内镜清洗与消毒环节感染因素分析及预防措施研究

Study of Major Risk Factors Analysis and Prevention Measures of Infection in Endoscopic Cleaning and Disinfection

目的:总结我院内镜中心清洗与消毒过程中发生感染的主要危险因素,制定相应的预防措施,降低内镜感染发生率,确保患者医疗安全。方法:专人检查内镜清洗消毒全过程,统计各个环节发生感染的危险因素。随机抽取600例消毒后处于备用状态的内镜,采集内镜内腔及外表面标本,检测结果作为评估清洗消毒质量指标。结果:检测600例样本合格584例,合格率97.3%,胃镜、肠镜、十二指肠镜、气管镜和超声内镜合格率分别为98.6%,96.8%,95.6%,96.0%和97.2%;16例不合格样本中共检出病原菌28株,其中幽门杆菌13株,大肠埃希菌7株,铜绿假单胞菌4株,绿脓杆菌2株,金黄色葡萄球菌1株,肺炎克雷伯菌1株;16例检测不合格原因分析中,刷洗不彻底占37.5%,未按说明要求使用多酶及消毒液占18.75%,特殊感染患者用过的内镜未做特殊处理占12.5%,内镜干燥不充分及工作人员手卫生不达标各占6.25%。结论:内镜清洗消毒环节引发感染的危险因素众多,应加强对内镜中心所有人员的感染控制教育,定期对清洗消毒人员进行职业化培训,规范管理清洗消毒流程,建立可追溯性登记系统,从各个环节把关内镜清洗消毒的质量,是预防消化内镜中心发生感染的主要手段。

Objective：To summarize the major risk factors of infection in the process of cleaning and disinfection of endoscopy center in our hospital,and formulate the corresponding prevention measures to reduce the incidence of endoscopic infection so as to ensure medical safety of patients.Methods：The specialist check the cleaning disinfection process,statistics of each link in the risk factors of infection.600 endoscopes were taken at random after disinfection,endoscopic inner cavity and the outer surface samples are collected,the cleaning and disinfection of the test results for evaluating quality indicators.Results：Testing 600 samples of qualified 584,and the percent of pass is 97.3%,gastroscopy,colonoscopy,duodenum mirror,bronchoscope,endoscopic ultrasonography qualified rate was98.6%,96.8%,95.6%,96.0%,97.2%,respectively.28 strains of pathogenic bacteria were detected in 16 cases of unqualified samples,including 13 strains of helicobacter pylori,7 strains of escherichia coli,4 strains of pseudomonas aeruginosa,2 strains of pseudomonas aeruginosa,1 strains of staphylococcus aureus,1 strains of Klebsiella pneumoniae;16 cases to detect unqualified reason analysis,scrub incomplete accounted for 37.5%,Not according to the instructions required to use multi-enzyme and disinfectant accounted for 18.75%,special infected patients did not do special treatment of endoscopy accounted for 12.5%,endoscopic insufficient drying and the staff hand hygiene is not up to standard accounted for 12.5%,respectively.Conclusion：Endoscopic cleaning and disinfection aspects of infection caused by many factors,infection control education should be strengthened for all personal in the endoscopy center,regular professional training of cleaning and sanitation personal,cleaning and disinfection process should be standardized management,establish traceability registration system,control the quality of the endoscope cleaning and disinfection from each link.It is the main measure to prevent digestive endoscopy center in infection.