广东省32所医院胃肠镜污染与消毒现状调查

目的了解广东省医院胃肠镜污染和消毒质量的状况,以便为改进和提高消毒质量提供依据。方法采用现场抽样检测方法,对广东省32所医院使用后和消毒后的胃肠镜进行了检测。结果广东省医院使用后的胃肠镜活检道平均污染细菌总数为209000～263000cfu/条,送气送水道平均污染细菌总数为197000～316000cfu/条,活检钳平均污染细菌总数为865～1560cfu/个。共检出绿脓杆菌11株,金黄色葡萄球菌6株,大肠埃希菌4株。三级综合性医院消毒后的胃肠镜活检道、送气送水道和活检钳检测合格率分别为45.45%、43.94%和52.17%;二级综合性医院消毒后的胃肠镜活检道、送气送水道和活检钳检测合格率分别为68.57%、48.57%和75.86%;专科医院消毒后的胃肠镜活检道、送气送水道和活检钳检测合格率分别为42.10%、15.79%和9.09%。结论广东省医院胃肠镜使用后微生物污染严重,消毒后合格率较低。     

Microbial bioburden in endoscope reprocessing and an in-use evaluation of the high-level disinfection capabilities of Cidex PA.

Most endoscopy clinics use 2% glutaraldehyde as a high-level disinfectant for reprocessing flexible endoscopes. However, even with contact times greater than 30 minutes, survival of organisms has been documented. We compared the high-level disinfection capabilities of glutaraldehyde (45-minute immersion) with a new peracetic acid germicide (20- to 25-minute immersion). Channels, valve housings, and outer sheaths were sampled to quantify bioburden levels after a patient procedure, after manual cleaning, and after disinfection. Total mean bioburden after clinical use was greater than 6 log10 colony-forming units (CFU). Manual cleaning reduced the bioburden by means of 4.7 log10 CFU (gastroscopes) and 6.2 log10 CFU (colonoscopes). High-level disinfection with the new product was achieved in five of six (product stressed by EPA Reuse Test) and 7 of 10 (product stressed by dilution and organic load) successfully disinfected endoscopes, whereas glutaraldehyde achieved it in 4 of 10 (product stressed by dilution and organic load). We conclude that the new peracetic acid product (20- and 25-minute contact time) is at least as effective as glutaraldehyde (45-minute contact time) for reducing the bioburden of vegetative aerobic organisms in endoscopes.     

消化内镜清洗消毒方法改进及其效果观察

目的探讨消化内镜引起医源性感染的因素及预防对策。方法从内镜的清洗消毒方法、附件的消毒灭菌和管理方法、预防消毒后内镜的二次污染3方面完善和加强消化内镜的院感管理,比较改进法与原方法内镜的消毒合格情况。结果改进后内镜清洗合格率从改进前74.2%提高到82.9%(P<0.05);内镜消毒合格率从改进前95.0%提高到100%(P<0.005);活检钳及一次性器械合格率从改进前75%上升至100%(P<0.005);口塞、弯盘消毒合格率从改进前92%上升至100%(P<0.005);采取预防内镜二次污染措施后检测镜身与弯曲部合格率从92%上升至100%(P<0.05);检测活检孔道合格率从98%上升至100%(P>0.05)。结论通过完善和加强消化内镜的院感管理,内镜与附件合格率达100%,避免了内镜二次污染,从而预防和控制消化内镜引起的医源性感染。     

酸性氧化电位水消毒法对麻醉喉镜镜片消毒效果的探讨

目的：比较酸性氧化电位水与常规消毒剂戊二醛、含氯制剂、过氧乙酸对麻醉喉镜镜片的消毒效果差异,了解酸性氧化电位水对麻醉喉镜镜片的消毒作用。方法：选择240例全麻手术患者使用后的麻醉喉镜镜片,分为2%戊二醛、1%过氧乙酸、1000mg/L含氯制剂、酸性氧化电位水（EOW）组4组,每组60例,按消毒时间的不同（3min,5min,7min）再分3组,每组20例,消毒后进行涂抹采样,细菌学检测;取结核杆菌、HBsAg阳性患者用后的麻醉喉镜镜片各20例,EOW3min消毒后涂抹采样,检测致病菌。按《内镜清洗消毒技术操作规范》要求对麻醉喉镜镜片清洗,采样,细菌菌落检测,致病菌检测,合格标准为细菌总数≤20cfu/件和没有检出致病菌。结果用SPSS软件分析,数据行χ2检验。结果：3minEOW组与其他三组比较差异有统计学意义（P〈0.05）;5minEOW组与含氯制剂组比较差异有统计学意义（P〈0.05）,与2%戊二醛和1%过氧乙酸组比较差异无统计学意义（P〉0.05）;7min EOW组与其他三组比较差异无统计学意义（P〉0.05）。乙肝和结核患者组EOW消毒3min没有检出致病菌。结论：EOW用于麻醉喉镜镜片的消毒效果确切,具有高效性、速效性、环保性和广谱性,在临床值得推广。     

