新型冠状病毒肺炎疫情下内镜再处理对消毒效果的影响及不合格因素分析

Effects of endoscopic reprocessing on disinfection and its influential factors during coronavirus disease 2019 pandemic

目的探讨新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)疫情下内镜再处理对消毒效果的影响及分析灭菌不合格因素。方法采用数字随机法选取重庆医科大学附属第二医院2019年11月—2020年1月按照《软式内镜清洗消毒技术规范》进行内镜清洗消毒的内镜450条作为对照组,2020年2—4月按照《中华医学会消化内镜学分会在新冠肺炎疫情形势下消化内镜中心清洗消毒建议方案》进行内镜清洗消毒的内镜450条作为观察组,对照组和观察组均包含胃镜和肠镜各200条,超声内镜50条。分别采用ATP荧光检测法和倾注培养法评价内镜的消毒效果,采用单因素和多因素Logistic回归分析影响内镜再处理后灭菌不合格的危险因素。结果观察组中胃镜、肠镜和超声内镜的消毒合格率与对照组相比差异无统计学意义(P>0.05),观察组中胃镜、肠镜和超声内镜的灭菌合格率和ATP检测合格率均明显高于对照组,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,未严格执行再处理流程(OR=7.96,95%CI:4.55~22.84,P<0.001)、操作不规范(OR=2.26,95%CI:1.24~5.63,P<0.001)、消毒液浓度不够(OR=5.43,95%CI:2.52~9.02,P<0.001)、多酶液浓度配比不够(OR=4.38,95%CI:1.95~8.61,P<0.001)、未及时清洗(OR=2.86,95%CI:1.33~6.42,P<0.001)、清洗不彻底(OR=3.75,95%CI:1.61~7.49,P<0.001)和内镜保存不当(OR=2.12,95%CI:1.36~4.12,P<0.001)是内镜再处理后灭菌不合格的独立危险因素。结论在COVID-19疫情下采用内镜再处理能够明显提高内镜的消毒效果。其中未严格执行再处理流程是导致内镜灭菌不合格的重要因素。

Objective To explore the effects of endoscopic reprocessing on disinfection and its influential factors under the coronavirus disease 2019(COVID-19)pandemic.Methods A total of 450 endoscopes cleaned and disinfected according to Technical Specifications for Cleaning and Disinfection of Endoscopes from November 2019 to January 2020,and 450 endoscopes cleaned and disinfected according to The recommended procedure for cleaning and disinfection of gastrointestinal endoscopes during COVID-19 epidemic by Chinese Society of Digestive Endoscopology from February to April 2020 in the Second Affiliated Hospital of Chongqing Medical University were enrolled in the control group and observation group respectively by random number method.Both the control group and the observation group contained 200 gastroscopes,200 enteroscopes and 50 ultrasound endoscopes.ATP fluorescence detection method and pour plate technique were used to evaluate the disinfection effect of endoscopes.Single factor analysis and multiple logistic regression were used to analyze the risk factors for unqualified sterilization after endoscopic reprocessing.Results The disinfection pass rates of gastroscopes,enteroscopes and ultrasound endoscopes in the observation group were not significantly different compared with those of the control group(P>0.05).The sterilization pass rates and ATP test pass rates of gastroscopes,enteroscopes and ultrasound endoscopes in the observation group were significantly higher than those in the control group(all P<0.05).Multivariate logistic regression analysis showed that non-strict implementation of endoscopic reprocessing(OR=7.96,95%CI:4.55-22.84,P<0.001),non-standard operation(OR=2.26,95%CI:1.24-5.63,P<0.001),insufficient concentration of disinfectant(OR=5.43,95%CI:2.52-9.02,P<0.001),insufficient concentration ratio of multi-enzyme solution(OR=4.38,95%CI:1.95-8.61,P<0.001),non-timely cleaning(OR=2.86,95%CI:1.33-6.42,P<0.001),incomplete cleaning(OR=3.75,95%CI:1.61-7.49,P<0.001)and improper endoscopic preservation(OR=2.12,95%CI:1.36-4.12,P<0.001)were independent risk factors for unqualified sterilization after endoscopic reprocessing.Conclusion In COVID-19 pandemic,endoscope reprocessing can significantly improve the disinfection effect of endoscopes,worthy of further clinical promotion.The failure to strictly implement the reprocessing procedure is an important factor that may lead to unqualified sterilization.