常规高水平消毒软式内镜细菌监测结果  

Surveillance of regular high-level disinfection of flexible endoscopes

作　　者：张燕华[1] 周英顺 陈建美[1] 白嘉伟 李琴 凌冬[1] ZHANG Yan-hua;ZHOU Ying-shun;CHEN Jian-mei;BAI Jia-wei;LI Qin;LING Dong(Chongzhou People's Hospital,Chong zhou,Sichuan 611230,China;不详)

机构地区：[1]崇州市人民医院医院感染管理科,四川崇州611230 [2]西南医科大学基础医学院病原生物学教研室,四川泸州646000

出　　处：《中华医院感染学杂志》2020年第24期3832-3836,共5页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金青年基金资助项目(31500114);四川省科技厅重点基金资助项目(2020YJ0338);四川省医学会基金资助项目(Q19024)。

摘　　要：目的了解常规高水平消毒后软式内镜细菌检出情况及分布特点,探索软式内镜清洗消毒重点环节。方法2019年11月-2020年8月对崇州市人民医院邻苯二甲醛消毒后软式内镜的外表面、内腔、活检口、注水注气口和负压吸引口进行微生物采样监测,共监测93条次内镜,350个标本。对比不同软式内镜、不同采样部位、不同采样时机内镜表面细菌监测情况。结果支气管镜、肠镜、胃镜细菌培养阳性率分别为40.00%、15.38%、7.69%(P<0.05);细菌阳性率最高的三个位点为内镜内腔(31.52%)、负压吸引口(18.37%)和活检口(17.72%)(P<0.05);主要检出细菌前五位分别为金黄色葡萄球菌(16.18%),铜绿假单胞菌(13.24%)、大肠埃希菌(8.82%)、嗜麦芽窄食单胞菌(4.41%)、鲍氏不动杆菌(2.94%);消毒柜内干燥内镜细菌检出阳性率(10.64%)低于消毒后立即采样的湿润内镜(25.31%)(P<0.05)。结论内镜清洗消毒是个复杂过程,应严格按照内镜清洗消毒规范进行内镜处理,加强内镜手工刷洗和干燥,实施多部门多学科协作管理。OBJECTIVE To investigate the detection rate and distribution of bacteria on the surface of flexible endoscopes after high level disinfection,in order to identify key steps of the sterilization procedures of endoscopes.METHODS A total of 350 specimens were collected from the outer surface,internal channels,instrument ports,air/water valves,suction valves of the flexible endoscopes processed by Ortho-phthalaldehyde.The specimens were cultured to detect the bacteria,and the positive rate of bacteria was compared among different types of endoscopes,at different sites of the endoscopes and at different sampling time.RESULTS The detection rate of bacteria on bronchoscopes,enteroscopes,and gastroscopes were 40.00%,15.38%,7.69%,respectively(P<0.05).The top three sites with the highest detection rate were found at internal channel(31.52%),suction port(18.37%)and biopsy port(17.72%).The most frequently detected bacteria were Staphylococcus aureus(16.18%),Pseudomonas aeruginosa(13.24%),Escherichia coli(8.82%),Stenotrophomonas maltophilia(4.41%)and Acinetobacter baumannii(2.94%).The positive rate of specimen taken from dried endoscopes in the drying cabinet(10.64%)was significantly lower than that from wet endoscopes immediately after disinfection(25.31%)(P<0.05).CONCLUSION Proper reprocessing of endoscopes is a complex process and should be performed with strict compliance with relevant endoscope reprocessing guidelines.Hand-brushing and drying should be reinforced,and multidisciplinary collaborative management should also be adopted.

关 键 词：软式内镜 清洗消毒 细菌培养 监测 

分 类 号：R187[医药卫生—流行病学]