新内镜中心验收过程发现的问题及对策
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摘要
目的新内镜中心验收过程中模拟内镜清洗消毒流程,查找存在的问题并给予解决方案。方法新内镜中心验收中采用人工和全自动机清洗方法模拟内镜清洗消毒流程,对终末漂洗用纯水及清洗消毒后内镜进行微生物学检测,根据检测结果分析不合格原因并针对性进行改进。结果纯水供给管道消毒前后内镜终末漂洗用纯水检测合格率分别0、100%,染菌量中位数(四分位数)分别为200(186,213)、1. 5(0,6) CFU/100 m L,差异有统计学意义(P <0. 01)。酶液浓度调整前后人工清洗消毒内镜检测合格率分别为80. 00%、91. 67%。全自动内镜清洗消毒机(AER)自身消毒前后,自动清洗消毒机空载运行后水标本检测合格率分别为30%、100%,染菌量中位数(四分位数)分别为97. 5(8,175)、4(1. 75,6. 00) CFU/100 m L,差异有统计学意义(P <0. 01)。对管腔疑似有生物膜形成的内镜用2 000 mg/L过氧乙酸消毒后,合格率达100%。结论新内镜中心纯水供给管道未消毒、内镜清洗环节中酶液浓度错误、AER未进行自身消毒、内镜管腔生物膜形成是此次新内镜中心验收过程中发现的问题,针对性改进后,问题得到解决。为保障医疗安全和医疗质量,医疗机构应积极重视新内镜中心启用前的验收工作,消除造成内镜消毒不合格的危险因素。
Objective To simulate the cleaning and disinfection process of endoscopes during the acceptance of new endoscopy center,find out the existing problems and put forward solutions. Methods Manual and automatic endoscope reprocessor( AER) washing methods were used to simulate the cleaning and disinfection process of endoscope during the acceptance process of new endoscopy center. Pure water used for end-rinse and endoscopes after cleaning and disinfection were performed microbial detection,according to detected results,causes for the unqualification were analyzed,the corresponding improvement was made. Results The qualified rates of pure water used for end-rinse of endoscopes before and after disinfection of pure water supply pipeline were 0 % and 100 % respectively,the median( quartile) of bacterial contamination were 200( 186,213) and 1. 5( 0,6) CFU/100 mL respectively,with significant difference( P < 0. 01). The qualified rates of manual cleaned and disinfected endoscopes before and after adjusting enzyme concentration were 80. 00 % and 91. 67 % respectively. Before and after AER were disinfected,the qualified rates of water specimens from AER at on-load condition were 30 % and 100 %respectively,the median( quartile) of bacterial contamination were 97. 5( 8,175) and 4( 1. 75,6. 00) CFU/100 mL respectively,with significant difference( P < 0. 01). After endoscope lumen with suspected biofilm formation was disinfected with 2 000 mg/L peracetic acid,the qualified rate was 100%. Conclusion Problems existed during the acceptance of new endoscopy center are non-disinfection of pure water supply pipeline,incorrect enzyme concentration for endoscopic cleaning,non-disinfection of AER,and formation of biofilm of endoscope lumen,after targeted improvement,these problems are solved. In order to ensure medical safety and quality,medical institutions should attach great importance to the acceptance before operation of new endoscopy center,and eliminate risk factors for unqualified endoscopy disinfection.
