钳子管道残留组织胶对内镜清洗消毒质量的影响

 目的 观察内镜下组织胶注射术后钳子管道组织胶残留情况, 评价残留组织胶对内镜清洗消毒质量的影响。方法 随机选取2021年6—8月某三甲医院消化内镜中心行内镜下组织胶注射术患者使用后的胃镜41条, 清洗消毒后采用管腔检测仪目测法观察内镜钳子管道组织胶残留情况并进行微生物检测, 比较有无残留组织胶内镜组的清洗消毒合格率和菌落数分布情况。结果 41条内镜下组织胶注射术使用后的钳子管道, 清洗消毒后28条有组织胶残留, 发生率为68.29%。组织胶残留部位以距离钳子管道出口0~2 cm处为主(23条), 组织胶残留形状多呈块状(23条)。28条残留组织胶内镜首次清洗消毒合格率为46.43%(13条), 13条无组织胶残留的内镜清洗消毒合格率为100%, 两组内镜首次清洗消毒合格率比较, 差异有统计学意义(χ²=8.794, P=0.003)。残留组织胶内镜组和无组织胶残留内镜组的菌落数分布比较, 差异有统计学意义(Z=-3.767, P＜0.001)。28条残留组织胶内镜重复清洗消毒合格率为53.57%(15条), 与残留组织胶内镜首次清洗消毒合格率比较, 差异无统计学意义(χ²=0.286, P=0.593)。残留组织胶内镜重复清洗消毒后菌落数与首次清洗消毒菌落数比较, 差异无统计学意义(Z=-1.185, P=0.236)。结论 内镜下组织胶注射术后钳子管道组织胶残留发生率高, 导致钳子管道清洗消毒不合格率及细菌检出率高, 降低了内镜清洗消毒质量。     

软式内镜一元过氧乙酸消毒液消毒效果

目的评价一元低腐蚀性过氧乙酸消毒液对通过建立铜绿假单胞菌生物膜模型的内镜钳子管道的消毒和生物膜去除效果,并观察验证过氧乙酸消毒液消毒的有效性和时效性。方法生物膜去除效果检测选取奥林帕斯内镜售后服务机构集中回收的临床已使用的内镜钳子管10条搭建生物膜模型后采用过氧乙酸浸泡后抽样。临床观察消毒液有效性和时效性,选取2019年1-12月300条胃镜和300条肠镜作为研究对象,采用过氧乙酸消毒液消毒,统计内镜消毒效果;比较每条内镜连续5 d经步骤a、b来采集样本以检测管道表面附着情况。比较连续使用14 d,浸泡212条内镜后消毒效果。结果内镜钳子管道经过刷洗+过氧乙酸杀灭5 min和15 min,细菌培养无菌生长,生物膜有效去除。胃镜消毒后菌落数平均为(9.362±2.621)CFU低于消毒前菌落数(P<0.001),胃镜消毒合格率为100.00%(300/300)。肠镜消毒后菌落数为0 CFU低于消毒前(P<0.001);肠镜消毒合格率为100.00%。连续使用过程中采集天数对菌落数目无明显影响,且采集天数、采集步骤的交互作用对菌落数目无明显影响。连续使用14 d后浓度仍>1 000 mg/L,为有效浓度,消毒后内镜抽样合格率为100.00%。结论过氧乙酸消毒液在软式内镜消毒中具有较好效果,能有效去除生物膜,具有较高安全性。     

