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。     

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。     

碱性电解水与医用清洗剂去除细菌生物膜的研究

目的探讨碱性电解水和医用清洗剂对人工细菌生物膜的去除效果。方法采用生物膜生成装置制备人工生物膜,将布满均质细菌生物膜的小圆片,分别放入碱性电解水和五种医用清洗剂(包括ZEN多功能机用清洗液、ANIOSYME DD1、强效清洗剂、芭格美清洗剂、鲁沃夫生物膜清洗液)中,置于40℃水浴箱中浸泡30min,评价不同清洗方法对细菌生物膜的去除效果。结果碱性电解水对人工细菌生物膜的去除率为99.95%,医用清洗剂A、C、D对人工细菌生物膜的去除效果较好,去除率分别为99.97%、99.99%、99.64%,清洗剂B和E的去除效果较差,去除率分别为79.52%、79.11%。结论碱性电解水可有效去除细菌生物膜,相比某些市售医用清洗剂,其去除效果更佳,可用于医疗器械的清洗。     

二氧化氯用于牙科水道消毒灭菌的效果评估

目的 调查使用二氧化氯消毒剂抑制牙科水道内细菌生长、定植的效果.方法 随机选择22个有独立供水系统的牙科水道单元,其中3个单元以及自来水作为对照;分别在水道处理前、处理后每周1次连续5周采集23个水道的样本;将这些水样本系列稀释、置于R2A琼脂培养板并设平行对照,于37℃孵育7 d,计数菌落.结果 3个对照水道的菌落数中位值为8440 CFU/ml,而19个经消毒处理水道的菌落数中位值为9160 CFU/ml;1周后,19个处理水道中的18个菌落数＜200 CFU/ml,到4周时,所有处理水道中的菌落数均为0 CFU/ml,并维持到第5周;扫描电镜检查显示类似结果,即经过化学消毒处理的牙科水道样本中几乎无生物膜,而未处理的对照水道有明显的生物膜形成.结论 在牙科水道中使用二氧化氯消毒剂可以有效抑制细菌生长和定植,使牙科用水达到美国牙科协会(ADA)制定的＜200 CFU/ml的目标.     

医院消毒工作质量检测

为了解我院消毒工作质量,对2002~2004年各科消毒工作质量进行了检测。1材料与方法对室内空气用直径9 cm普通营养琼脂平板沉降5 min采样,以检测细菌总数≤200 CFU/m3(Ⅱ类)、≤500 CFU/m3(Ⅲ类)为合格;对医务人员手、物体表面用浸有无菌生理盐水棉拭子涂抹采样,检测细菌总数≤5 CFU/cm2(Ⅱ类)或≤10 CFU/cm2(Ⅲ类)为合格;使用中消毒剂1 ml加至9 ml相应中和剂中,细菌总数≤100 CFU/ml,不得检出致病菌为合格;用嗜热脂肪芽胞杆菌菌片检测压力蒸汽灭菌效果,对无菌医疗用品作无菌检测,无菌者为合格。2结果与对策结果证明,各科的消毒工作合格…     

次氯酸消毒剂应用于全自动软式内镜清洗消毒机的消毒效果

目的研究次氯酸消毒剂应用于全自动软式内镜清洗消毒机消毒纤维支气管镜的消毒效果。方法监测某院2018年6—7月(共计48 d)使用的7条纤维支气管镜。采用次氯酸消毒剂对临床使用后的纤维支气管镜进行机洗消毒5 min,分别采用ATP荧光检测法和滤膜法、倾注法对纤维支气管镜外表面及内腔面的消毒效果进行监测和评价。结果 7条纤维支气管镜共送至消毒供应中心清洗消毒159次。分不同日期随机抽样30次,采用ATP荧光法检测表面洁净度,RLU范围10～64,中位数为22,合格率100%。共检测内腔面159次,滤膜法与倾注法检出菌落计数均为0～6 CFU/件,合格率均为100%。稳定性试验7个周期的结果显示,次氯酸消毒剂应用于全自动内镜清洗消毒机,有效氯的初始浓度为210 mg/L,经一周消毒后,处理内镜20～32条不等,有效氯浓度为74～106 mg/L。结论次氯酸消毒剂应用于全自动软式内镜清洗消毒机消毒纤维支气管镜可达到规定的消毒要求,次氯酸消毒剂机洗使用7 d时仍能保持有效浓度。     