Do conventional cleaning and disinfection techniques avoid the risk of endoscopic Helicobacter pylori transmission?

BACKGROUND AND STUDY AIMS: The aim of the present study was to determine whether endoscopes serve as a reservoir for Helicobacter pylori and whether the disinfection technique currently recommended for manual cleaning and disinfection of the instruments completely removes the risk of H. pylori transmission. PATIENTS AND METHODS: A prospective study was carried out in 400 patients who were undergoing upper gastrointestinal endoscopy for routine clinical indications. The patients' H. pylori status of the patients was identified using a urea detection system (HUT) and culture. H. pylori contamination was assayed by culturing rinsing samples from the endoscopes before and after manual cleaning and disinfection. Gastric biopsies were assayed using rapid urease testing (Helicobacter urease test, HUT) of two antral and gastric body biopsies and cultures. RESULTS: A total of 128 of the 400 patients examined were found to be H. pylori-positive using HUT testing. Endoscopes were contaminated in 54 of the 128 rinsing samples from endoscopes used in H. pylori-positive patients (42 %) before cleaning and disinfection. One of the 128 rinsing samples (0.8 %) was found to be contaminated with H. pylori even after routine manual cleaning and disinfection - indicating that these cleaning and disinfection procedures may be insufficient to eradicate H. pylori from endoscopes completely. No seroconversion was observed during serological follow-up in the patient who had previously been examined with an endoscope contaminated with H. pylori. The patient was still found to be seronegative 5 months after inoculation. CONCLUSIONS: Endoscopes are frequently contaminated with H. pylori immediately after gastroduodenal endoscopy in H. pylori-infected patients. Iatrogenic transmission is possible, as H. pylori can survive manual cleaning and disinfection with 2 % glutaraldehyde, particularly when there is ineffective cleaning before disinfection.     

强氧化离子水对微生物杀灭效果的临床研究

目的研究强氧化离子水对微生物的杀灭效果.方法用强氧化离子水、1%"文华”消毒灵、2%戊二醛分别对工作人员双手、镊子、胃镜进行消毒,并按消毒技术规范进行采样.结果强氧化离子水对手微生物的杀灭率为88.4%.强氧化离子水与1%消毒灵对被有机物污染的镊子作用类同,均会影响消毒剂的杀灭效果.强氧化离子水与2%戊二醛能100%杀灭大肠埃希菌和灭活乙型肝炎表面抗原(HBsAg),对枯草杆菌黑色变种芽孢杀灭率分别为99.73%、100%.结论强氧化离子水具有较强的消毒杀菌作用,对人体无毒、无刺激,对环境无污染,是新一代的消毒杀菌剂.     

胃肠镜消毒效果及其影响因素的研究

目的了解广东省医院胃肠镜消毒效果及其影响因素。方法采用现场采样和实验室检测方法对省内32所医院的胃肠镜使用和消毒现场进行调查。结果胃肠镜检查室的通风状况可能是影响胃肠镜消毒效果的危险因素;消毒后的胃肠镜的储存条件和清洗消毒人员的培训内容可能是影响胃肠镜消毒效果的保护因素。用清洁毛刷彻底刷洗活检孔道、用注射器抽吸酶洗液冲洗送气送水管道及活检孔道、用酶洗液浸泡的时间、刷洗钳瓣内面和关节处和清洗后并擦干可能是影响胃肠镜消毒效果的保护因素。按照关键影响因素进行的胃肠镜模拟现场消毒试验结果表明,可将传统方法的消毒合格率78.33%提高到98.33%。结论严格控制胃肠镜清洗消毒程序中的有关因素,可明显改善胃肠镜消毒效果。     

Determination of glutaraldehyde residues on flexible endoscopes after chemothermal treatment in an endoscope washer-disinfector.

