗﻮر دﻛﻮﻧﻜﺲ در ﻏﻠﻈﺖ ﻫﺎي 5/0 ، 1 و 2 درﺻﺪ؛ ﺳـﺎﻳﺪﻛﺲ در دﻣﺎي 37 درﺟﻪ ﺑﻪ ﻣـﺪت 48 ﺳـﺎﻋﺖ ﻗـﺮار داده ﺷـﺪ و در ﻏﻠﻈﺖﻫﺎي 5/0، 1 و 2 درﺻﺪ؛ ﻛﺮﺋﻮﻟﻴﻦ در ﻏﻠﻈﺖ ﻫﺎي ﻧﻤﻮﻧــﻪﻫــﺎﻳﻲ ﻛــﻪ در آن ﮔــﺎز و ﻛــﺪورت اﻳﺠــﺎد ﺷــﺪ در 5/3، 5 و 7 درﺻﺪ. ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ اﻳﻦ ﻛﻪ ﻣﻴـﺰان و ﻳـﺎ ﺷـﺪت ﻣﺤـﻴﻂ ﻛﺸـﺖ EMB ﻛﺸـﺖ داده ﺷـﺪ و ﻣـﻮرد ﺑﺮرﺳـﻲ آﻟﻮدﮔﻲ ﻣﺤﻴﻄﻲ ﻛﻒ اﺗﺎقﻫﺎ و ﺳـﻄﻮح ﻓﻴﺰﻳﻜـﻲ در ﻣﺮاﻛـﺰ ﻣﻴﻜﺮوﺑﻴﻮﻟﻮژﻳﻚ ﻗﺮار ﮔﺮﻓﺖ(1، 8). درﻣﺎﻧﻲ ﺑﺮ اﺳﺎس ﺗﻌﺪاد ﻣﻴﻜﺮوارﮔﺎﻧﻴﺴﻢ ﻫﺎي ﻣﻮﺟﻮد در ﻫـﺮ ﺳﺎﻧﺘﻲ ﻣﺘﺮ ﻣﺮﺑﻊ آن ﻣﺤﻴﻂ ﺳﻨﺠﻴﺪه ﻣﻲ ﺷﻮد و ﺑﺮاﺳﺎس روش روش ﻛﺸﺖ و ﺷﻨﺎﺳﺎﻳﻲ اﺷﺮﺷﻴﺎﻛﻠﻲ اﺳﺘﺎﻧﺪارد ﻣﻮﺟﻮد، ﺗﻌﺪاد ﺑـﻴﺶ از 10 ﻣﻴﻜﺮوارﮔﺎﻧﻴﺴـﻢ در ﻧﻤﻮﻧﻪ ﻫﺎ ﺑـﻪ وﺳـﻴﻠﻪ ﺳـﻮاپ اﺳـﺘﺮﻳﻞ ﮔﺮﻓﺘـﻪ ﺷـﺪ و ﺑـﻪ ﻫﺮ ﺳﺎﻧﺘﻲﻣﺘﺮ ﻣﺮﺑﻊ ﻧﺸـﺎﻧﻪ آﻟـﻮدﮔﻲ آن ﻣﺤـﻴﻂ ﺑـﺎ دﺳـﺘﮕﺎه ﻣﺤﻴﻂ ﻫﺎي آب ﮔﻮﺷﺖ ﻧﻮﺗﺮﻳﻨـﺖ ﺑـﺮاث و ﻻﻛﺘـﻮز ﺑـﺮاث ﻣﻮرد ﺑﺮرﺳﻲ ﻣﻲﺑﺎﺷﺪ(7،1) و از آﻧﺠﺎﺋﻲ ﻛﻪ ﺗﻬﻴﻪ ﻧﻤﻮﻧـﻪ ﺑـﺎ ﺑﺮاي رﺷﺪ ﺑﺎﻛﺘﺮي ﺗﻠﻘﻴﺢ ﮔﺮدﻳﺪ و ﺑﻪ ﻣﺪت 48 ﺳﺎﻋﺖ در ﺳﻮآپ از ﻳﻚ ﺳـﺎﻧﺘﻲ ﻣﺘـﺮ ﻣﺮﺑـﻊ ﻣﺤـﻴﻂ ﺑـﻪ راﺣﺘـﻲ ﻣﻴﺴـﺮ اﻧﻜﻮﺑﺎﺗﻮر 37درﺟﻪ ﺳﺎﻧﺘﻲﮔﺮاد ﻧﮕـﻪ داري ﺷـﺪه ﺳـﭙﺲ ﺑـﻪ ﻧﻴﺴﺖ، ﻟـﺬا از ﻣﺴـﺎﺣﺖ ﺑـﻴﺶ ﺗـﺮي (100ﺳـﺎﻧﺘﻲ ﻣﺘـﺮ ﻣﺮﺑـﻊ ) ﻣﺤﻴﻂ،EMB اﮔﺎر ﺗﻠﻘﻴﺢ ﮔﺮدﻳﺪ.
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