改进内镜清洗方法的临床应用研究

Clinical effect of improved endoscopic cleaning method

目的检测冲洗后内镜不同部位的有菌率,比较清洗方法改进前后的清洗效果。方法对《内镜清洗消毒技术操作规范》中酶处理和刷洗的方法进行改进,刷洗时调整大小螺旋的方向,并在清洗剂中初洗;刷洗手法从直刷改为螺旋式刷洗;延长冲洗时间,流程改进前后采集内镜不同部位的标本进行细菌学检验,改进后采集不同清洗阶段的标本进行ATP值测定,以检测清洗效果。结果内镜有菌率45°孔道最高为48.0%、90°孔道次之为44.0%、镜表最低为20.0%,不同部位有菌率比较,差异有统计学意义(P<0.05);改进清洗方法前细菌阳性率为34.5%,改进后为0,差异有统计学意义(P<0.05);离体后-预处理-初洗后(酶洗后)-冲洗后污染物下降明显,提高了内镜清洗的清洁度。结论流程改进后清洗内镜效果优于流程改进前。

OBJECTIVE To detect the rate of bacteria of different parts of endoscope,to compare the cleaning effect before and after the improvement of the cleaning method.METHODS The enzyme treatment and brushing method in the ＂specification for cleaning and disinfection of endoscopes（2004）＂ were improved.The direction of the spiral was adjusted during washing,and the initial cleaning was conducted with the cleaning agent.For scrubbing skills,the straight brushing was changed to a spiral cleaning.The flushing time was prolonged.Specimens of different parts of endoscopes before and after process improvement were collected for bacteriological examination.After process improvement,specimens of different cleaning stages were collected for ATP test in order to test the cleaning effect.RESULTS The bacteria positive rate in different parts had significant difference（χ^2=12.280,P=0.006）.45°channel had the highest rate of bacteria（48.0%）,followed by 90°channel（44.0%）,the mirror surface had the minimum（20.0%）.Prior to the improvement,the bacterial positive rate was 34.50%,and reduced to 0% after improvement,with significant difference（P〈0.001）.With the process of separationpretreatment-initial brushing（enzyme washing）-flushing,the contaminants were significantly reduced and the clean level of the endoscope was improved.CONCLUSIONEndoscope cleaning effect after process improvement is better than that before process improvement.