医院消毒供应中心压力蒸汽灭菌程序现状调查

Current status of autoclave steam sterilization procedures in central sterile supply departments

目的 了解医院消毒供应中心（CSSD）压力蒸汽灭菌程序现状,为实施规范化管理、确保消毒质量提供科学依据。方法 采用问卷形式收集整理2014年我国二级乙等及以上等级医院28个省市726家医院的消毒供应中心在处理一般及特殊器械时压力蒸汽灭菌程序的选用情况以及面临的问题。结果 726份有效问卷的统计结果显示：医院消毒供应中心的日常消毒程序中,71.63%采用延长灭菌暴露时间的灭菌程序;83.61%医院要求器械公司提供清洗、包装、灭菌方法和灭菌循环参数,并遵循其要求进行灭菌;77.41%医院采取延长灭菌暴露时间和干燥时间的措施,选择的灭菌循环参数多为134℃10~12min占38.29%,干燥时间多为10min占35.61%;68.04%医院曾遇到过器械厂家不提供特殊器械灭菌方法和灭菌循环参数的情况,此时50.46%医院会选择采用常规循环参数灭菌,40.37%医院会根据经验采用延长暴露时间的灭菌循环程序;对于一些特殊器械的厂家提供的灭菌方法和灭菌循环参数,有25.76%消毒供应中心由于设备原因无法遵从。结论 医院在对外来器械进行灭菌环节中存在一些问题,有待进一步加强并规范管理;越来越多的医疗器械需要采用延长灭菌程序,应强化医疗器械厂家提供灭菌方法和灭菌循环参数的要求,CSSD应严格按照厂家提供的方法和参数进行处理;对于特定灭菌程序,应采用相应的指示物进行灭菌效果的监测。

OBJECTIVE To understand the current status of autoclave steam sterilization procedures in central ster- ile supply departments （CSSD） so as to provide scientific basis for standardized management and ensure the quality of disinfection. METHODS By means of questionnaire survey, the autoclave steam sterilization procedures that were chosen for disinfection of general and special instruments in the CSSDs of 726 grade B or above hospitals in 28 provinces in 2014 were investigated, and the facing problems were analyzed. RESULTS The statistical analysis of the 726 valid questionnaires indicated that among the daily disinfection procedures that were adopted in the CSSDs, 71.63% prolonged the exposure time in daily sterilization procedures, 83.61 % followed the manufacturersr rec- ommended parameters and requirements of the procedures for cleaning, packaging, and sterilization; 77.41 % ex- tended the sterilization exposure time or dry time, the sterilization cycle parameters that were most frequently cho- sen were as follows： 38.29% chose 134 ℃ for 10-12 rain, 35.61% chose 10min for dry time. Among 68.04% of the surveyed hospitals which did not receive the sterilization instructions for instruments from equipment manufac- turers, 50.46 % chose the conventional cycle parameters, while 40.37 % extended the exposure time of the sterili- zation cycles based on the individual empirical justifications. However, 25. 76% of the surveyed CSSDs failed to follow the sterilization methods and sterilization cycle parameters offered by the manufactures due to the facilities. CONCLUSION The surveys reveal that the wide inconsistencies still exist in the sterilization of the loaner instru- ments, thus, the standardized management should be carried out and further strengthened. As more and more medical equipments are required to extend the sterilization cycles, it is necessary to intensify the requirements to offer the sterilization methods and sterilization cycle parameters; the CSSDs should carry out the operations by strictly following the methods and parameters offered by the manufactures. As for the special sterilization proce- dures, it is necessary to conduct the surveillance of sterilization effect by using corresponding indicators.