BACKGROUND AND STUDY AIMS: Although there are several cases of glutaraldehyde-induced colitis following colonoscopy there is only one study on residues after disinfecting. Our report describes the determination of water-soluble glutaraldehyde residues after processing endoscopes with a glutaraldehyde-containing disinfectant. MATERIALS AND METHODS: A gastroscope and a colonoscope were processed in a washer-disinfector and then immersed in 201 of NaCl solution. Glutaraldehyde was determined by high performance liquid chromatography in 84 samples. Samples were taken after immersing the endoscopes for 5 h and 24 h with and without rinsing the channels. RESULTS: After 5 h and with the channels having been rinsed, the median for colonoscopes was only 0.409 mg/l. The highest level of glutaraldehyde was 0.846 mg/l. CONCLUSIONS: After endoscopes have been processed in the washer-disinfector there is no risk of a glutaraldehyde-induced colitis, proctitis or diarrhoea.     

Microbicidal activity of octenidine hydrochloride, a new alkanediylbis[pyridine] germicidal agent.

The potential of octenidine hydrochloride (WIN 41464-2) as a topical microbicide was measured both by in vitro death kinetics and reductions in numbers of bacteria on the skin of cynomolgus monkeys. Semilogarithmic survival curves were plotted to measure the microbicidal activity of various concentrations of octenidine against Staphylococcus aureus. The microbicidal activity of octenidine was also determined for Staphylococcus epidermidis, Proteus mirabilis, Streptococcus pyogenes, Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, Serratia marcescens, and Candida albicans. Death rates for the same microbial strains were compared with those obtained by using chlorhexidine gluconate. Octenidine concentrations of less than 1.5 microM (0.94 microgram/ml) caused a greater than 99% reduction of each microbial population within 15 min. Staphylococcus epidermidis was the most susceptible of the test organisms, and E. coli and C. albicans were the least susceptible. Octenidine was more active than chlorhexidine against each test strain. Skin-degerming activities of aqueous and formulated octenidine and formulated chlorhexidine were compared in single and multiple applications of these agents to the hand and foot surfaces of monkeys by using a glove-juice extraction procedure to measure the skin microflora. Aqueous octenidine, at a concentration of 0.2 to 1.6% reduced resident microflora populations from 90 to 99.98%, depending on the concentration and number of applications. Octenidine formulated at 2% in a surfactant-based vehicle exhibited significantly better skin-degerming activity than did either a nonmedicated vehicle or the Hibiclens brand of 4% chlorhexidine gluconate.     

酸性氧化电位水与戊二醛对临床内镜消毒效果及人体危害性调查

为了解酸性氧化电位水和戊二醛对临床使用中内镜消毒效果,采用现场采样检测方法进行了监测比较。结果,采用酸性氧化电位水清洗消毒胃镜和肠镜3 m in,对自然菌消除率为99.3%~99.95%;清洗消毒作用5 m in,未检出存活菌。用20 g/L戊二醛对胃镜和肠镜清洗消毒作用5 m in,对自然菌消除率为90.38%~93.04%;清洗消毒作用10 m in,对自然菌消除率为99.92%~99.96%。结论,酸性氧化电位水对临床使用中胃镜和肠镜清洗消毒效果比戊二醛作用快速,容易冲洗且无刺激性气味。     

Current instrument reprocessing practices. Results of a national survey.

In June 1998, a questionnaire was mailed to approximately 2,900 healthcare professionals to assess current instrument reprocessing and infection control practices and determine whether they have changed during the past decade. Surveys were returned from 146 respondents whose facilities performed gastrointestinal endoscopy. Most respondents were registered nurses and almost all worked in healthcare facilities located in the United States. More than 75% of the respondents reported that infection control practices in endoscopy have improved during the past 10 years. Most respondents used glutaraldehyde to reprocess flexible endoscopes. Immersing endoscopes for 20 minutes at room temperature was commonly practiced. Almost 75% of respondents used an automated device to reprocess flexible endoscopes. Most respondents terminally rinsed the endoscope's channels with 70% alcohol followed by forced-air drying. Few respondents outsourced instruments to a commercial reprocessing company and almost 50% reused disposable items. While some practices in endoscope reprocessing have changed during the past several years, others have not. In general, infection controls appear to have improved during the past decade, with the possible exception of a trend to reuse single-use items.     

