不同检测方法对内镜消毒效果监测的应用性研究

Different test methods for detecting disinfection effect of endoscope

目的探讨胰蛋白胨葡萄糖培养基(TGEA)法和营养琼脂法对内镜终末漂洗水的监测效果,以及比较试剂盒过滤集菌法和传统过滤集菌法对内镜消毒质量的监测效果。方法调查天津市24家医疗机构内镜中心基本信息,随机抽取终末漂洗水及内镜管腔冲洗水水样,分别采用两种方法检测细菌菌落数。结果 TGEA法对终末漂洗水监测所得检出率(96.7% vs 73.3%)、菌落数(中位数44 CFU/100 ml vs 8 CFU/100 ml)均高于营养琼脂法,差异有统计学意义(P <0.05),Bland-Altman分析显示两方法一致性较差;试剂盒过滤集菌法和传统过滤集菌法监测内镜消毒质量检出率(60.0%vs 56.7%)及菌落数(中位数2 CFU/件vs 1 CFU/件)相近,差异无统计学意义(P>0.05),Bland-Altman分析显示两方法一致性较好。结论被调查单位对终末漂洗水及内镜消毒质量的监测水平较低、采用检测方法规范性差。TGEA法对终末漂洗水检测更具敏感性、临床适应性强,试剂盒过滤集菌法操作简单、快捷、高效、准确,两种方法均适合内镜中心的日常监测。

Objective To compare tryptone glucose extract agar(TGEA) method with nutrient agar medium method in the monitoring of final rinse water, comparing reagent kit membrane filtration method with traditional membrane filtration method in the quality monitoring of endoscope disinfection. Methods The basic information of endoscope center was investing from 24 hospitals in Tianjin. The way of random sampling was used to sample the final rinse water and the flushing water of the endoscope biopsy channel. Using two methods respectively to detect the number of bacterial colonies. Results Compared with nutrient agar medium method, TGEA method has the statistical significant(P < 0.05) higher detection rate(96.7% vs 73.3%) and bacterial colony number(median 44 CFU/100 ml vs 8 CFU/100 ml) when monitoring final rinse water. Bland-Altman analysis shows that these two methods are lack of consistency. On the contrary, when monitoring endoscopic disinfection effect, these two methods show similar results(P > 0.05) in both detection rate(60.0% vs 56.7%) and bacterial colony number(median 2 CFU/piece vs 1 CFU/piece). And the consistency can be proved by Bland-Altman analysis. Conclusions According to the survey analysis, there are still plenty of rooms for the improvement of monitoring level and the standardization of test method when dealing with final rinse water and endoscopic disinfection effect. TGEA method is proved to be more sensitive and clinically adaptable for the detection of final rinse water, while reagent kit membrane filtration method has its strengths in portability, efficiency, accuracy and operation simplicity. Both two methods would be suitable for the routine monitoring of endoscope center in hospitals.