Expiration Date Of Sterile Packages Of Strategic Reserve In Inland And Highland Regions Under Natural Environment

A great number of sterile packages, such as operational instrument sets and chest drainage packages, are needed in war wound treatment or civil rescue, which are usually kept under natural environment. A great deal of these packages are reserved in different military hospitals and are important part of strategic reserve .Objectives:To study expiration date of the sterile packages between inland region and highland region under natural environment could provide information about expiration date of the sterile goods under differentially natural environment and new methods about management on strategic reserve for Medical Therapy Unit of armed forces ,which could adopt sterilization and regulation means reasonably for strategic reserve and to reduce wastage and medical cost.Methods:1. The sterile packages of strategic reserve preparation ,sterilization and preservation: In inland and highland regions, standard procedures were taken according to the Technical Standard of Disinfection to wash, pack. Then steam sterilization, physical monitoring, chemical monitoring, biological monitoring were followed and the sterile packages were kept under natural environment. In highland region, the storage boxes were kept in open conditions and in closed conditions.2. Monitoring of natural environment: The temperature, humidity, persons in the experiment sites and climate were monitored everyday.3. Sampling and cultivation: In inland and highland regions, samples were taken from the packages and underwent bacterial culture at different time-points. Just on the disinfection day of sterile packages of strategic reserve and before sampling in sterile packages every time, the Plate Exposure Method and the Sampling Method outside the Items and Surroundings in the Technical Standard for Disinfection were utilized to culture the air bacteria strains and bacteria strains in the storage boxes respectively. 4. Identification of bacteria : Bacteria strains in the packages, the air bacteria strains and bacteria strains in the storage boxes were identified according to bacteria morphous, Garm's stain, test under microscope, biochemistry tests and VITEK Identification System.5. Empirical study on homology: Genomic DNA from the bacteria strains in sterile packages of strategic reserve, the air bacteria strains in combat readiness warehouse and bacte- ria strains in boxes were extracted and used as templates to amplify the 16SrRNA- 23SrRNA ITS sequences by PCR. The PCR products were extracted and sequenced and multiple sequences homology analysis was performed with ClustalW2 software.Results:1. The expiration time of sterile packages: In inland region, , the expiration time of sterile packages was 40 days in open conditions under natural environment whereas the expiration time was 91 days in open conditions and 106 days in closed conditions under natural environment in highland region.2. Results of monitoring of natural environment: In inland region, it was 35 sunny days during 49 days and temperature was about 24℃～27℃and humidity was about 50%～75% in the experiment sites in which there were 6 persons everyday; In highland region, it was 106 sunny days during 122 days and temperature was about -12℃～15.8℃and humidity was about 10%～46.9% in the experiment sites in which there were about 22 persons every day.3. Results of bacteriology: In inland region, there were 3 species bacteria in sterile packages which were Micrococcus luteus, Staphylococcus cohnii ureal and Bacillus cereus. The air bacterial density was 465.8cfu/m3 and dominant species were Micrococcus luteus, Bacillus cereus, Corynebacterium and Staphylococcus cohnii ureal. Bacterial density of the storage boxes was 1.22cfu/cm2 and dominant bacteria were fungi, Micrococcus luteus, Staphylococcus aureus.In highland region, there were 4 species bacteria in sterile packages which were Staphylococcus aureus, Staphylococcus hominis, Staphylococcus xylose and Bacillus cereus in open conditions. The major bacteria in sterile packages in closed conditions were Bacillus cereus. The air bacterial density was 365cfu/m3 and dominant bacteria were Bacillus cereus, Staphylococcus xylose, Staphylococcus hominis and Bacillus circulans. Bacterial density in open storage boxes was 7.54cfu/cm2 and dominant bacteria were Bacillus cereus, Bacillus badius, Staphylococcus xylose, Listeria, Staphylococcus hominis and Bacillus circulans; In closed storage boxes, bacterial density was 3.42cfu/cm2 and dominant bacteria were Bacillus cereus, Staphylococcus hominis, Staphylococcus xylose and Bacillus circulans.4. Results of homology: In inland region, the 16SrRNA-23SrRNA ITS sequences of bacteria strains in sterile packages shared about 98~99% homology with which from the air bacteria strains in combat readiness warehouse and 97~99% homology with which from the storage boxes. Meanwhile, The sequences of the air bacteria strains shared about 99~100% homology with which from the storage boxes.In highland region, the 16SrRNA-23SrRNA ITS sequences of bacteria strains in sterile packages shared about 99~100% homology with which from the air bacteria strains in combat readiness warehouse and 99~100% homology with which from the storage boxes. The sequences of the air bacteria strains shared about 99% homology with which from the storage boxes.Conclusions:1. Under natural environment, expiration time of sterile packages of strategic reserve exists regional difference. It was 40 days in inland region whereas 91 days in open conditions and 106 days in closed conditions in highland region, which both were longer than standard of the Technical Standard of Disinfection.2. The storage environment is the most influential role on expiration time of sterile packages of strategic reserve. When the sterile packages of strategic reserve are kept under natural environment, the influential role is more obvious.3. The bacteria in sterile packages of strategic reserve came from the air. In two regions, the 16SrRNA-23SrRNA ITS sequences between bacteria strains in sterile packages and air bacteria strains in combat readiness warehouse were homology sequences by ITS-PCR.4. To ensure the expiration time of sterile package of strategic reserve, corresponding management methods are important guarantee which can provide new methods about management on strategic reserve.