新内镜中心验收过程发现的问题及对策

目的 新内镜中心验收过程中模拟内镜清洗消毒流程,查找存在的问题并给予解决方案。方法 新内镜中心验收中采用人工和全自动机清洗方法模拟内镜清洗消毒流程,对终末漂洗用纯水及清洗消毒后内镜进行微生物学检测,根据检测结果分析不合格原因并针对性进行改进。结果 纯水供给管道消毒前后内镜终末漂洗用纯水检测合格率分别0、100%,染菌量中位数（四分位数）分别为200（186,213）、1.5（0,6）CFU/100 mL,差异有统计学意义（P<0.01）。酶液浓度调整前后人工清洗消毒内镜检测合格率分别为80.00%、91.67%。全自动内镜清洗消毒机（AER）自身消毒前后,自动清洗消毒机空载运行后水标本检测合格率分别为30%、100%,染菌量中位数（四分位数）分别为97.5（8,175）、4（1.75,6.00）CFU/100 mL,差异有统计学意义（P<0.01）。对管腔疑似有生物膜形成的内镜用2 000 mg/L过氧乙酸消毒后,合格率达100%。结论 新内镜中心纯水供给管道未消毒、内镜清洗环节中酶液浓度错误、AER未进行自身消毒、内镜管腔生物膜形成是此次新内镜中心验收过程中发现的问题,针对性改进后,问题得到解决。为保障医疗安全和医疗质量,医疗机构应积极重视新内镜中心启用前的验收工作,消除造成内镜消毒不合格的危险因素。     

多重耐药菌感染患者清创术后内镜灭菌方法研究

 目的 探讨过氧乙酸和环氧乙烷两种不同方法对胰腺包裹性坏死(WON)并多重耐药菌(MDRO)感染(经皮/经胃)内镜下清创术内镜的灭菌效果。方法 选取江西省某三级甲等医院WON并MDRO感染(经皮/经胃)内镜下清创术患者使用带副送水功能的内镜,采用随机数字表法将其分为两组:A组采用过氧乙酸浸泡灭菌,B组采用环氧乙烷低温灭菌。滤膜法采集内镜的钳子管道、送气/送水管道和副送水管道3个位点标本进行微生物培养,比较两组内镜灭菌合格率、菌落数和检出MDRO情况。结果 共采集78条副送水内镜,A组和B组各39条,共234份标本,A组和B组内镜灭菌合格率分别为61.54%、100%。A组钳子管道灭菌合格率为82.05%,送气/送水管道灭菌合格率为89.74%, 副送水管道灭菌合格率为74.36%,B组3个位点灭菌合格率均为100%。A组钳子管道、送气/送水管道和副送水管道菌落总数范围分别为0~6、0~112、0~23 CFU,分离MDRO 36株,以多重耐药铜绿假单胞菌、耐甲氧西林金黄色葡萄球菌和多重耐药肺炎克雷伯菌为主。将A组15条不合格的内镜转为环氧乙烷低温灭菌后,微生物学监测合格率达100%。结论 对于WON并MDRO感染(经皮/经胃)内镜下清创术的内镜,环氧乙烷低温灭菌方法更有效。对内镜的微生物学监测不能仅局限于钳子管道的监测,带副送水功能的内镜需监测副送水管道,以降低感染风险。     

过氧乙酸类消毒剂对生物膜消毒清除效果

目的研究3种过氧乙酸消毒剂对铜绿假单胞菌人工生物膜的去除率,并对使用过的内镜进行临床消毒试验,评估3种消毒剂对生物膜的去除效果。方法参照T/WSJD 002-2019人工制备生物膜;按照WS507-2016和GB 15982-2012进行内镜的临床消毒试验,并采样检测内镜消毒的质量,综合评价消毒剂去除生物膜的效果。结果平整表面培养法和管腔内表面培养法制备的人工生物膜细菌计数达1×107~1×108CFU/样本;消毒作用1 min,3种消毒剂对两种生物膜的去除率均为100.00%;243条内镜临床试验的菌落总数A0<20 CFU/件,B090%,达到合格标准;表明消毒剂可达到高水平消毒,对生物膜有清洁去除效果。     

内镜管腔铜绿假单胞菌生物膜及其清洗效果的研究

目的研究内镜管腔铜绿假单胞菌生物膜的形成和清洗效果。方法采用持续灌流培养技术、模拟清洗试验以及扫描电镜观察内镜管腔,人工培养生物膜形成及其对不同清洗方法的清洗效果。结果体外连续培养5～7 d模拟内镜管腔的铜绿假单胞菌生物膜形成稳定,不易冲洗脱落,膜中细菌浓度达(106～107)CFU/cm2;不含刷洗的内镜清洗程序的无菌水、低浓度多酶清洗液、无酶清洗液、高浓度多酶清洗液对生物膜细菌的清除对数值为0.12、0.42、2.11、1.54,正常内镜清洗程序4种清洗对生物膜经过人工刷洗后对生物膜细菌的对数值为0.23、0.67、2.67、1.95。结论铜绿假单胞菌生物膜能在管腔类器械中形成,采用正确的内镜清洗方法和清洗液是将其去除的关键。     