Non-United States guidelines for endoscope reprocessing

A worldwide concern has emerged with regard to endoscope disinfection, and many gastrointestinal endoscopy associations have guidelines for proper disinfection of endoscopes and endoscopic accessories. They are not much different from those of the American Society of Gastrointestinal Endoscopy and include mechanical cleaning as the first and most important step followed by immersion in 2% glutaraldehyde for periods ranging from 5 to 20 minutes. Lack of compliance with these guidelines has been noted, however, in 20 to 70% of centers in Europe, the United Kingdom, Australia, and Asia. Automated disinfectors are being universally recommended to ensure better compliance. Two other improvements are use of peracetic acid as an alternative disinfectant and use of a disposable sheath over the endoscope.     

广东省32所医院胃肠镜清洗消毒管理现状调查

目的了解广东省医院胃肠镜消毒管理现状,以便改进胃肠镜消毒质量。方法采用实地考察和问卷调查的方式,对广东省32所医院胃肠镜清洗消毒管理情况进行了调查。结果三级综合性医院胃肠镜消毒质量合格率为92.31%,二级综合性医院和专科医院合格率分别为85.71%和50.00%。三类医院胃肠镜清洗消毒有专人负责分别占100%、85.71%和66.67%;三类医院胃肠镜清洗消毒专职人员的培训率分别为84.62%、85.71%和41.67%。在所调查的32所医院中共有7所医院使用酸性氧化电位水消毒胃肠镜,能正确规范使用酸性氧化电位水消毒的医院仅有1所。结论广东省不同类型医院胃肠镜检查室的消毒管理现状存在问题,需要加强管理。     

Maintenance antisepsis in reducing the rate of late-onset central venous catheter-related bloodstream infection: A comparison of 0.05% and 1% chlorhexidine

BackgroundBundled measures have been recommended to reduce the risk of central venous catheter (CVC)-related bloodstream infection. However, the importance of each procedure involved in CVC insertion/management for preventing catheter-related bloodstream infection (CRBSI) has not been thoroughly assessed. We aimed to analyze the effectiveness of maintenance antisepsis at the CVC insertion site in reducing the CRBSI risk through comparing the use of 0.05% chlorhexidine to 1% chlorhexidine.Patients and methodsIn the South Miyagi Medical Center, Japan, 372 patients with a CVC who had undergone antisepsis maintenance using 0.05% chlorhexidine swabs 12 months prior to implementing 1% chlorhexidine swabs, and 344 patients at 12 months post-implementation of 1% chlorhexidine swabs, were followed prospectively for the development of CRBSI and signs of infection, and their data compared.ResultsPost-implementation of the 1% chlorhexidine swabs, the CRBSI rate decreased from 3.64/1000 catheter-days to 1.77/1000 catheter-days. The risk of CRBSI decreased to 0.465 (95% confidence interval [CI]: 0.216–1.001). Furthermore, the risk of CRBSI ≥20 days after CVC insertion decreased to 0.200 (95% CI: 0.049–0.867); however, we found no difference between 0.05% and 1% chlorhexidine use within 19 days of CVC insertion. The increased number of patients with insertion site tenderness after implementing 1% chlorhexidine indicated a possible adverse effect of chlorhexidine.ConclusionMaintenance antisepsis with 1% chlorhexidine decreased the risk of developing CRBSI ≥20 days after CVC insertion, indicating the effectiveness of antisepsis with 1% chlorhexidine. Our data highlight the importance of maintenance antisepsis in reducing the rate of late-phase CRBSI.     

医用三原子氧化三蒸水与埃索美拉唑三联疗法治疗幽门螺杆菌感染慢性胃炎的疗效观察

目的比较饮用三原子氧化三蒸水联合埃索美拉唑三联疗法治疗幽门螺杆菌（Helicobacter pylori,Hp）所致慢性胃炎的治疗效果。方法 99例Hp慢性胃炎患者根据治疗方法分为3组各33例,医用三原子氧化水组给予医用三原子氧化三蒸水（300mL/次,2次/d）治疗;三联治疗组给予埃索美拉唑（20mg/次,1次/d）＋阿莫西林片（1 000mg/次,2次/d）＋克拉霉素片（500mg/次,2次/d）治疗;联合治疗组给予医用三原子氧化三蒸水＋埃索美拉唑三联疗法,用量、用法同上述;抗Hp治疗2周后,3组患者均服用埃索美拉唑治疗4周,停药4周后再次行14 C-尿素呼气试验检测Hp。结果治疗后,医用三原子氧化水组Hp阴性18例,Hp清除率为54.55%,三联治疗组Hp阴性26例,Hp清除率为78.79%,联合治疗组Hp阴性32例,Hp清除率为96.97%,3组比较差异均有统计学意义（P〈0.05）。结论医用三原子氧化三蒸水具有清除Hp的功能,与埃索美拉唑三联疗法联合应用可提高慢性胃炎患者Hp清除率。     

