微酸性氧化电位水消毒消化内镜的可行性研究

目的探讨微酸性氧化电位水应用于消化道内镜消毒的可行性。方法利用氧化电位水生成器生产出微酸性氧化电位水,观察所制备的微酸性氧化电位水应用于消化内镜的消毒效果。结果对215条次内镜消毒后的细菌培养,微酸性氧化电位水与2％戊二醛机洗的平均杀菌率分别为99．92％和99．85％,而手洗的平均杀菌率分别为99．85％和99．84％,二者差异无统计学意义（P〉0．05）,两种方法合格率均为100％。内镜经微酸性氧化电位水消毒浸泡,所有内镜均无老化、变形,消毒液对内镜清洗消毒机均无损伤。结论微酸性氧化电位水应用于消化道内镜的清洗消毒切实可行。     

氧（酸）化电位水、戊二醛对消化内镜消毒效果的比较

目的：对比氧化水和戊二醛在消毒内镜方面的效果。方法：分别制备污染程度基本相同的内镜，分别以氧化水和戊二醛消毒。观察不同时间的消毒效果。结果：氧化水可在30秒钟杀灭乙肝病毒和大部分细菌，戊二醛则需要20～30min才可达到类似的消毒效果。结论：氧化水在内镜消毒方面优于戊二醛。     

日本消化内镜学会消毒委员会报告

2000年7月28日日本消化内镜学会召开了消毒委员会会议,对消化内镜的清洗、消毒等相关的新问题进行了讨论,最后得出以下的三项结论,由会长小越和荣转发,现介绍于我学会杂志上,供全国同道参考。     

消化内镜清洗消毒的研究

为选择方便、实用、可靠的清洗消毒方法和高效、广谱、无毒付作用的内镜消毒剂。在近１５万例次内镜检查、治疗的同时，对内镜的清洗、消毒进行了一系列研究。内镜使用后，先对镜身及孔道附着物彻底清除，再用三步法对内镜清洗、消毒，基本达到灭菌目的。手工操作应强调规范、到位，机械自动洗消可减轻劳动强度，并可避免人为因素影响消毒效果。常用消毒剂新洁尔灭、戊二醛等，能有效杀灭常见微生物，但有一定的毒付作用。酸化电位水具有高氧化还原电位、低ｐＨ值和氧化能力，是一种高效、迅速、安全、方便的消毒制剂。     

消化内镜及附件的清洗消毒和保养

随着消化内镜检查的广泛应用和治疗的不断开展，内镜及附件的种类越来越多，特别是有些附件如：活检钳、注射针、细胞刷、圈套器、切开刀、导丝等在内镜检查治疗中突破人体黏膜屏障而造成损伤，均是造成医源性感染的危险因素，尤其是HBV、HCV、TB、沙门氏菌及Hp的交叉感染已引起人们的高度重视，因此，内镜及附件消毒十分重要。我院内镜清洗消毒方法按卫生部2004年版《内镜清洗消毒技术操作规范》的要求进行，并且早在2002年就积极采取了酸性氧化电位水消毒内镜和2％碱性戊二醛溶液浸泡，或环氧乙烷灭菌非耐高温配件、高压消毒灭菌耐高温配件等先进措施，并且分区域、分病种、分时间从多方面杜绝交叉感染的发生。工作人员在诊疗清洗消毒时，需穿工作服及一次性无菌手术衣，戴一次性口罩、帽子、橡胶手套等。在诊疗时凡进入人体消化道的内镜。     

消化内镜清洗消毒规范化培训研究

目的 调查消化内镜清洗消毒人员对内镜清洗消毒规范的掌握情况,探讨短期有效、理论结合实践的培训方法,提高消化内镜的清洗消毒水平.方法 参照2004年《内镜清洗消毒技术操作规范》及2012年《软式内镜清洗消毒技术规范》草案自行设计两套试题,对参加清洗消毒培训班的110名学员考核,然后进行1天理论培训和半天“手把手”操作培训.培训后再次理论和操作考核,应用现场采样监测内镜洗消是否达到灭菌标准.结果 110名学员中,来自省、市和县级医院分别为23(20.9％)、57(51.8％)和30(27.3％).以80分(总分100)为理论考核合格,培训前总合格率为50.0％,其中省级(56.5％)和市级(52.6％)两组接近(P＞0.05),均显著高于县级学员(40.0％,P＜0.05).培训后理论考核总合格率提高至96.4％,3组(省级100％、市级96.5％和县级93.3％)无显著差异.97.3％(107/110)学员内镜洗消达到无菌标准(省级100％、市级98.2％和县级93.3％,P＞0.05).结论 短期理论及操作培训是针对内镜清洗消毒规范普及的一种有效教学和培训方法,可快速显著提高从业人员的理论和操作水平.     