酸性氧化电位水现场消毒效果试验研究

目的验证酸性氧化电位水的现场消毒效果。方法参照国家卫生部有关消毒规范方法对医务人员手、一般物体表面、医疗器械、消化内镜分消毒组与阳性对照组进行现场消毒试验。结果对30人次手消毒作用1 min,自然菌平均杀灭对数值为2.72;对物体表面作用5 min,自然菌平均杀灭对数值>1.00;对使用后一般医疗器械常规清洗后浸泡消毒10 min,器械表面细菌的总平均杀灭对数值>1.00;对使用后胃镜、肠镜常规清洗和酶洗处理后消毒3 min,各内镜细菌总数范围为0~2 CFU/件,且均未检出致病菌;试验各组均消毒合格。结论酸性氧化电位水的现场消毒效果良好。     

生物膜清洗剂对呼吸机管路生物膜清洗效果的评价

目的评价生物膜清洗剂对呼吸机管路生物膜的清洗效果。方法将临床使用7d以上的3根呼吸管路分别截取22条2cm×2cm的小管路,共截取66条,随机分到生物膜清洗剂组、多酶清洗剂组和水洗对照组,每组22条;分别清洗后,用生物膜菌落计数评价清洗剂对生物膜的清洗效果。结果水洗对照组的平均菌落数为224.136×105 CFU/ml,多酶清洗剂组的平均菌落数为150.591×105 CFU/ml,生物膜清洗剂组的平均菌落数为10.295×105 CFU/ml;与水洗对照组相比,多酶清洗剂组和生物膜清洗剂组的平均菌落数明显减少(P0.01);生物膜清洗剂组菌落数较多酶清洗剂组亦明显减少(P0.01);多酶清洗剂对生物膜的去除率为32.81%,生物膜清洗剂对生物膜的去除率为95.41%,差异有统计学意义(P0.01)。结论生物膜清洗剂对呼吸机管路生物膜的清洗效果最佳,值得临床推广应用。     

血管留置针注射帽3种消毒方法效果实验比较

比较不同消毒剂对血管留置针注射帽的消毒效果,探索简单有效的消毒方法。采用实验方法,将临床分离的金黄色葡萄球菌实验性污染血管留置针注射帽,分1．0×10。CFU、5．0x10。CFU及1．0×10sCFU3个数量级;设乙醇棉签、碘伏棉签和洗必泰乙醇棉签消毒3个实验组,同时设生理盐水组为对照组,每组40份样本。采样后所有标本接种于血平板,37℃培养48h,计算菌落数。当金黄色葡萄球菌污染量为1．0×10。CFU时,对照组细菌生长量为（52．12±4．31）CFU,实验组3种消毒方法消毒后注射帽均无细菌生长;污染量为5．0×10。CFU时,对照组细菌生长量为（116．25±10．52）CFU,洗必泰乙醇组和乙醇组所有注射帽无细菌生长,碘伏组注射帽细菌生长量为（6．78±3．60）CFU,碘伏组与洗必泰乙醇组和乙醇组消毒后注射帽细菌数量间差异有统计学意义（F=1．84,P〈0．05）;污染量为1．0×10^5 CFU时,对照组细菌生长量为（283．34±16．41）CFU,洗必泰乙醇组无细菌生长,乙醇组细菌生长量为（10．12±3．42）CFU,碘伏组细菌生长量为（63．26±10．63）CFU,三组问细菌数量差异有统计学意义（F=4．23,P〈0．01）。提示洗必泰乙醇组对血管留置针注射帽的消毒效果最好,是最佳选择。     