一种新型生物膜清洗液清洗效果的临床研究

目的调查临床内镜复用过程中细菌生物膜的污染情况,检测生物膜清洗液在内镜清洗消毒中对细菌生物膜的清洗效果。方法参照GB15982和WS507《软式内镜清洗消毒技术规范》监测2017年1月-2017年3月临床80例内镜使用后的消毒效果,并采用活菌计数法评价内镜生物膜去除效果。结果在高水平消毒合格的前提下,10.0%电子胃镜检出细菌生物膜,15.0%电子肠镜检出细菌生物膜。生物膜清洗液对电子胃镜和电子肠镜细菌生物膜的去除率高达99.0%以上,能彻底清除内镜腔体内形成的细菌生物膜,保证后续消毒(灭菌)效果。结论与常规多酶清洗液相比,生物膜清洗液能有效去除内镜腔内的细菌生物膜,保证了消毒(灭菌)效果,避免医院感染。     

有关内镜再处理的一些问题

1　为何内镜清洗时必须选择酶洁液 由于内镜管道尤其是软式内镜设计非常复杂 ,很难彻底刷洗至内部管道的各个表面 ;尤其是不平、缝隙、粗糙的表面。 内镜管道粘附有很多人体有机分泌物 ,如血、粘液、组织、痰和粪便等 ,只用自来水很难完全冲洗干净。如长期洗不干净 ,就可能形成生物膜 ,造成暴发性感染。 一般软式内镜带菌量很高 (胃镜约为10 6 CFU/件 ,肠镜可达 >10 9CFU /件 )。 酶洁液可以进入管腔深部 (将酶洁液浸没内镜 ,抽吸至管腔的深部 ) ,渗透至管腔的所有表面 ,并分解有机污物 ,降低内镜生物负荷 3～ 5个对数级水平 ,可大大加快…     

输卵管阻塞性不孕症行选择性介入治疗临床效果分析

目的探讨选择性输卵管造影术（SSG）的诊断及输卵管阻塞选择性介入再通术（FTR）的治疗效果。方法对162例经子宫输卵管造影术（HSG）诊断为输卵管阻塞不孕症患者行（SSG）及（FTR）诊治分析。结果162例患者有267条近端阻塞的输卵管，236条管腔获得再通，其中69条仅输卵管选择性造影（SSG）就获得了再通，占31．57％。其余均采用输卵管选择性造影（SSG）和再通术（FTR）获得再通，选择性插管成功率为98．27％，近端阻塞复通成功率为94．26％。结论SSG及FTR技术操作简便，疗效确切，安全有效，值得临床推广，是治疗近端输卵管阻塞的重要方法。     

储存时间对消毒后软式内镜微生物污染的影响

目的 监测消毒后软式内镜在存放不同时间的微生物污染情况，以探讨软式内镜的安全储存期。方法 采用便利抽样法选取重庆市某三甲医院内镜中心的27条软式内镜进行前瞻性研究，2017年10月-2019年2月，纳入消毒后内镜生物学监测合格的内镜，并常温下储存24、48、72、168 h，监测内镜管腔及表面菌落数及其合格率，同时监测镜柜空气与物体表面菌落数及其合格率。结果 108条次软式内镜分别储存24、48、72、168 h，内镜管腔与表面菌落合格率均为100%。其中108条次内镜储存24、48、72、168 h的表面菌落数为0；108条次内镜储存24、48、72 h的管腔菌落数为0，储存168 h 107条次内镜管腔菌落数为0，1条次内镜管腔菌落数为6 CFU/件，但无致病菌。镜柜空气与物体表面菌落数合格率均为100%。结论 软式内镜高水平消毒合格后在合格环境下储存168 h是安全的，使用前可不必再消毒。     

两种储存柜对消化内镜管腔干燥的影响研究

目的 探究智能内镜储存柜和标准内镜储存柜在干燥消化内镜管腔中的价值.方法 根据压力气枪对活检管腔充气的时间,将240条内镜分为30 s、40 s、50 s充气组,每组80条,充气结束后30 s、40 s、50 s充气组各排除已干燥内镜13、30、41条,将每组中干燥不合格的内镜采用随机数字法分为试验组和对照组,试验组放...     