影响戊二醛消毒内镜的效果观察

1997年以来,我院将 2％戊二醛用于胃镜消毒。由于戊二醛易挥发,易受多种因素的影响,直接影响到消毒效果,现将几种影响因素报告如下。 　　1.一般资料：使用者为各种需作胃镜的患者,（乙肝除外）,包括上消化道肿瘤,消化性溃疡,急慢性胃炎等。 　　2.配制方法： 25％的戊二醛溶液 100ml,加蒸馏水 1 250ml,加 3％碳酸氢钠 3.75g,配制成 2％碱性戊二醛。 　　3.检查方法及分组： (1)取少量 2％戊二醛消毒液 2份作对照,一份密封,一份暴露于空气中。胃镜使用后,用 1： 200 84消毒液及清水冲洗各部件及镜身全部活动旋钮,吸引冲洗 10…     

万金消毒液和2%碱性戊二醛对消化内镜的消毒效果比较

2008年5～9月，我们比较了万金消毒液与2％碱性戊二醛对消化内镜的消毒效果。现将结果报告如下。     

酸性氧化电位水对胃镜污染枯草杆菌黑色变种芽孢的消毒研究

近年来,消化内镜的清洗及消毒是否彻底,已成为医学界、患者和社会媒体关注的问题。酸性氧化电位水(EOW)是近年来出现的内镜消毒剂。为了对内镜全自动清洗消毒机产生的EOW灭菌的效果进行科学的评价,现对其进行枯草杆菌黑色变种芽孢的杀灭试验,通过模拟试验观察EOW杀灭胃镜污染细菌效果,并通过自来水替代EOW的方法进行对比研究,尝试确定有效的最短消毒时间。     

Strongly acidic electrolyzed water: valuable disinfectant of endoscopes

Background: Glutaraldehyde (GA) is currently considered to be the best disinfectant for endoscope disinfection. However, GA poses high risks for medical staff involved in the process and also to the environment. Strongly acidic electrolyzed water (SAEW) has been recently re‐evaluated for its potent bactericidal effect and environmental safety. Methods: Through the aspiration channel of the scopes, upper GI endoscopes and colonoscopes were experimentally contaminated with Pseudomonas aeruginosa, Mycobacterium avium and hepatitis B surface antigen positive blood. Four disinfection methods were tested: manual washing only, soaking in 3% GA for 5 and 10 min, and a 10‐s soak in SAEW with 50 or 100 mL of aspiration. Results: Direct plating culture was positive for Pseudomononas contamination after manual washing only (1/5) and after a 5‐min soak in 3% GA. Complete disinfection, confirmed by enrichment culture and polymerase chain reaction (PCR) of Pseudomonas and hepatitis B surface antigen positive blood on the contaminated upper GI endoscope was obtained after a 10‐min soak in GA and after using SAEW (0/5). Mycobacterum avium are rather resistant against SAEW as determined by broth culture and PCR (1/5). Conclusion: Strongly acidic electrolyzed water is a valuable disinfectant for endoscopes.     

Efficacy of electrolyzed acid water in reprocessing patient-used flexible upper endoscopes: Comparison with 2% alkaline glutaraldehyde

BACKGROUND AND AIM: Two percent glutaraldehyde, the most widely used liquid chemical germicide (LCG), may be hazardous to patients and medical personnel. Alternatives to glutaraldehyde, such as electrolyzed acid water (EAW), are being developed, but data from well-controlled studies with patient-used endoscopes are rare. The purpose of the present paper was to evaluate the high-level disinfection capability of EAW and compare it with glutaraldehyde. METHODS: A random sample of 125 endoscopes was collected immediately after upper endoscopic examination. After careful manual cleaning, endoscopes were divided into a glutaraldehyde and EAW group. After the disinfection procedure, samples from working channel (S-1), insertion tube (S-2), umbilical cord (S-3), and angulation knob (S-4) were taken and cultured. Another twenty endoscopes were experimentally contaminated with hepatitis B virus (HBV) and samples were collected after contamination (T-1), after manual cleaning (T-2), and after final disinfection (T-3). Polymerase chain reaction (PCR) for HBV-DNA was performed. RESULTS: In the EAW group, culture-positive rates were 3.2% in S-1, 9.5% in S-2, 3.2% in S-3, and 27.0% in the S-4 samples. There was no significant difference between the EAW and glutaraldehyde groups for all sampling sites. However, in both groups, disinfection of the angulation knobs (S-4) was less efficient than the others. For the T-1 site, HBV-DNA was detected from all of them, and in 95% (19/20) of T-2. However, HBV-DNA was not detected from T-3 samples. CONCLUSIONS: Electrolyzed acid water is as efficient as glutaraldehyde in eliminating bacteria from patient-used endoscopes. After disinfection procedures using both methods, HBV-DNA was not detected from any endoscopes experimentally contaminated with HBV-positive mixed sera. However, some bacteria may remain on the surface of the endoscopes. Therefore, more careful precleaning of the endoscopes may help achieve high-level disinfection in the clinical setting.     

