夜间手术污染器械不同预处理保湿方法与放置时间对器械清洗质量的影响

Effects of different pretreatment moisturizing methods and placement time on the cleaning quality of contaminated nocturnal surgical instrument

目的探讨夜间手术污染器械不同预处理保湿方法与放置时间对器械清洗质量的影响,以探讨适合于夜间手术污染器械的最优预处理方法。方法将污染器械根据预处理方法不同分成4组:A组(无菌水擦拭)、B组(无菌水擦拭+喷酶保湿)、C组(无菌水擦拭+喷泡沫保湿)、D组(无菌水擦拭+喷碱性剂保湿),每组夜间手术污染器械分别放置8h、16h,分别为1200件,然后按标准清洗后采用目测法、放大镜观察法、三磷酸腺苷(adenosine triphosphate,ATP)检测、细菌检测综合评价其清洗质量。结果 4组夜间手术污染器械放置8h和16h的ATP检测和细菌检测合格率均为100.00%。4组夜间手术污染器械放置8h目测法和放大镜观察法合格率比较,差异无统计学意义(均P>0.05)。4组夜间手术污染器械放置16h目测法和放大镜观察法合格率比较,差异有统计学意义(均P<0.001),其中夜间手术污染器械放置16h目测法和放大镜观察法A组与B组、B组与D组比较,差异无统计学意义(均P>0.0125);C组优于A组、B组、D组,D组优于A组,组间比较,差异有统计学意义(均P<0.0125)。结论经预处理保湿后夜间手术污染器械如需放置8h,建议优先选择无菌水擦拭器械进行预处理,其可减少成本及人力;经预处理保湿后夜间手术污染器械如需放置超过8h,建议可选用无菌水擦拭+喷泡沫保湿法、无菌水擦拭+喷碱性剂保湿法,但其成本及使用便利性不同,各医院可根据污染器械特性和实际运营成本选择预处理保湿方法。

Objective To study the effects of different pretreatment moisturizing methods and placement time on the cleaning quality of contaminated nocturnal surgical instrument and find the best cleaning way. Methods The night-time contaminated instruments were divided into four groups, based on the different pretreatment methods to keep the equipment moist： Group A（treated with sterile water）, Group B（with sterile water and spray enzyme）, Group C（with sterile water and spray foam）, Group D（with sterile water and spray alkaline agent）. The contaminated nocturnal surgical instrument（1,200 pieces） was placed for 8 h and another 16 h. After the standard cleaning, the cleaning quality was evaluated by visualization, observation with magnifier and gauges of adenosine triphosphate（ATP） and bacteria. Results The qualification rate of gauges of ATP and bacteria reached both 100.00% after 8 h and16 h. There was no statistically significant difference between the 8 h visual method and the magnifying observation method（all P〈0.05）.There was a statistically significant difference between the 16 h visual method and the magnifying observation method（all P〈0.05）. There was no statistically significant difference between group A and group B, group B and group D through visual observation（all P〈0.0125）.Group C was significantly better than group A, group B and group D, and group D was significantly better than group A（all P〈0.0125）.Conclusions The clearing method with sterile water is recommended as a priority for reduction of the cost and labor if the night-time equipment should be placed for 8 h. If the pretreated equipment for moisturizing has to be placed for more than 8 h, the clearing method with sterile water plus moisturization method with spray foam, or the clearing method with sterile water plus moisturization method with spray alkaline is suggested. Each hospital can choose different ways according to the contaminated instrument and cost.