Wie steht es um die Hygiene beim Endoskopieren?

Flexible endoscopy is essential for the practice of modern medicine. However, with inadequate reprocessing of endoscopes and additional instruments, infections can be transmitted. Therefore, guidelines for reprocessing flexible endoscopes have been published in many countries. The goal of the present survey was to examine the current compliance with German Guidelines in a German urban region, covering all hospitals (15 hospitals) and private practices (23 practices) of this area, without any exception. All endoscopic units in Frankfort on the Main were visited by members of the Public Health Service, using a checklist based on the recommendations of the German Guidelines. In 2004, a reevaluation of 14 hospitals and 20 private practices took place, either by analysing the written reports of the institutions or by revisiting the institutions. In 2003, compliance with the guidelines in hospitals was satisfactory. In practices, however, many problems were identified in 2003. Between 2003 and 2004, great improvements could be seen (data of 2003 in parentheses). At the end of 2004, in 90% of the practices adequate storage of the endoscope without risk of recontamination (2003:52%), correct reprocessing the bottle and the tube for air/water channel flushing including filling with sterilized water was observed (2003:74% and 52%). In 100% of the practices, ultrasonic cleaning (2003:26%) and sterilizing of endoscopic accessories was guaranteed (2003:57%) and routine tests of endoscopes after reprocessing (2003:56%) were performed. In conclusion the relevance and the effect of the advising and control of public health have been so efficient that between 2003 and 2004 most faults have been corrected. Therefore control visits of the Public Health Services should not only cover hygiene in reprocessing the endoscopes but also hygiene in reprocessing endoscopic accessories as well.     

German guidelines for reprocessing endoscopes and endoscopic accessories: guideline compliance in Frankfurt/Main, Germany

Guidelines for reprocessing flexible endoscopes have been published in many countries. The present survey investigated compliance with German guidelines in all hospitals and private practices in Frankfurt/Main, Germany. In 2003, all endoscopic units in Frankfurt/Main [15 hospitals and 23 private practices (10 large practices performing >1,000 endoscopies/year and 13 small practices performing <1,000 endoscopies/year)] were visited by members of the Public Health Service and assessed using a checklist based on the recommendations of the German guidelines. In 2004, a re-evaluation took place, either by analysing the written reports of the institutions or by visiting them again. Meanwhile, one hospital had closed and three small practices had ceased performing endoscopy, so the re-evaluation encompassed 14 hospitals and 20 private practices. In 2003, hospital compliance with the guidelines was satisfactory but many problems were identified in private practices. Between 2003 and 2004, great improvements were made. By the end of 2004, 90% of private practices had adequate storage facilities for reprocessed endoscopes, and were performing reprocessing of bottles and tubes for air-/water-channel flushing correctly (2003: adequate storage 52%; correct reprocessing 74%). Sterilization of endoscopic accessories was satisfactory, and routine testing of endoscopes after reprocessing was performed in all private practices at the end of 2004 (2003: sterilization of accessories 57%; microbiological control tests 56%). In 2003, although hospital compliance with the guidelines was satisfactory, mandatory improvements were required in private practices, notably in smaller units. Infection control advice and the control of public health regulations resulted in the correction of most processing faults between 2003 and 2004.     

Unusual implication of biopsy forceps in outbreaks of Pseudomonas aeruginosa infections and pseudo-infections related to bronchoscopy

Between January and April 2003, a sudden increase in positive respiratory tract specimens for Pseudomonas aeruginosa was observed in an intensive care unit of the University Teaching Hospital of Montpellier, France. Most of the strains were cultured from bronchoalveolar lavage fluid samples, suggesting that bronchoscopic procedures could be implicated. The relationships between isolates were investigated by antibiotyping and pulsed-field gel electrophoresis. Both phenotypic and molecular markers allowed identification of two consecutive nosocomial outbreaks of respiratory infections related to two different bronchoscopes. These two outbreaks implicated nine and seven patients, respectively. Four of these 16 patients had true infections and recovered with antibiotic therapy. Inspection of both bronchoscopes revealed a damaged internal channel caused by defective biopsy forceps. These defects led to improper cleaning and disinfection of the bronchoscopes despite adherence to all current reprocessing procedures. The two outbreaks were controlled after replacing the inner channels of the bronchoscopes and switching from use of re-usable to disposable biopsy forceps. These outbreaks emphasize the need to establish surveillance procedures for detecting contamination of bronchoscopes, and the importance of recording each endoscopic procedure to facilitate further investigations if needed.     