乳果糖和食醋预防肝性脑病的疗效观察

[目的]探讨乳果糖和食醋预防肝硬化上消化道出血后肝性脑病（HE）的疗效.[方法]将70例确诊肝硬化合并上消化道出血患者随机分为两组（各35例）,对照组采用常规治疗,治疗组在常规治疗的基础上加用乳果糖口服及食醋灌肠,1个月后观察疗效.[结果]治疗后比较,治疗组发生HE患病率明显低于对照组,且差异有显著性（P〈0.05）.治疗组血氨含量明显下降,数字连接实验（NCT）较对照组缩短（P〈0.01）.[结论]乳果糖和食醋能有效预防肝硬化上消化道出血后HE的发生.     

Improvement of the automatic endoscopic reprocessor: self-cleaning disinfecting connectors between endoscope and reprocessor

BACKGROUND AND STUDY AIMS: We have previously pointed out a defect of automatic endoscopic reprocessors, i. e. the contamination of the connecting part between the endoscope and the reprocessor. We evaluated a newly designed connector (MH-861; Olympus, Tokyo, Japan) with a self-cleaning and disinfection mechanism, which enabled cleaning and disinfection of both the connector itself and its interface with the suction and air/water valves during a reprocessing cycle, which was not previously possible. METHODS: Ten upper gastrointestinal endscopes were examined in the study. Swabs were taken from the suction and air/water valves for microbiological culture before and after reprocessing by the washer-disinfector. The numbers of contaminated endoscopes before and after reprocessing with the new connector were compared. RESULTS: Before the procedure there were five contaminated endoscopes and none after the procedure. When the new connector was used, the difference in cleaning and disinfection of the connecting parts was significant (P = 0.0325). CONCLUSIONS: We conclude that the newly developed connector permits effective cleaning and disinfection by automatic reprocessors.     

不同消毒剂对工勤人员手消毒效果的比较

目的比较不同消毒剂对工勤人员手消毒的效果。方法分甲、乙、丙3组,甲组将工勤人员洗手前与使用抗菌洗手液搓拭1 min、用流动水冲洗后作对比;乙组将工勤人员洗手前与使用4%洗必泰外科洗手液搓拭1 min、流动水冲洗后作对比;丙组将工勤人员洗手前与使用消毒凝胶搓拭1 min、自然干燥后作对比。结果洗手前与使用抗菌洗手液后细菌检测结果差异无统计学意义(P>0.05);洗手前与使用4%洗必泰外科洗手液后细菌检测结果差异有统计学意义(P<0.01);洗手前与使用消毒凝胶搓拭后细菌检测结果差异有统计学意义(P<0.01)结论抗菌洗手液对杀灭皮肤表面暂住菌效果相对较差;4%洗必泰外科洗手液与消毒凝胶均对杀灭皮肤表面暂住菌效果较好。     

不同剂量奥美拉唑治疗非静脉曲张上消化道出血的疗效比较

【目的】探讨不同剂量奥美拉唑治疗非静脉曲张上消化道出血的疗效。【方法】选取2012年6月至2013年7月本院收治的128例非静脉曲张上消化道出血患者,随机分为观察组和对照组各64例,观察组给予大剂量奥美拉唑治疗,对照组给予常规剂量奥美拉唑治疗,比较两组患者的临床疗效并记录分析两组患者治疗前后各观察指标的变化,并于治疗72 h后评估两组患者的胃内 pH 值及不良反应发生情况。【结果】观察组临床疗效优于对照组（P＜0．05）;观测指标改善情况、胃内 pH 值及不良反应发生情况两组间无显著性差异（P＞0．05）。【结论】大剂量奥美拉唑治疗非静脉曲张上消化道出血有良好的临床疗效。     

绿脓杆菌在外环境中存活的研究

<正> 绿脓杆菌为医院感染中的常见菌,在有的医院中甚至连锦不断,给患者造成极大的危害,也影响了医疗质量的提高。该菌属自由营生的菌类,为了解其在外环境中的存活情况及对某些消毒剂的耐受能力,在实验室中进行了试验。现将结果报告于下。