固体清洗剂和多酶清洗剂清洗手术器械的效果比较

目的比较固体清洗剂和液体多酶清洗剂清洗手术器械的效果，并进行成本分析，为消毒供应中心提供新的清洗技术选择。方法将消毒供应中心4台清洗消毒机随机平分为实验组和对照组，实验组使用固体清洗剂，对照组使用液体多酶清洗剂对手术器械进行清洗。对两组手术器械的清洗效果，采用目测(裸眼和10倍光源放大镜）、ATP生物荧光检测和蛋白残留检测方法进行效果评价，并对两组的清洗成本以及产生的医疗废弃物进行统计分析。结果肉眼裸视评价清洗效果，实验组合格率为97.70%（4 678/4 788），对照组为92.01%（5 075/5 516）；10倍光源放大镜评价清洗效果，实验组合格率为94.30%（2 546/2 700），对照组为88.72%（2 453/2 765）；实验组合格率均高于对照组，差异具有统计学意义（P=0.000）。ATP荧光检测法评价清洗效果，实验组合格率为84.41%（996/1 180），对照组为86.83%（1 042/1 200），两组差异无统计学意义（P=0.092）。实验组蛋白残留检测阳性率为3.71%（26/700），对照组为16.31%（106/650），实验组蛋白残留检测阳性率比对照组低，差异有统计学意义（P=0.000）。实验组清洗成本为对照组的2/3；实验组产生医疗废弃物（塑料薄膜）0.40 kg，对照组（空桶）为12.30 kg。结论固体清洗技术可以高效去除手术器械的蛋白污染，并降低清洗成本，减少医疗废物的产生，是值得推广的新型清洗技术。

Comparison in the cleaning efficacy of surgical instruments by solid detergent and multi enzymatic detergent

Objective To compare the cleaning efficacy of surgical instruments by solid detergent and Liguid multi-enzymatic detergent,and conduct cost-effectiveness analysis,so as to provide new cleaning technique for central sterile supply department（CSSD）.Methods Four washer-disinfectors in CSSD were randomly divided into experi-mental and control group,experimental group adopted new solid detergent for cleaning surgical instruments,control group used liquid enzymatic detergent.Cleaning efficacy of two groups were evaluated by visual observation（naked syesight and 10 ×magnifier with light）,ATP bioluminescence assay and residual protein test.Cleaning cost and medical waste generated by different detergents during the same period were analyzed statistically.Results Qualified rate of cleaning observed by naked syesight was 97.70% （4 678/4 788）in experimental group and 92.01%（5 075/5 516） in control group;qualified rate of cleaning observed by 10×magnifier with light was 94.30%（2 546/2 700）in experimen-tal group and 88.72%（2 453/2 765）in control group ;qualified rate in experimental group were both higher than in con-trol group （P =0.000）.ATP bioluminescence assay showed that qualified rate of cleaning of experimental group and control group was 84.41%（996/ 1 180）and 86.83%（1 042/1 200）respectively,there was no statistical difference between two groups（P =0.092）.Residual protein test positive of experimental group and control group was 3.71% （26/700）and 16.31%（106/650））respectively,experimental group was lower than control group （P =0.000）.Cleaning cost of experi-mental group was 2/3 of control group;medical waste produced in experimental group （plastic film）and control group （empty barrel）was 0.40kg and 12.30kg respectively.Conclusion Solid detergent cleaning can efficiently eliminate the protein soil on surgical instruments,reduce cleaning cost and production of medical waste,it is a novel technology applied to surgical instrument cleaning.