十二指肠镜清洗消毒安全性研究

Safety of cleaning and disinfection of duodenoscope for endoscopic retrograde cholangiopancreatography

目的评价经内镜逆行胰胆管造影术（ERCP）所用十二指肠镜清洗消毒的安全性。方法以2016年5月4日至5月31日黑龙江省医院消化病院消化内镜中心ERCP所用的十二指肠镜为研究对象，十二指肠镜清洗、过氧乙酸灭菌粉消毒后，采集样抬钳器和工作管道标本行细菌培养，评价十二指肠镜的临床应用安全性。结果60次十二指肠镜高水平消毒中，1次消毒剂未达有效浓度从实验中剔除。59份抬钳器采样标本细菌培养均阴性，59份工作管道采样标本中4份培养阳性（6．8％），包括3份肺炎克雷伯菌，1份铜绿假单胞菌，均来自同一根十二指肠镜。结论过氧乙酸灭菌粉对ERCP使用的十二指肠镜高水平消毒有效；抬钳器采样标本即使培养阴性也不能除外污染存在，十二指肠镜高水平消毒仍有感染传播风险，应定期监督培养并及时对十二指肠镜进行再处理。

Objective To investigate the safety of cleaning and disinfection of duodenoscope used in endoscopic retrograde cholangiopancreatography （ERCP）. Methods The duodenoscopes, which were used in Endoscopy Center of Digestive Disease Hospital, Heilongjiang Provincial Hospital from May 4 to May 31 2016, were cleaned manually and disinfected with sterilization powder. The samples from elevator and elevator channel were collected for bacterial culture to evaluate the safety of clinical application of duodenoscope. Results Among 60 high level disinfections, one was excluded because disinfectant concentration wasn＇t effective. Among 59 elevator samples no positive cultures were detected, while among 59 channel samples, 4（6. 8%） cultures were positive and all from the same duodenoscope, including 3 cases of KlebsieUa pneumonia and 1 case of Pseudomonas aeruginosa. Conclusion Sterilization powder is effective for disinfection of duodenoscope used for ERCP. Residual organic material can＇t be excluded from elevator sample even if it is negative for culture. Duodenoscope with high level disinfection still has the risk of transmitted infection, and should be monitored regularly by culture and reprocessed in time.