骨科外来器械不同清洗方法的质量比较

Different cleaning methods for extraneous instruments at department of orthopedics

目的不同清洗方法对骨科外来器械清洗质量的影响比较，寻求最佳的清洗方法。方法将器械商送到消毒供应中心的2400件外来器械，接收、清点按器械污染程度及种类分类后，分为A、B、C三组，采用3种清洗方法，分别为A组（酶泡＋进清洗机）；B组（酶泡＋超声波清洗＋进清洗机）；C组（酶泡＋人工干预刷洗＋超声波清洗＋进清洗机），并将3种清洗效果进行比较。结果A、B、C三组表面光滑类器械清洗效果均较好，合格率目测为98．0％、100．0％、100．0％，放大镜下为98．0％、99．0％、100．0％，差异无统计学意义（P〉0．05）；A、B、C三组的结构复杂多关节类合格率目测为88．0％、97．0％、98．0％，放大镜下为86．0％、96．0％、97．0％；A、B、C三组的管腔螺钉类合格率目测为85．0％、94．5％、98．0％，放大镜下为82．0％、92．2％、96．5％；B组与c组结构复杂多关节类与管腔螺钉类的清洗合格率显著高于A组，尤以c组合格率最高，差异有统计学意义（P〈0．05）。结论清洗消毒机适合没有明显污染且结构简单的器械，污染严重、结构复杂及管腔类器械采用酶泡＋人工干预清洗＋超声波清洗＋进清洗机的清洗方法清洗效果最佳。

Objective To compare the effects of different cleaning methods on the cleaning quality of extraneous instruments at department of orthopedics and to find the best cleaning method. Methods 2 400 extraneous instruments in the sterilizing supply center provided by the supplier were accepted and separated into three group A, group B, and group C according to the pollution degree and types. They were cleaned by three methods. Group A were immersed with enzyme and put into the washing machine. Group B were immersed with enzyme, ultrasonicly cleaned, and put into the washing machine. Group C were immersed with enzyme, washed, ultrasonicly cleaned, and put into the washing machine. The effects of these three methods were compared. Results All the three methods were effective in cleaning instruments with smooth surface and the qualified rate was 98.0% in group A, 100.0% in group B, and 100.0% in group C and the qualified rates under magnifier were 98.0%, 99.0%, and 100.0%, respectively. For cleaning instruments with complex multi-joints, the qualified rates were 88.0%, 97.0%, and 98.0% under eyes and were 86.0%, 96.0%, and 97.0% under magnifier in group A, group B, and group C, respectively. For cleaning instruments with pipe, cavity, and screw, the qualified rates were 85.0%, 94.5%, and 98.0% under eyes and were 82.0%, 92.2%, and 96.5% under magnifier in group A, group B, and group C, respectively. For cleaning instruments with complex multi-joints or those with pipe, cavity, and screw, group B and group C were better and group A and group C was the best, with statistical differences （ P 〈 0.05 ） . Conclusion Washing machine is suitable for less-polluted and simple instruments; while immersing with enzyme, putting into the washing machine, washing, and ultrasonic cleaning may be a better way for those severe polluted screws with complex structures.