【摘要】 目的 分析医院候诊室感染性呼吸颗粒（IRPs）分布特征，并探讨室内空气环境因素对细菌IRPs分布特征的影响。方法 2024年夏季和冬季选取北京市某区内三所三级医院9个非感染科室候诊室进行基本情况现场勘查，采用撞击法采集36份空气标本分析可培养细菌浓度及粒径分布；采用气旋法采集36份IRPs标本，使用荧光聚合酶链式反应（PCR）法分析呼吸道主要病原体。结果 夏季候诊室IRPs中细菌总数中位数为1 035 CFU/m³,高于冬季（中位数为295 CFU/m³）,差异有统计学意义（P<0.05）。夏季和冬季不同类型候诊室IRPs中细菌总数中位数均为急诊科候诊室<呼吸科候诊室<儿科候诊室<普通门诊候诊室，不同候诊室间细菌总数差异无统计学意义（P>0.05）。夏季和冬季候诊室细菌IRPs粒径主要分布在<4.7μm,占比分别为73.77%、69.44%。候诊室IRPs中细菌总数与室内空气温度、相对湿度、PM₁₀和PM_2.5均呈正相关（均P<0.01）,与室内风速呈负相关（P<0.01）。夏季和冬季不同类型候诊室IRPs中呼吸道传染性和非传染性病原体检出种类不同。夏季检出病原体主要集中于呼吸道非传染性病原体（大肠埃希菌、肺炎克雷伯菌、金黄色葡萄菌）。冬季有呼吸道传染性病原体（病毒和肺炎支原体）检出，且不同类型候诊室检出种类不同。冬季IRPs中检出呼吸道非传染性病原体主要集中在大肠埃希菌、肺炎克雷伯菌和金黄色葡萄球菌。结论 候诊室细菌IRPs粒径主要分布在<4.7μm,可进入人体下呼吸道，对健康构成潜在风险。候诊室IRPs中检出呼吸道主要传染性和非传染性病原体，提示就诊者和医护人员存在一定的感染暴露风险。更多还原

【Abstract】 Objective To analyze the distribution characteristics of infectious respiratory particles（IRPs） in hospital waiting rooms, and explore the impact of indoor air environmental on the distribution characteristics of bacterial IRPs. Methods In the summer and winter of 2024, nine waiting rooms in non-infectious departments of three ter-tiary hospitals in a district of Beijing were selected for on-site investigation on basic conditions. Concentration and distribution of particle diameter of cultivable bacteria from 36 air specimens collected by the impacting method were analyzed. Cyclone method was employed to collect 36 IRPs specimens. Major respiratory pathogens were analyzed by fluorescence polymerase chain reaction（PCR）. Results The median of the total bacterial count in IRPs in the waiting rooms in summer was 1 035 CFU/m³, which was higher than that in winter（295 CFU/m³）, with statistically significant difference（P<0.05）. The orders of medians of the total bacterial count from IRPs of different types in the waiting rooms in both summer and winter were as follows: emergency department waiting room <respiratory department waiting room <pediatric waiting room <general outpatient waiting room. There was no statistically significant difference in the total bacterial count among different waiting rooms（P>0.05）. Particle diameter of bacterial IRPs in the waiting rooms in summer and winter mainly distributed in the range of <4.7 μm, accounting for 73.77% and 69.44%, respectively. The total number of bacteria in IRPs in the waiting rooms was positively correlated with indoor air temperature, relative humidity, PM₁₀, and PM_2.5（all P<0.01）, while negatively correlated with indoor wind speed（all P<0.01）. The types of respiratory infectious and non-infectious pathogens detected from IRPs in different types of waiting rooms were different between summer and winter. The pathogens detected in summer were mainly concentrated in respiratory non-infectious pathogens（Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus）. In winter, respiratory infectious pathogens（virus and Mycoplasma pneumoniae） were detected. The types of detected pathogens in different types of waiting rooms were different. Non-infectious respiratory pathogens detected from IRPs in winter were mainly Escherichia coli, Klebsiella pneumoniae, and Staphylococcus aureus. Conclusion Particle diameter of bacterial IRPs in the waiting room is mainly <4.7 μm. These particles can enter the lower respiratory tract of human body, and pose potential risk to health. The detection of main infectious and non-infectious respiratory pathogens from IRPs in waiting rooms suggests risk of exposure to infection for patients and healthcare workers.更多还原