一起干燥用压缩空气引起的肠镜二次污染案例报告

Enteroscope secondary contamination caused by compressed air for drying:one case report

目的 分析消毒后肠镜菌落数超标原因,进一步提高软式内镜的再处理水平。方法 分析2021年8月某院消化内镜中心进行的第3季度常规环境卫生学监测资料,查找引起消毒后肠镜二次污染的原因,进行整改。结果 监测的4条胃镜、2份纯化水、2份使用中消毒剂、3份环境物体表面和2份医务人员卫生手消毒标本均合格;而4条肠镜可见大量细菌生长,染菌量分别为252、315、273、268 CFU/件,均检出放射根瘤菌、藤黄微球菌、少动鞘氨醇单胞菌。对引起肠镜监测不合格的可能风险因素进行识别,进一步对气源喷枪喷出的气体、空气过滤器内部及过滤器出口端送气管道进行采样,检出大量的上述微生物。在更换空压机、空气过滤器及气路管道后,气源喷枪气体中细菌数量明显减少。对4条不合格的肠镜重新清洗、消毒、干燥,并进行染菌量检测,结果均合格。结论 消化内镜清洗工作站气路污染是此次消毒后肠镜管腔内部菌落数超标的主要原因。建议应将气路维护及生物学监测纳入相应指南中,减少由此引起的医院感染。

Objective To analyze the causes of exceeding standard of colony count of enteroscope after disinfection,and further improve the reprocessing level of flexible endoscope.Methods Data of the third quarter routine environmental hygiene monitoring of digestive endoscopy center of a hospital conducted in August 2021 were analyzed,causes of secondary contamination of enteroscope after disinfection were found out and rectified.Results The monitored four gastroscopes,two specimens of purified water,two specimens of in-use disinfectants,three specimens of environmental object surfaces and two specimens of hygienic hand disinfection of health care workers were all qualified;however,a large number of bacteria were detected from four enteroscopies,bacterial colony number were 252,315,273,and 268 CFU/piece respectively,all specimens were detected Rhizobium radiobacter,Micrococcus luteus,and Sphingomonas paucimobilis.Possible risk factors leading to the failure of enteroscope monitoring were identified,specimens of air from air spray gun,inside of air filter and air line of filter outlet were detected further,a large number of the above microorganisms were found out.After the replacement of air compressor,air filter and air line,the number of bacteria in air from air spray gun decreased obviously.The 4 unqualified enteroscopes were cleaned,disinfected and dried again,bacterial contamination was detected,all were all qualified.Conclusion Contamination of air line of the digestive endoscope cleaning workstation is the main cause for the excessive number of bacteria in the lumen of enteroscope after disinfection.It is suggested that air line maintenance and biological monitoring should be included in the corresponding guidelines,so as to reduce healthcare-associated infection.