内镜清洗消毒过程中污染因素及预防措施研究

Risk factors for contamination during cleaning and disinfection of endoscopes and prevention measures

目的研究内镜清洗消毒过程中发生医源性感染的危险因素,并提出相对的预防策略,降低内镜使用引发的感染率。方法通过现场检查总结内镜清洗消毒过程中发生医源性感染的危险因素,并随机抽检184件处于临用状态的内镜,通过内腔取样及外表面取样检测内镜清洗、消毒质量。结果 184份样本检查合格169份,合格率为91.85%;胃镜、支气管镜、肠镜、喉镜合格率分别为86.00%、95.56%、89.36%、97.62%;15份标本检验菌落数超标,共检测出26株病原菌,其中幽门螺杆菌14株、大肠埃希菌8株、铜绿假单胞菌2株、金黄色葡萄球菌及结核分枝杆菌各1株;15份标本检查不合格原因中,清洗不彻底占40.00%、消毒液使用不当占40.00%、个人防护不当占13.33%、特殊感染者内镜未特殊处理占6.67%。结论内镜清洗、消毒过程中引发医源性感染的危险因素复杂,临床应加强对内镜清洗、消毒工作人员的教育、培养,规范内镜清洗、消毒流程,建立科学化监测模式,杜绝医源性感染。

OBJECTIVE To explore the risk factors for iatrogenic infections during the cleaning and disinfection of endoscopes and put forward corresponding prevention countermeasures so as to reduce the incidence of infections due to the use of endoscopes .METHODS The risk factors for the iatrogenic infections were observed through onsite examination during the cleaning and disinfection of endoscopes ,totally 184 endoscopes in use were randomly ex‐tracted .The quality of cleaning and disinfection of the endoscopes was determined through the sampling of lumens and surfaces of the endoscopes .RESULTS Of 184 samples ,169 were qualified with the qualified rate of 91 .85% ;the qualified rates of the gastroscopes ,bronchoscopes ,colonoscopes ,and laryngoscopes were 86 .00% ,95 .56% , 89 .36% ,and 97 .62% ,respectively .The bacterial colony counts of 15 samples exceeded the standard .A total of 26 strains of pathogens have been isolated ,including 14 strains of Helicobacter pylori ,8 strains of Escherichia coli ,2 strains of Pseudomonas aeruginosa ,1 strain of Staphylococcus aureus ,and 1 strain of Mycobacterium tu‐berculosis .Among the causes of unqualified cleaning and disinfection of the 15 samples ,the incomplete cleaning ac‐counted for 40 .00% ,the inappropriate use of disinfectants 40 .00% ,the inappropriate self‐protection 13 .33% , not taking special treatment for patients with special infections 6 .67% .CONCLUSION The risk factors for the iat‐rogenic infections during the cleaning and disinfection of endoscopes are complicated .It is necessary for the hospital to strengthen the cleaning of endoscopes ,education of disinfection staff ,and culture ,standardize the cleaning and disinfection procedure ,and establish scientific surveillance mode so as to prevent the iatrogenic infections .