逆行胰胆管造影前内镜孔道酸化水消毒与术后感染的关系研究

目的观察内镜孔道的消毒与内镜逆行胰胆管造影(ERCP)术后感染发生的关系。方法选择2010年3月至7月北京友谊医院收治的胆胰疾病患者58例,随机分成ERCP插管前经内镜孔道酸化水消毒组(实验组)和常规ERCP插管组(对照组),每组29例。实验组在乳头插管前用酸化水20 mL冲洗内镜孔道2次。操作结束后,两组均在活检孔道内注入10 mL生理盐水,在内镜头端应用无菌试管接收活检孔道流出液体,行常规细菌培养。结果 58例患者均成功行ERCP治疗。其中实验组患者6.9%(2/29)术后出现发热,经抗感染治疗后体温降至正常、黄疸消退。内镜孔道细菌培养19例培养标本有细菌生长;对照组患者27.6%(8/29)出现术后发热,其中发生化脓性胆管炎2例,行再次ERCP治疗。对照组29例标本均有细菌生长。结论 ERCP插管前行酸化水内镜孔道再次消毒可减少术后感染的发生。     

酶洁液和氧化电位水在胃镜全浸泡式消毒中的效果观察

目的评价酶洁液清洗氧化电位水(EOW)全浸泡对胃镜消毒的效果。方法对120例接受胃镜检查的病人按清洗方法随机分成酶洁液组(60人)和流动水组(60人),两组于胃镜清洗、酶洁液浸泡及流水清洗前后留取镜身、钳道和操作部样本行细菌培养,检测清洗效果。两组胃镜清洗后按EOW浸泡消毒时间2min和4min各分两个时间组,每组30例,消毒后留取镜身、钳道和操作部样本进行细菌培养,检测EOW的消毒效果。结果①清洗前胃镜污染情况严重,细菌培养阳性为:操作部115例(95.8%),镜身、钳道120例(100%);②酶洁液清洗后操作部阳性11例(18.3%),镜身、钳道细菌培养阳性14例(23.3%),而流动水清洗后操作部阳性19例(31.7%),镜身、钳道细菌培养阳性26例(43.3%),两组具有显著性差异(P<0.05);③酶洁液组消毒2min后,细菌培养阳性均为0,而流动水组清洗消毒2min后镜身及钳道7例(23.3%)阳性,操作部6例(20.0%)阳性,两组有显著性差异(P<0.05);消毒4min两组细菌培养均为阴性。结论酶洁液清洗消毒更彻底,经EOW消毒4min可以达到消毒标准。     

胶囊内镜对胃肠道疾病的诊断意义

目的 评价胶囊内镜对胃肠道疾病的诊断价值。方法 应用胶囊内镜对13例不明原因消化道出血、6例反复腹泻、4例腹痛及l例转移性腺癌寻找原发灶患者进行检查。结果在13例不明原因消化道出血患者中，发现小肠血管发育不良7例，其中有l例合并有回肠溃疡，小肠血管瘤l例，小肠恶性淋巴瘤l例，十二指肠球部溃疡l例，小肠克罗恩病l例，未见异常2例；在6例反复腹泻患者中，发现l例溃疡性空回肠炎，其余5例均考虑功能性胃肠道疾病；在4例腹痛患者中，发现糜烂性胃炎2例，十二指肠降部糜烂l例，正常l例；l例转移性腺癌检查发现小肠腺癌。结论 胶囊内镜对胃肠道疾病尤其是小肠疾病有较高的诊断价值。     

电解酸性水对消化内镜消毒的效果

目的探讨电解酸性水消毒法对消化内镜消毒中的消毒效果和应用价值.方法行内镜检查的患者130例,拔镜后立即在距内镜先端10 cm处,1.0 cm范围内用无菌棉签擦试镜身一圈,同时在活检孔道注入生理盐水2 mL,在内镜头端应用无菌试管接收活检孔道流出的液体,混合后即刻放培养基中分别进行培养.52例作常规细菌培养,68例作幽门螺杆菌培养,观察细菌生长情况.然后将内镜置入电解酸性水洗消机Clean TOP WM-1消毒槽消毒7min.再同法取样进行细菌培养.对体外已培养的各种细菌进行了定量灭菌实验.10例内镜检查前发现HBsAg阳性的受检者,消毒前后取样,分别行PCR方法进行HBV-DNA的检测结果 52例消毒前36例有细菌生长,消毒后36阳性者细菌培养全部阴性68例中消毒前39例幽门螺杆菌的尿素酶试验和幽门螺杆菌培养均阳性,消毒后39例细菌培养全部变为阴性.对体外培养的各种细菌灭菌后再培养全部阴性10例HBsAg(+)受检者,消毒前6例HBV DNA阳性,经电解酸性水消毒7min后,6例阳性者皆为阴性.结论电解酸性水对各种细菌和肝炎病毒具有很强的杀灭效果,是一种高效的内镜消毒新方法.     

