三磷酸腺苷生物荧光法应用于软式内镜再处理流程质量监测的评价

Effect evaluation of adenosine triphosphate bioluminescence test on quality monitoring of flexible endoscope reprocessing

目的评价三磷酸腺苷（ATP）生物荧光法应用于软式内镜再处理流程质量监测的效力。方法将使用后的同一型号的胃镜随机分为A、B两组，均由专人执行标准化的清洗消毒流程。A组于清洗及消毒后先进行ATP生物荧光法检测，再进行微生物学采样；B组清洗及消毒后检测方法顺序相反。比较ATP生物荧光法与微生物学监测在内镜清洗与消毒后生物负载的差异，分析两种方法对清洗、消毒效果检测的相关性。结果有效样本共51例，按ATP生物荧光法检测标准，23例清洗合格，清洗合格率45．1％；按微生物学监测标准，47例消毒合格，消毒合格率92．2％。A、B组检测顺序不同，但两组清洗合格率（50．0％比40．0％，X。=0．515，P=0．473）与消毒合格率（96．2％比88．0％×。0．316，P=0．574）组间比较，差异无统计学意义。经ATP检测，内镜清洗后的相对光单位（RLU）对数值高于消毒后，差异有统计学意义（1．68＋0．50比0．88＋0．49，t=2．335，P=0．024）。消毒合格的内镜无论是清洗后或消毒后，ATP检测RLU对数值均低于消毒不合格的内镜（t=2．505，P=0．016；t=2．485，_P=0．016）。将ATP检测结果与微生物学监测结果做相关分析，显示内镜清洗后ATP检测结果与微生物学监测结果低度相关，相关性无统计学意义（r=0．199，P=0．171）；内镜消毒后ATP检测结果与微生物学监测结果存在低度相关性，有统计学意义（r=0．391，P=0．005）。内镜清洗后ATP检测结果与消毒后微生物学监测结果存在低度相关性，有统计学意义（r=0．301，P=0．032）。结论ATP生物荧光法可反应内镜生物负载变化的趋势，可作为内镜再处理流程中质量监控的方法。

Objective To evaluate the efficacy of adenosine triphosphate （ATP） bioluminescence test on quality monitoring of flexible endoscope reprocessing. Methods The patient-used gastroscopes were randomly assigned to two groups after standard reprocessing by one nurse. The group A were assessed by ATP test followed by microbiological surveillance test after cleaning and disinfection; and the gastroscopes in group B were tested in a reverse order. The biological load after endoscopic cleaning and disinfection were compared between ATP test and microbiological surveillance, and the correlation of the two tests on quality assessing of endoscopic cleanliness and disinfection were analyzed. Results A total of 51 samples were valid. The qualified rate of cleaning was 45.1% （ 23/51 ） detected by ATP test, and the qualified rate of disinfection was 92. 2% （47/51） detected by microbiological surveillance. There was no statistical difference in cleaning qualification rate （50. 0% VS 40. 0% ,X2= 0. 515, P= 0. 473 ） and disinfection qualification rate （96. 2% VS 88. 0%, X2=0. 316, P=0. 574） between the two groups. The logarithmic value of relative light unit （RLU） of ATP test after cleaning was higher than the value after disinfection （ 1.68±0. 50 VS 0. 88±0.49, t = 2. 335,P = 0. 024）. For gastroscopes disinfected appropriately, the RLU logarithmic value of ATP test after cleaning （t= 2. 505, P=0. 016） and disinfection （t = 2. 485, P= 0. 016） were lower than that of disqualification. The correlation between the value of ATP test and the colony forming units of microbiological surveillance after cleaning was not statistically significant （r= 0. 199, P= 0. 171）, but there was a low correlation between the two monitoring results after disinfection （ r = 0. 391, P = 0. 005 ）. There was a low correlation between the value of ATP test after cleaning and the colony forming units of microbiological surveillance after disinfection （r= 0. 301, P= 0. 032）. Conclusion ATP bioluminescence test can be used to evaluate the trend of endoscopic biological load change and the quality of flexible endoscope reprocessing.