减压沸腾技术用于腔镜器械清洗效果研究

Effect of decompression boiling technology on cleaning of laparoscopic instruments

目的比较三种清洗方法对腔镜器械的清洗效果,探索最佳清洗实践。方法选取2018年4月-7月浙江大学医学院附属第一医院肝胆胰外科腔镜下胆囊切除手术后60 min内回收的90套器械,每次按顺序分为A组、B组和C组,每组150件器械。A组规范拆卸后采用规范手工清洗联合超声清洗;B组规范拆卸后装载配套清洗框中置入减压沸腾清洗机清洗;C组规范拆卸后先在含酶清洗剂中浸泡5 min,刷去可见污染物,然后再装载配套清洗框中置入减压沸腾清洗机清洗。本次研究用放大镜目测法、管腔白通条法、残留蛋白测试法对每组器械进行清洗效果检测,其中120件管腔类器械经上述三种方法检测,30件非管腔类器械经放大镜目测和残留蛋白测试法两种方法检测。采用SPSS 19.0进行统计分析。结果A组器械总合格率为55.33%;B组器械总合格率为53.33%;C组器械总合格率为93.33%。三组总体合格率比较,差异有统计学意义(χ~2=69.287,P<0.001),C组清洗总体合格率高于A组和B组(χ~2=56.764、61.364,均P<0.001)。结论采用规范拆卸、含酶清洗剂浸泡、手工刷洗预处理配合减压沸腾清洗机清洗能提高腔镜器械的清洗效果。

OBJECTIVE To compare the effects of three different cleaning methods on cleaning of laparoscopic instruments and explore the optimal cleaning practice.METHODS From Apr,2018 to Jul,2018,a total of 90 sets of laparoscopic instruments that were recycled within 60 min after laparoscopic cholecystectomy were divided into the group A,the group B,and the group C in order,with 150 instruments in each group.The instruments in the group A were disassembled and washed by hand combined with ultrasonic cleaning;the instruments in the group B were disassembled,loaded into the supporting cleaning frame and put into the decompression boiling cleaning machine for cleaning;the instruments in the group C were disassembled,soaked in the enzyme-containing cleaning agent for 5 minutes to remove the visible contaminants and were loaded into supporting cleaning frame and put into the decompression boiling cleaning machine for cleaning.In this study,the cleaning effects were evaluated by magnifying glass visual inspection method,tube white strip method and residual protein test.Among all the instruments,the cleaning effects of 120 lumen instruments were evaluated by the above three methods,and the cleaning effects of 30 non-lumen instruments were evaluated by magnifying glass visual inspection method and residual protein test.The statistical analysis was performed with the use of SPSS 19.0.RESULTS The total qualified rate of the group A 55.33%,the group B 53.33%,the group C 93.33%,and there was significant difference in the total qualified rate among the three groups(χ~2=69.287,P<0.001).The total qualified rate of cleaning of the group C was significantly higher than that of the group A and the group B(χ~2=56.764,61.364,all P<0.001).CONCLUSION The cleaning effect of the laparoscopic instruments can be improved by standard disassembly,pre-soaking with enzyme cleaner,manual scrubbing and decompression boiling cleaning.