EndoSheath endoscopic system

To address the problems inherent in reprocessing endoscopes--the time required (about an hour per use), the difficulty of the process, and the adverse consequences of endoscope contamination--Vision Sciences Inc. introduced the EndoSheath endoscopic system. It consists of a disposable sheath that fits over a specially designed reusable fiberoptic endoscope. When an endoscopic procedure is completed, the sheath is discarded, and the endoscope is wiped with alcohol and reused. We evaluated one of the EndoSheath products--a sheathed sigmoidoscope--for its suitability in an endoscopy suite. We examined the unit and surveyed a number of users. We found that, although it would considerably shorten the time between endoscopic procedures, the unit was not well suited for an endoscopy suite because it provided no more protection than would be afforded by a carefully followed reprocessing protocol. However, users informed us that the sigmoidoscope and one other product--a nasopharyngo-laryngoscope--would likely be useful in a doctor's office or a hospital clinic.     

湖州市学生午餐主要致病菌污染状况

  目的  了解湖州市学生午餐主要食源性致病菌污染状况, 为卫生监管、食源性疾病防制提供参考。  方法  2021年随机采集湖州市77所大中小学校及幼儿园食堂的学生午餐225份, 对其开展大肠埃希菌、金黄色葡萄球菌、蜡样芽孢杆菌、沙门菌、弯曲菌、单核细胞增生李斯特菌以及致泻性大肠埃希菌检测, 依据相关标准对其进行微生物污染状况评价。  结果  225份学生午餐总体不合格率为2.67%(6/225), 其中大肠埃希菌>100 CFU/g的比例为1.33%(3/225), 蜡样芽胞杆菌、金黄色葡萄球菌、单核细胞增生李斯特菌和致泻性大肠埃希菌的检出率分别为7.11%, 1.33%, 0.89%和0.44%, 金黄色葡萄球菌≥104 CFU/g和蜡样芽胞杆菌≥105 CFU/g的比例均为0。不同学校类型间学生午餐不合格率差异有统计学意义(P < 0.05), 不合格样品主要来自小学食堂, 其不合格率为5.63%(4/71)。  结论  湖州市学生午餐总体卫生状况尚可, 但存在不同程度的食源性致病菌污染, 尤其应加强对小学的监督与管理。     

Aufbereitung von Cystoskopen in der Urologie. Was geschieht wirklich?

After having been informed about current guidelines, all urologic units in hospitals and private practices in Frankfurt/Main were visited in 2005/6 by members of the public health department and assessed using a checklist based on the recommendations of the German Guidelines for reprocessing medical instruments including rigid and flexible cystoscopes. In 12 hospitals and 22 private practices cystoscopy was performed using rigid cystoscopes, whereas flexible cystoscopes were used in 7 hospitals and 8 private practices. Cystoscopy with flexible instruments was more common in ambulatory than in clinic settings (about 1150/year vs. 280/year). In hospitals, reprocessing of the rigid cystoscopes was performed in special units for reprocessing (disinfection, sterilisation) using validated automatic processes, whereas reprocessing of flexible cystoscopes often was performed in the urologic units themselves, and not always in a correct manner. In the private practices, mainly manual reprocessing procedures were in use for rigid cystoscopes, in 18 out of 22 practices correct. However, only in 50 % of the private practices, sterilisation equipment was available for reprocessing rigid cystoscopes and/or endoscopic accessories. Flexible cystoscopes were reprocessed using a washer-disinfector in one practice, in the other ones, manual reprocessing was performed. In two practices only, reprocessing according to the guidelines was seen. Infection control advice and repeated control of the public health department resulted in the correction of most processing faults within some months.