耳鼻咽喉科内镜室清洗消毒及微生物污染调查分析和对策

Investigation and analysis of cleaning and disinfection and microbial contamination in the endoscopic room of otolaryngology department and countermeasures

目的通过调查耳鼻咽喉内镜室清洗消毒及微生物污染情况,分析在内镜诊疗过程中可能会引起相关问题的环节,制定对应的防治措施,优化评价方法,减少医院内镜室感染发生的可能。方法采集分析西南医科大学附属医院耳鼻咽喉内镜室清洗消毒的基本情况,观察不同检测方法的内镜清洗合格率、内镜消毒操作合格率、内镜消毒合格率及细菌分型。将采取改进措施前后3个月的相关指标分为对照组和观察组,分析比较各项指标。结果采用蛋白残留、ATP生物荧光检测的方式所得出的阳性检出率明显高于10倍光源放大镜,差异有统计学意义(P<0.05);观察组采用10倍光源放大镜检查,阳性检出率和对照组比较差异无统计学意义(P>0.05)。观察组蛋白残留检测阳性检出率明显低于对照组,差异有统计学意义(P<0.05)。ATP生物荧光检测仪阳性检出率观察组明显低于对照组,差异有统计学意义(P<0.05)。观察组内镜消毒操作合格率、消毒结果合格率明显高于对照组,差异有统计学意义(P<0.05);试验24份标本共分离出细菌66株。结论ATP荧光检测仪是较适合耳鼻咽喉内镜室快速可靠的检测内镜清洗效果的方法,并且应规范清洗消毒流程,完善质量评估系统,预防院内感染。

Objective To investigate the cleaning and disinfection and microbial contamination in the otorhinolaryngological endoscopy room,analyze the possible links that may cause related problems in the endoscopic diagnosis and treatment,formulate corresponding prevention and treatment measures,optimize evaluation methods,and reduce the possibility of endoscopic nosocomial infection.Method The basic conditions of cleaning and disinfection of the otolaryngology endoscopy room were collected and analyzed,and the qualified rate of endoscopic cleaning and disinfection operation of different detection methods were observed.Endoscope disinfection rate and bacteria classification were used.The indicators of 3 months before and after the improvement measures were divided into control group and observation group,and the indicators were analyzed and compared.Result Endoscopic cleaning rate index residual protein test positive rate and ATP bioluminescence detect was significantly higher than 10×magnifier visual inspection with light source,the difference was statistically significant(P<0.05),the 10×magnifier visual inspection with light sourcer positive detection rate of the observation group and the control group had no significant difference(P>0.05).There were statistically significant differences between the two groups in residual protein detection and ATP bioluminescence positive rate.The qualified rate of endoscopic disinfection and the qualified rate of endoscopic disinfection in the observation group were both lower than those in the control group,and the difference was statistically significant(P<0.05).66 bacteria strains were isolated from 24 specimens.Conclusion ATP fluorescence detector is suitable for rapid and reliable detection of endoscopic cleaning effect in otolaryngology endoscopy room,and the cleaning and disinfection process should be standardized to improve the quality evaluation system and prevent nosocomial infection.