The Utility of Upper Endoscopy in Patients with Concomitant Upper Gastrointestinal Bleeding and Acute Myocardial Infarction

Patients who present with upper gastrointestinal bleeding (UGIB) in the setting of acute myocardial infarction (AMI) may have suffered an UGIB that subsequently led to an AMI or endured an AMI and subsequently suffered a UGIB as a consequence of anticoagulation. We hypothesized that patients in the former group bled from more severe upper tract lesions. The aim of this study was to evaluate predictors for endoscopic therapy in patients who suffer a concomitant UGIB and AMI. Retrospective, single center medical record abstraction of hospital admissions from January 1, 1996–December 31, 2002. During the study period, 183 patients underwent an esophagogastroduodenoscopy (EGD) within 7 days of suffering an AMI and UGIB (AMI group N=105, UGIB group N=78). A higher proportion of patients in the UGIB group (41%) was found to have high-risk UGI lesions requiring endoscopic treatment compared to patients in the AMI group (17%; P < 0.004). UGIB as the inciting event and patients suffering from hematemesis and hemodynamic instability were significantly associated with requiring endoscopic therapy. Although predominantly diagnostic, endoscopic findings in the AMI group did alter the decision to perform cardiac catheterization in 43% of patients. Severe complications occurred in 1% (95% confidence interval, 0%–4%) of patients. We conclude that in patients suffering from concomitant UGIB and AMI, urgent endoscopy was most beneficial in patients with UGIB as the initial event and those presenting with hematemesis and hemodynamic instability. In patients without these clinical features, urgent endoscopy may be delayed, unless cardiac management decisions are dependent on endoscopic findings.     

Guidelines for standardizing cleansing and disinfection of gastrointestinal endoscopes

As part of the activities toward standardizing endoscopy procedures, the Japan Gastroenterological Endoscopy Society has prepared guidelines for cleansing and disinfection of gastrointestinal endoscopes. The environment of gastrointestinal endoscopy differs between Japan and advanced Western countries. In advanced Western countries, gastrointestinal endoscopy is performed almost exclusively at specialized facilities, where strict provisions are observed for cleansing and disinfecting endoscopes. In Japan, however, gastrointestinal endoscopy is performed even in small clinics, and the annual number of gastrointestinal endoscopy cases is enormous. In addition, the method for cleansing and disinfecting endoscopes differs among hospitals. Although there is a distinct lack of evidence for how gastrointestinal endoscopes are cleaned and disinfected, it is necessary to standardize the method for doing so to advance the field of endoscopic medicine.     

The global impact of COVID-19 on gastrointestinal endoscopy units: An international survey of endoscopists

Background & study aimsCorona virus disease-19 (COVID-19) pandemic has markedly impacted routine medical services including gastrointestinal (GI) endoscopy. We aim to report the real-life performance in high volume GI endoscopy units during the pandemic.Patients and methodsA web-based survey covering all aspects of daily performance in GI endoscopy units was sent to endoscopy units worldwide. Responses were collected and data were analyzed to reveal the effect of COVID-19 pandemic on endoscopy practice.ResultsParticipants from 48 countries (n = 163) responded to the survey with response rate of 67.35%. The majority (85%) decreased procedure volume by over 50%, and four endoscopy units (2.45%) completely stopped. The top three indications for procedures included upper GI bleeding (89.6%), lower GI bleeding (65.6%) and cholangitis (62.6%). The majority (93.9%) triaged patients for COVID-19 prior to procedure. N95 masks were used in (57.1%), isolation gowns in (74.2%) and head covers in (78.5%). Most centers (65%) did not extend use of N95 masks, however 50.9% of centers reused N95 masks. Almost all (91.4%) centers used standard endoscopic decontamination and most (69%) had no negative pressure rooms. Forty-two centers (25.8%) reported positive cases of SARS-CoV-2 infection among patients and 50 (30.7%) centers reported positive cases of SARS-CoV-2 infection among their healthcare workers.ConclusionsMost GI endoscopy centers had a significant reduction in their volume and most procedures performed were urgent. Most centers used the recommended personal protective equipment (PPE) by GI societies however there is still a possibility of transmission of SARS-CoV-2 infection in GI endoscopy units.