十二指肠镜相关感染暴发案例及原因分析的系统评价

Systematic review of cases and causes for outbreaks of duodenoscopy associated infections

目的探究十二指肠镜相关感染暴发事件的主要特点及可能的原因。方法采用系统评价的方法,以"十二指肠镜"、"感染"、"暴发"等为关键词,分别检索中国知网(CNKI)、万方、PubMed所有已公开发表的文献,综合分析十二指肠镜相关感染暴发的特点及可能原因。结果依据纳入、排除标准,最终纳入文献19篇,以美国的感染暴发最为多见,共报道9篇;暴发共涉及患者204例;有12篇培养出目标致病菌,且以内镜腔道和抬钳器部位的分离最为常见;十二指肠镜清洗消毒不彻底是导致暴发的主要原因,其中又可细分为十二指肠镜设计缺陷、清洗不彻底、消毒不合理及存储和监测不到位等原因。结论十二指肠镜相关感染暴发的主要原因是清洗和消毒不彻底,临床工作中应亟需采取相关措施,注重十二指肠镜的清洗、消毒流程,从而最大程度地减少暴发事件的发生。

OBJECTIVE To investigate the main characteristics and possible causes for the outbreaks of duodenoscopy associated infections.METHODS A systematic review was conducted.The key words of ＂duodenoscopy＂, ＂infection＂ and ＂outbreak＂ were selected to search the published articles in CNKI,Wanfang and PubMed.The characteristics and possible causes for the outbreaks of duodenoscopy associated infections were comprehensively analyzed.RESULTS According to the inclusion and exclusion criteria,19 articles were included.Totally 9 of 19 articles were reported in America,involving 204 patients.Totally 12 articles reported positive culture,mostly in endoscopic cavity and forceps placement.Incomplete cleaning and disinfection were the main causes for the outbreaks,including the design defects of duodenoscopy,incomplete cleaning,unreasonable disinfection and unqualified storage and monitoring,etc.CONCLUSION Incomplete cleaning and disinfection are the main causes for outbreaks of duodenoscopy associated infections.Effective measure should be taken,especially paying attention to the cleaning and disinfection process of duodenoscopy,so as to minimize the occurrence of outbreaks.