四川省部分医院软式内镜清洗消毒现状调查及效果监测

目的了解软式内镜使用后和消毒后污染状况,获得内镜原始致病菌及消毒后残留细菌并对其进行耐消毒剂基因检测(qacA/B或qacE△1),比较戊二醛、邻苯二甲醛、含氯制剂3种消毒剂消毒内镜效果,为内镜清洗消毒工作提供参考依据。方法于2019-03/12抽取14家医院共36条内镜进行检测,按照内镜清洗消毒技术操作规范处理样品,同时通过增菌、分离培养等方法获得内镜原始致病菌。结果使用后内镜检出肺炎克雷伯菌、大肠埃希菌大肠埃希菌、铜绿假单胞菌等菌,消毒后内镜检出肺炎克雷伯菌、大肠埃希菌、表皮葡萄球菌等菌。内镜中分离出的细菌均未检出耐消毒剂基因qacA/B或qacE△1。36条内镜消毒合格率为88.89%。终末漂洗用纯化水细菌总数严重超标,微生物检测均不合格。结论使用后内镜载菌量较高。内镜消毒效果良好,内镜消毒质量仍需提高,其中邻苯二甲醛在较短时间达到消毒要求。内镜中分离的细菌,未发现携带耐消毒剂基因qacA/B或qacE△1。终末漂洗用纯化水是内镜清洗消毒的关键环节,应加强终末漂洗纯化水水质控制。     

一元过氧乙酸清除消化内镜生物膜的效果

目的调查临床重复使用内镜的生物膜污染情况,检测一元过氧乙酸对内镜污染生物膜的清除效果。方法按照《医院消毒卫生标准》GB15982-2012中方法检测2019年8-10月临床200例次重复使用的内镜消毒后的消毒效果,采用活菌计数法检测内镜生物膜污染情况。分别采用一元过氧乙酸、戊二醛清除生物膜,监测生物膜的去除效果。结果高水平消毒前提下,经检测30%的内镜出现生物膜;一元过氧乙酸对生物膜的清除率均>99%,戊二醛对生物膜的清除效率仅为62%,差异有统计学意义(P<0.05)。一元过氧乙酸连续使用14天后,所有内镜均未形成生物膜,与戊二醛组对比菌落计数,差异有统计学意义(P<0.05)。结论一元过氧乙酸可有效清除内镜生物膜,并可预防控制生物膜的生成。     

Mimicking disinfection and drying of biofilms in contaminated endoscopes

The effects of peracetic acid-based (PAA) disinfectant with, and without, additional drying on Candida albicans, Candida parapsilosis, Pseudomonas aeruginosa and Stenotrophomonas maltophilia, isolated from contaminated flexible endoscopes, in single- and dual-species biofilms were studied. Biofilms were prepared in sterile tissue culture polystyrene 96-well microtitre plates and were quantified using the tetrazolium salt (MTT) reduction assay and by counting colony-forming yeasts and bacteria from 10-fold serial biofilm dilutions on agar plates. An in vitro biofilm model was applied to mimic the biofilm formation inside the endoscope channels and to imitate the disinfection and drying procedures used for reprocessing of flexible endoscopes. The PAA-based disinfectant was effective against bacteria and yeasts in the planktonic and biofilm states directly after treatment, but allowed regrowth of all biofilms if the drying procedure was skipped. No biofilm regrowth occurred in wells after a drying procedure in all single- and dual-species biofilms. Routine cleaning procedures do not remove biofilm reliably from endoscope channels if the accurate drying procedure is not applied. This may explain the failure of decontamination during endoscope reprocessing.     

