清洗刷与活检钳模拟通过内镜钳子管道对其表面粗糙度及细菌黏附性的影响

Impact of cleaning brush and biopsy forceps on the surface roughness and bacterial adhesion of forceps channel in simulation

目的分析两种器械对内镜钳子管道表面粗糙度(Ra)及细菌黏附性的影响。方法截取等长全新聚四氟乙烯(Teflon)管弯曲固定后,分别使用清洗刷(A组)、活检钳(B组)在不同通过次数下模拟临床操作,检测钳子管道Ra与表面形貌;将铜绿假单胞菌接种于各组Teflon管上,检测表面菌落形成单位与细菌黏附量。结果无器械通过的Teflon管表面光滑无划痕,随着通过次数增加,表面划痕逐渐密集,以清洗刷更明显。通过次数为0、50、100、200时,A、B两组间Ra比较,差异均无统计学意义;但通过次数为500时,两组间Ra比较,A组>B组(P<0.01)。两组内不同通过次数时的Ra比较,0次与50次相比,差异无统计学意义;但0次时的Ra均<100、200、500次的Ra,差异有统计学意义(P<0.01)。无器械通过的Teflon管表面生物膜分布均匀,随着通过次数增加,A组Teflon管表面生物膜覆盖较为紧密,且可见划痕处黏附的菌落。A、B两组间菌落计数在0、50、100、200次的情况下比较,差异无统计学意义;在500次的情况下,A组>B组(P<0.01)。A、B两组通过次数为50、100、200时的菌落数分别与通过次数为0时相比,差异无统计学意义(P>0.05);但通过次数为500时,A组的菌落数均值>0次(P<0.01),B组与0次比较,差异无统计学意义(P=0.186)。结论内镜清洗刷和活检钳反复通过钳子管道,均会增加内镜钳子管道的Ra,导致细菌黏附量增加,以清洗刷作用更为明显,提示临床应加强对器械的使用管理并研发更好的清洗工具。

Objective To analyze the effect of two instruments on the surface roughness(Ra)and bacterial adhesion of endoscope forceps channel.Methods Equal length sections of new polytetrafluoroethylene(Teflon)tubes were bent and fixed.Cleaning brush(Group A)and biopsy forceps(Group B)were used to simulate clinical operations with different passing frequencies.Surface roughness(Ra)and morphology were measured.Pseudomonas aeruginosa was inoculated onto the Teflon tubes in each group to evaluate surface colony-forming units and bacterial adhesion.Results Teflon tube surfaces without instrument passage were smooth and without scratches.As the passage frequency increased,surface scratches became denser,with more significant effects observed in Group A.At passage frequencies of 0,50,100,and 200,there were no statistically significant differences in Ra between Groups A and B.However,at a passage frequency of 500,Ra in Group A was greater than in Group B(P<0.01).When comparing different passage frequencies within each group,there were no statistically significant differences between 0 and 50 passages,but Ra at 0 passages was significantly lower than at 100,200,and 500 passages(P<0.01).Initially,biofilms were evenly distributed on the Teflon tube surfaces without instrument passage,but with increased passage frequency,Group A showed more densely covered biofilms,with visible bacterial colonies at the scratch sites.There were no significant differences in colony counts between Groups A and B at 0,50,100,and 200 passage frequencies.However,at 500 passages,Group A had a higher colony count than Group B(P<0.01).When comparing the colony counts at 50,100,and 200 passage frequencies with those at 0 passages within each group,no statistically significant differences were found(P>0.05).However,at 500 passages,the mean colony count in Group A was higher than at 0 passages(P<0.01),while no statistically significant difference was observed in Group B compared to 0 passages(P=0.186).Conclusion Repeated passage of endoscope cleaning brush and biopsy forceps through forceps’channels increases the Ra of the endoscope forceps’channels,leading to an increase in bacterial adhesion.The effect is more significant with the cleaning brush.This highlights the need to strengthen the management of instrument usage in clinical settings and develop better cleaning tools.