Objective To simulate the cleaning and disinfection process of endoscopes during the acceptance of new endoscopy center,find out the existing problems and put forward solutions. Methods Manual and automatic endoscope reprocessor( AER) washing methods were used to simulate the cleaning and disinfection process of endoscope during the acceptance process of new endoscopy center. Pure water used for end-rinse and endoscopes after cleaning and disinfection were performed microbial detection,according to detected results,causes for the unqualification were analyzed,the corresponding improvement was made. Results The qualified rates of pure water used for end-rinse of endoscopes before and after disinfection of pure water supply pipeline were 0 % and 100 % respectively,the median( quartile) of bacterial contamination were 200( 186,213) and 1. 5( 0,6) CFU/100 mL respectively,with significant difference( P < 0. 01). The qualified rates of manual cleaned and disinfected endoscopes before and after adjusting enzyme concentration were 80. 00 % and 91. 67 % respectively. Before and after AER were disinfected,the qualified rates of water specimens from AER at on-load condition were 30 % and 100 %respectively,the median( quartile) of bacterial contamination were 97. 5( 8,175) and 4( 1. 75,6. 00) CFU/100 mL respectively,with significant difference( P < 0. 01). After endoscope lumen with suspected biofilm formation was disinfected with 2 000 mg/L peracetic acid,the qualified rate was 100%. Conclusion Problems existed during the acceptance of new endoscopy center are non-disinfection of pure water supply pipeline,incorrect enzyme concentration for endoscopic cleaning,non-disinfection of AER,and formation of biofilm of endoscope lumen,after targeted improvement,these problems are solved. In order to ensure medical safety and quality,medical institutions should attach great importance to the acceptance before operation of new endoscopy center,and eliminate risk factors for unqualified endoscopy disinfection.
引文
[1]孔金艳,唐平,张修礼,等. 82所医疗机构消化内镜清洗消毒现状调查分析[J].中华医院感染学杂志,2010,20(18):2795-2797.
[2]陈亚飞,王琇,范颖,等.吉林省62所医院消化内镜清洗消毒现状问卷调查[J].中国消毒学杂志,2017,34(10):932-935.
[3] Park S,Jang JY,Koo JS,et al. A review of current disinfectants for gastrointestinal endoscopic reprocessing[J]. Clin Endosc,2013,46(4):337-341.
[4] Rutala WA,Weber DJ. Outbreaks of carbapenem-resistant Enterobacteriaceae infections associated with duodenoscopes:What can we do to prevent infections?[J]. Am J Infect Control,2016,44(5 Suppl):e47-e51.
[5]赵平凡,张红梅,马志杰,等.内镜清洗消毒流程改进对降低医院感染的效果分析[J].中华医院感染学杂志,2016,26(16):3827-3829.
[6]周照彦,高晓东,胡必杰.医院水源性感染的预防与控制[J].中华医院感染学杂志,2014,24(7):1818-1819.
[7]田春梅,董青,赵奇,等.医疗用水消毒质量调查分析[J].中华医院感染学杂志,2015,25(11):2632-2634.
[8] Frǎ爫ilǎO,Tan爫ǎu M. Cleaning and disinfection in gastrointestinal endoscopy:current status in Romania[J]. J Gastrointestin Liver Dis,2006,15(1):89-93.
[9]谈智,陈越英,孙巍,等.江苏省医疗机构内镜清洗消毒现状及影响因素分析[J].中国消毒学杂志,2015,32(5):458-460.
[10]李六亿.内镜医院感染现状、存在问题与管理对策[J].中华医院感染学杂志,2005,15(4):423-425.
[11]石瑞春,杨理华,杨志伟,等.改进清洗消毒流程对消化内镜消毒效果和感染防控效果观察[J].中国消毒学杂志,2015,32(4):338-340.
[12]付艳.浅析消化内镜清洗消毒的优化管理[J].中国医疗器械信息,2017,23(12):110-111.
[13]张丽华,彭虹,陈奕杏,等.改进消化内镜清洗消毒流程中失效模式与效应评价[J].中国消毒学杂志,2013,30(11):1026-1028.
[14]许文,李颖,戈伟,等.机洗前不同预清洗方法对软式内镜清洗消毒效果的比较[J].中国消毒学杂志,2015,32(5):520-522.
[15]班海群,张流波.全国39家医院内镜清洗消毒质量监测结果分析[J].中国卫生标准管理,2013,4(4~5):70-75.
[16] Nwokediuko SC,Obienu O. Sedation practices for routine diagnostic upper gastrointestinal endoscopy in Nigeria[J]. World J Gastrointest Endosc,2012,4(6):260-265.
[17]马久红.十二指肠镜感染风险与清洗消毒[J].世界华人消化杂志,2016,24(32):4337-4342.
