内镜细胞刷清洗与灭菌方法的现场模拟试验研究

Washing and Sterilization Methods for Endoscopic Cell Brush:A Simulated Experimental Research

目的比较内镜细胞刷不同清洗和灭菌方法的效果,探讨有效的清洗、灭菌方法。方法枯草芽胞杆菌黑色变种芽胞和血液制成混悬液,将细胞刷浸染,模拟临床使用造成的混合污染,干燥后采用手工清洗、超声机清洗、多酶洗液+手工清洗、多酶洗液+超声机清洗,再分别采用戊二醛浸泡5、10 h,戊二醛熏蒸5 h、环氧乙烷灭菌柜进行灭菌,对清洗样本进行隐血试验(OB试验)和细菌培养。结果清洗效果:多酶洗液+超声机清洗效果最好,OB试验阳性率最低、芽胞清除率为99.90%,单纯手工清洗效果最差,OB阳性率为56.67%、芽胞清除率最低为90.87%;灭菌效果:环氧乙烷灭菌柜和戊二醛浸泡10 h灭菌,所有样本无菌生长;戊二醛浸泡5 h灭菌,未清洗样本仍有菌生长,清洗后可达灭菌合格;戊二醛熏蒸5 h均有菌生长,灭菌不合格。结论清洗可提高灭菌合格率,对混合污染内镜细胞刷,多酶洗液+超声机清洗是最有效的清洗方法,灭菌方法可采用环氧乙烷灭菌柜或戊二醛浸泡10 h。

OBJECTIVE To explore the efficientcy of washing and sterilization methods for the endoscopic cell brush. METHODS The contaminated cell brush with the mixture of Bacillus subtilis vat. niger spore and blood was washed by four methods：manually washing, multienzyme plus manually washing, ultrasonic cleaner washing, and multienzyme plus ultrasonic cleaner washing, and then dipped in glutaraldehyde for 5 h or 10 h, fumigated with glutaraldehyde for 5 h, and sterilized with 3M ethylene oxide box. The positive rates of occult blood test（OB test）, the cleaning rates of B. subtilis var. niger spore and the sterilization eligibility ratio of four serilization methods were compared. RESULTS The washing method that multienzyme plus ultrasonic cleaner washing could clear effectively the contaminated cell brush that the positive rates of OB test was 0 and the cleaning rates of B. subtilis var. niger spore was 99.90%. The positive rates of OB test and the cleaning rates of B. subtilis var. niger spore of manually washing was 56. 67% and 90.87%. Fumigated in 3M ethylene oxide box or dipped in glutaraldehyde for 10 h could kill all the spores, but dipped in glutaraldehyde for 5 h or fumigated with glutaraldehyde for 5 h could not. CONCLUSIONS The mixed contaminated endoscopic cell brush should be washed effectively by multienzyme＋ ultrasonic cleaner washing, and should be sterilized by fumigated in ethylene oxide box or dipped in glutaraldehyde for 10 h.