预处理方式及不同储存环境对消毒后内镜清洁效果的影响研究

Pretreatment methods and different storage environments of endoscope cleaning after disinfection

目的了解不同储存环境及预处理方式下消毒后内镜的细菌污染状况,为加强内镜消毒、规范清洗消毒行为提供相关依据。方法选择2018年1月至12月西南医科大学附属医院内镜医学部的112套内镜,通过分别研究对照组用无菌水浸湿纱布、实验组用3M清洗液的不同预处理方式,以及高水平消毒后于洁净环境中不同温度分组(15℃~25℃、26℃~30℃、30℃~40℃)、湿度分组(41%~60%、61%~80%、81%~85%)存放12 h后收集内镜管腔洗脱液进行微生物培养,以及在温度15℃、湿度40%时,3M预处理及高水平消毒后不同储存时间(12 h、24 h、48 h、72 h、96 h)消毒后内镜的微生物生长情况。结果经3M清洗液预处理的实验组较经无菌水浸湿纱布预处理的对照组微生物阳性率低(P <0.05),且细菌菌落总数较对照组也低(P <0.05);阳性内镜分离培养出7种条件致病菌:藤黄微球菌、凝固酶阴性葡萄球菌、肠球菌、肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌及曲霉菌,肠球菌只在肠镜中检出且检出率较其他6种病原菌多。温度15℃、湿度40%时,经严格预处理及高水平消毒后的112份消化内镜存储12~24 h时,管腔无菌生长;储存48~96 h,随时间延长内镜管腔均呈现逐步增多的微生物生长(P <0.05)。温度在30℃~40℃、湿度81%~85%的储存环境下,检出的阳性内镜比例最高,为29.46%;在温度为15℃~25℃、湿度为41%~60%检出的阳性率最低,阳性率为2.68%。3个温度分组中所有湿度为61%~80%组、81%~85%组阳性率均较同组中湿度41%~60%组阳性率高,差异均有统计学意义(P <0.05);3个温度分组中湿度为61%~80%组、81%~85%组微生物生长阳性率较温度15℃~25℃和湿度41%~60%组阳性率高,差异均有统计学意义(P <0.05)。结论 3M清洗液预处理有效提高内镜清洗质量,经高水平消毒的消化内镜在温度为15℃~25℃、湿度为40%~60%存储24 h内时可减少内镜储存的微生物污染风险。

Objective To study bacterial contamination status of endoscopes after disinfection in different storage environments and pretreatment methods, and provide relevant evidence for endoscope disinfection and standard cleaning. Methods From January to December in 2018, 112 endoscopes data were collected. By different pretreatment methods, control group was wet with gauze in sterile water, and experimental group in 3 M cleaning solution, and high-level disinfection in cleaning environment at different temperature groups(15 ℃-25 ℃, 26 ℃-30 ℃, 30 ℃-40 ℃), different humidity groups(41 %-60 %,61 %-80 %, 80 %-85 %). After storage 12-hour, the endoscopy lumen eluate was collected for microbial culture, and with15 ℃, humidity of 40 %, 3 M pretreatment and high-level disinfection at different storage times(12-hour, 24-hour, 48-hour,72-hour and 96-hour),the microbial growth of endoscope after disinfection were observed. Results The microbial positive rate in experimental group was lower than that in control group(P < 0.05), and total number of bacterial colonies was lower than that in control group(P < 0.05);Seven types of pathogenic bacteria were isolated and cultured by positive endoscopy: Micrococcus luteus, coagulase-negative staphylococcus, enterococcus, Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa and Aspergillus, Enterococcus was detected in enteroscopy and detection rate was more than other 6 pathogenic bacteria. There was no bacteria growth in 112 digestive endoscopy lumen after strict pretreatment and high level disinfection at15 ℃ with humidity 40 % staged for 12-24 hours, after storage 48-96 hours, the microbes in endoscopy lumen gradually increased with time(P < 0.05). At 30 ℃-40 ℃ with humidity 81 %-85 %, the endoscopy highest positive rate(29.46 %)was detected, and at 15 ℃-25 ℃ with humidity 41 %-60 %, the lowest positive rate(2.68 %) was detected. In 3 temperature groups, the positive rates of 61 %-80 % humidity group and 81 %-85 % humidity group were higher than those of 41 %-60 % humidity group, and the differences were statistically significant(P < 0.05);In 3 temperature groups, microbial growth positive rate of 61 %-80 % humidity group and 81 %-85 % humidity group were higher than that of 15 ℃-25 ℃ with41 %-60 % humidity group, the differences were statistically significant(P < 0.05). Conclusion It is demonstrated that 3 M cleaning solution pretreatment effectively could improve quality of endoscope cleaning. The high-level sterilized digestive endoscopes could reduce risk of microbial contamination storage at 15 ℃-25 ℃ with humidity of 40 %-60 % for 12-hour.