医院内窥镜消毒现况调查

目的：了解上海市医院对内窥镜消毒的现况，进一步规范消毒操作方法。方法：对上海市41家医疗机构进行各类内窥镜检查人次构成比、污染情况、消毒方法与效果以及消毒剂副反应等进行调查，结果：平均约每70名就诊病人有1人接受各种内窥镜检查，其中胃镜、肠镜检查人次占60．23％与21．15％，喉镜与支气管镜占8．22％、2．34％，膀脱镜占6．51％，腹腔与关节镜占1．55％。各类内窥镜的污染程度也以胃镜与脑镜最严重，细菌菌落总数分别为2824cfu／100cm2与408cfu／100cm2，其次为喉镜148cfu／100cm2，经常规消毒后，胃镜的合格率71％～77％。内窥镜消毒主要存在以下问题：（1）消毒剂选用不当：采用低水平消毒剂占10．75％；（2）消毒时间未达规定时间：膀胱镜全部未达到灭菌时间，其他消毒类内窥镜与灭菌类内窥镜作用时间符合率也仅24．39％与35．29％；（3）部分医院用自来水配制灭菌剂及作灭菌后冲洗。19．44％（7／36）的医院反映戊二醛对工作人员有头痛、皮肤粘膜刺激等副反应，2778％（10／36）的医院反应戊二醛对内窥镜镜面与通道有损害作用。结论：内窥镜的消毒灭菌剂还有待改进，内窥镜的消毒操作应进一步规范。

Investigation on endioscopy disinfection in hospitals

Contamination disinfection methods. effects and side-effects for endoscopes were investigated in 41 hospitals of Shanghai. Results showed: about 1 of 70 case going to doct0r would receive endoscopic examinatoty in which gastrocopy. entercopy. laryngoscope. cystocope. bronchocopy. peritoneoscope and arthroscope accounted for 60. 23%.21. 15 %.8. 22%.6. 51%.2. 34% and1. 55% respectively. In different endoscopes, the contamination of gastrocopy and entercopy were most serious, then the laryngoscope, the total bacteria colong was 2824cfu/100cm2.408cfu/100cm2 and 148cfu/100cm2 respectively. After routine disinfection, the qualited rate of gastrocopy was 71%~77%. The main problems of endoscopy disinfection were: (1)Using low level disinfectants, accounted for 10. 75 %, (2) Unsufficien disinfectiom time, cystocope disinfection time did all not come to fixed time, other endoscopy disinfection or sterilization did not come to fixed time accounted for 75. 61 % or 64. 71 %; (3)rinsing endoscopes with tap water after sterilization in some hospitals.In addition, 7 of 36 hospitals (19. 44% ) reflected that glutaraldehyde may induce headache, skin and mucous membrance stimulation atc; 10 of 36 (27. 78%) hospitals reflected glutaraldehyde may damage lens and channels of endoscopes. This investigalion poined out: the disinfectants of endoscopes should be improved, the operation of endoscopy disinfection should be normalized.