全自动内镜清洗消毒机消毒纤维支气管镜失败原因分析

Analysis on failure in disinfection of fiber optic bronchoscope by auto washing and disinfecting machine

目的分析纤维支气管镜清洗消毒机消毒失败原因,提出针对性改进措施,达到全自动内镜清洗消毒机消毒效能最佳化。方法 2013-2014年按国家规范对内镜内腔面采样,针对7例阳性标本进行细菌学鉴定,从内镜预处理、设备维护管理、消毒剂管理、人员培训4个方面查找失败原因,分别从管理、培训、标准流程的制定、设备清洗保养等方面提出针对性改进措施。结果通过根因分析,发现主要原因为人员培训不到位、操作人员对设备过度依赖、未实施有效预清洗、全自动清洗消毒机自身清洁消毒不到位、未建立标准化操作及维护保养流程等;通过建立内镜首洗负责制、设备预防性维护计划、标准化操作及管理流程、强化人员培训4项改进措施,进行针对性管理,纤维支气管内镜清洗消毒后期采样合格率达标。结论全自动内镜清洗消毒机运用过程必须加强预处理、设备的维护保养、注重人员的培训和标准化流程的建立,才能确保清洗消毒效果。

OBJECTIVE To analyze the reasons for the failure in disinfection of fiber optic bronchoscope by the washing and disinfecting machine ,and propose the specific corrective measures so as to achieve the maximum function of the automatic endoscope washing and disinfection machine .METHODS Samples of the inner surface of the fiber optic bronchoscope were collected according to the national standards ,and 7 positive samples were analyzed for bacterial identification .The reasons for the failure were explored from four aspects including the pre-processing of fiber optic bronchoscope , the equipment maintenance and management , the management of disinfectants and the training of the technicians .Corrective measures were proposed from aspects including man-agement ,training ,formulation of standard procedures ,and maintenance of equipment ,etc .RESULTS The cause analysis revealed that the main reasons included the imperfect personnel training , the operators′ excessive dependence on equipment ,the effective pre-cleaning unimplemented ,the lack of cleaning and disinfection of the machine ,the lack of standard procedures of operations and maintenance .After the four corrective measures to establish the endoscope washing system ,strengthen the maintenance of the equipments ,improve the training of the technicians ,and set up the standardized procedures were taken and the targeted management was performed , the passing rate of samples taken from the fiber optic bronchoscope was qualified .CONCLUSION To strengthen the maintenance of the equipment , and emphasize the training of the technicians , set up the standardized procedures are necessary to guarantee the function of the full-automatic washing and disinfecting machine for fibro bronchoscope .