[18] Kovaleva J,Peters FT,van der Mei HC,et al. Transmission of infection by flexible gastrointestinal endoscopy and bronchoscopy[J]. Clin Microbiol Rev,2013,26(2):231-254.
[19] Coelho-Prabhu N,Oxentenko AS,Osmon DR,et al. Increased risk of prosthetic joint infection associated with esophago-gastro-duodenoscopy with biopsy[J]. Acta Orthop,2013,84(1):82-86.
[20]马苏,傅增军,丁文霞,等.消化内镜腔细菌生物膜有效清除方法[J].中国消毒学杂志,2017,34(9):807-810.
[2]陈亚飞,王琇,范颖,等.吉林省62所医院消化内镜清洗消毒现状问卷调查[J].中国消毒学杂志,2017,34(10):932-935.
[3] Park S,Jang JY,Koo JS,et al. A review of current disinfectants for gastrointestinal endoscopic reprocessing[J]. Clin Endosc,2013,46(4):337-341.
[4] Rutala WA,Weber DJ. Outbreaks of carbapenem-resistant Enterobacteriaceae infections associated with duodenoscopes:What can we do to prevent infections?[J]. Am J Infect Control,2016,44(5 Suppl):e47-e51.
[5]赵平凡,张红梅,马志杰,等.内镜清洗消毒流程改进对降低医院感染的效果分析[J].中华医院感染学杂志,2016,26(16):3827-3829.
[6]周照彦,高晓东,胡必杰.医院水源性感染的预防与控制[J].中华医院感染学杂志,2014,24(7):1818-1819.
[7]田春梅,董青,赵奇,等.医疗用水消毒质量调查分析[J].中华医院感染学杂志,2015,25(11):2632-2634.
[8] Frǎ爫ilǎO,Tan爫ǎu M. Cleaning and disinfection in gastrointestinal endoscopy:current status in Romania[J]. J Gastrointestin Liver Dis,2006,15(1):89-93.
[9]谈智,陈越英,孙巍,等.江苏省医疗机构内镜清洗消毒现状及影响因素分析[J].中国消毒学杂志,2015,32(5):458-460.
[10]李六亿.内镜医院感染现状、存在问题与管理对策[J].中华医院感染学杂志,2005,15(4):423-425.
[11]石瑞春,杨理华,杨志伟,等.改进清洗消毒流程对消化内镜消毒效果和感染防控效果观察[J].中国消毒学杂志,2015,32(4):338-340.
[12]付艳.浅析消化内镜清洗消毒的优化管理[J].中国医疗器械信息,2017,23(12):110-111.
[13]张丽华,彭虹,陈奕杏,等.改进消化内镜清洗消毒流程中失效模式与效应评价[J].中国消毒学杂志,2013,30(11):1026-1028.
[14]许文,李颖,戈伟,等.机洗前不同预清洗方法对软式内镜清洗消毒效果的比较[J].中国消毒学杂志,2015,32(5):520-522.
[15]班海群,张流波.全国39家医院内镜清洗消毒质量监测结果分析[J].中国卫生标准管理,2013,4(4~5):70-75.
[16] Nwokediuko SC,Obienu O. Sedation practices for routine diagnostic upper gastrointestinal endoscopy in Nigeria[J]. World J Gastrointest Endosc,2012,4(6):260-265.
[17]马久红.十二指肠镜感染风险与清洗消毒[J].世界华人消化杂志,2016,24(32):4337-4342.
[18] Kovaleva J,Peters FT,van der Mei HC,et al. Transmission of infection by flexible gastrointestinal endoscopy and bronchoscopy[J]. Clin Microbiol Rev,2013,26(2):231-254.
[19] Coelho-Prabhu N,Oxentenko AS,Osmon DR,et al. Increased risk of prosthetic joint infection associated with esophago-gastro-duodenoscopy with biopsy[J]. Acta Orthop,2013,84(1):82-86.
[20]马苏,傅增军,丁文霞,等.消化内镜腔细菌生物膜有效清除方法[J].中国消毒学杂志,2017,34(9):807-810.