上海市94所医疗机构内镜终末漂洗用水管理现场调查  

On-site investigation of endoscope final rinsing water management in 94 medical institutions in Shanghai

作　　者：张娜 齐敏克[2] 史庆丰 刘佳 张元[1,4] 崔一忻[3,4] 高晓东 HANG Na;QI Min-ke;SHI Qing-feng;LIU Jia;ZHANG Yuan;CUI Yi-xin;GAO Xiao-don(Eye&ENT Hospital,Fudan University,Shanghai 20003l,China;不详)

机构地区：[1]复旦大学附属眼耳鼻喉科医院感染管理科,上海200031 [2]新疆医科大学第一附属医院感染管理科,新疆乌鲁木齐830054 [3]复旦大学附属中山医院感染管理科,上海200032 [4]复旦大学医院感染与控制研究所,上海200032

出　　处：《中华医院感染学杂志》2024年第16期2551-2555,共5页Chinese Journal of Nosocomiology

基　　金：上海市加强公共卫生体系建设三年行动计划(2023-2025年)重点学科(GWVI-11.1-04);上海市卫生健康委员会卫生健康政策研究课题(2024HP40);上海申康医院发展中心优化管理专项(SHDC22021315、SHDC22022215)

摘　　要：目的调查上海市各级医疗机构内镜中心终末漂洗用水的管理现状,为提高用水质量、制定质控标准及监管措施提供依据。方法2023年上海市院内感染质量控制(简称质控)督查期间,现场对所督查医疗机构的内镜中心进行终末漂洗用水的管理调研,调研内容包含终末漂洗水的管理、采样和检测方法、水路消毒方法。结果在质控调查的106所医疗机构中,有94所医院配备了内镜中心;不到30%的医疗机构对检查性内镜和治疗性内镜分区域进行独立的清洗和消毒,而大约15%的内镜中心无独立的纯化水处理系统;三级医院、二级医院和社会办医院的内镜终末漂洗水中使用纯化水的比例分别为85.7%、87.8%和90.9%;调查发现78.6%的三级医院、51.2%的二级医院和81.8%的社会办医院每月对终末漂洗水进行采样监测(P<0.05);通过投放含氯等化学消毒剂的方式消毒管路的比例分别为14.3%、22.0%和18.2%;使用R2A平板培养纯化水的比例分别是35.7%、36.6%和27.3%,而各级医院之间无统计学差异。结论上海市内镜用水现状不容乐观,存在管理人员认知不足,医院重视程度不够,临床执行不统一,监管力度不够等现象,今后应开展针对性培训,以降低感染发生风险。OBJECTIVE To investigate the management status of final rinsing water in endoscopy centers of various levels of medical institutions in Shanghai.The findings will provide a basis for improving water quality,establishing quality control standards,and implementing regulatory measures.METHODS During the Shanghai hospital infection quality control inspection in 2023,on-site research was conducted on the management of final rinsing water in the endoscopy centers of the inspected medical institutions.The research included the management of final rinsing water,sampling and testing methods and waterway disinfection methods.RESULTS Among the 106 medical institutions under inspection,94 hospitals were equipped with endoscopy centers.Less than 30%of the medical institutions independently cleaned and disinfected diagnostic and therapeutic endoscopes in separate areas,and approximately 15%of the endoscopy centers lacked independent purified water treatment systems.The proportions of using purified water in final rinsing were 85.7%,87.8%,and 90.9%in tertiary hospitals,secondary hospitals,and privately-run hospitals,respectively.The investigation found that 78.6%of tertiary hospitals,51.2%of secondary hospitals,and 81.8%of privately-run hospitals conducted monthly sampling and monitoring of final rinsing water(P<0.05).The proportions of disinfecting pipelines by chlorine-based disinfectants were 14.3%,22.0%,and 18.2%in each level,and the proportions of using R2A agar plate for culture detection of purified water were 35.7%,36.6%,and 27.3%,respectively,with no significant difference among different levels of hospitals.CONCLUSION The current status of endoscope water management in Shanghai is not optimistic,including insufficient cognition of management personnel,inadequate hospital attention,inconsistent clinical implementation,and insufficient regulatory efforts.Targeted training should be carried out in the future to reduce the risk of infection.

关 键 词：内镜 软式内镜 终末漂洗水 纯化水 水样采集 用水管理 

分 类 号：R187[医药卫生—流行病学]