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。     

Long-term effects of disinfectants on the community composition of drinking water biofilms

Numerous investigations have demonstrated efficiencies of different disinfection methods, but until now only little is known about long-term effects on community compositions of drinking water biofilms. Changes in the community structure, especially regrowth of hygienically relevant microorganisms could be critical for the drinking water quality. In this study the long-term effect of disinfection methods on biofilm communities in drinking water systems was analysed. Old drinking water biofilms grown in silicone tubes were exposed to different preparations of disinfectants (free chlorine, chlorine dioxide, hydrogen peroxide combined with fruit acid, silver and silver with peracetic acid, respectively) and subsequently further exposed in the original drinking water. The comparison of the treated and regrown biofilm populations with untreated ones by the DNA-fingerprinting method denaturing gradient gel electrophoresis (DGGE) revealed a considerable population shift caused by the disinfectants. The disinfection methods induced a selection pressure on the biofilm populations depending on the composition and concentrations. The similarities between the treated and untreated biofilms were generally low. Compared to preparations with peracetic acid the disinfection with hydrogen peroxide and silver resulted in higher similarities of the treated and untreated biofilms, but the microbial diversity increased. It can be concluded that the disinfectants have a major impact on the drinking water biofilm communities and that possibly the intervention selects persisters and microorganisms, which can live on the residuals of the dead biofilm cells. For the evaluation of the efficiency of disinfection methods in drinking water installations it is necessary not only to consider reduction of certain bacteria but also to pay attention to the biofilm community.     

Surface fixation of dried blood by glutaraldehyde and peracetic acid

The difficulties of successful prion inactivation by chemical agents has led to changes in recommendations regarding the reprocessing of instruments including flexible endoscopes. One of the changes is the preference for peracetic acid instead of glutaraldehyde in order to avoid fixation of organic material, but the surface fixation by various active agents has not been fully investigated. We used a standardized amount of dried blood soil on metal carriers (on average 22 mg). One part of the carriers was exposed to different disinfectants (four based on peracetic acid, three based on glutaraldehyde, two based on quaternary ammonium compounds (QAC), one based on QAC and amines, one based on phenols and one cleaning agent) and air dried. The difference compared with the non-exposed soiled carrier was taken as the measure of blood removal by exposure to the disinfectants. In addition the other part of the carriers was exposed to a cleaning agent and air dried. The cleaning agent itself was capable of removing more than 99% of the dried blood and served as a control for non-fixation. The rate of fixation of dried blood was calculated as the ratio of the weight of residual soil on 'soiled, disinfected and cleaned' carriers and on 'soiled and disinfected' carriers. All experiments were repeated eight times. Blood removal varied between 90.3% +/- 1.5% (phenol-based disinfectant) and < 10% (glutaraldehyde-based preparations). Fixation of the remainder was between 76.9 +/- 8.4% and 102.5 +/- 1.1% with glutaraldehyde and between 19.2% +/- 3.3% and 78.1% +/- 2.4% with peracetic acid. No other preparations showed a potential for blood fixation (< 1.3%). Our findings underline the potential for blood fixation, not only by glutaraldehyde, but also by peracetic acid, and support the evidence that effective cleaning should precede the chemical disinfection.     

Comparison of the disinfectant efficacy of Perasafe and 2% glutaraldehyde in in vitro tests

Two percent glutaraldehyde has been the reference disinfectant for high-level disinfection, but its frequent association with adverse effects has stimulated a search for newer disinfectants. We compared the efficacy of 2% glutaraldehyde with that of a new disinfectant formulation, Perasafe (0.2% peracetic acid) in six in vitro tests: germicidal effect in a suspension of micro-organisms; using a microbe-contaminated metallic endodoncy file; an endoscope model; a modified capacity test; a sporicidal test, and corrosiveness on metallic instruments. Both products were effective germicides in 10-20 min, completely destroying microbial inocula except for Mycobacterium and spores. Internal irrigation of endoscopes with 100 mL of either was totally effective. Both substances resisted inactivation after repeated inoculation and did not corrode clean instruments; however, when organic matter was added the 0.2% peracetic acid formulation cleaned without corrosion, while 2% glutaraldehyde fixed the matter to the scalpel, causing corrosion within 2 h. In summary, Perasafe is a good substitute for 2% glutaraldehyde for high-level disinfection.     

两种内镜消毒剂相关性能比较

目的比较一元过氧乙酸消毒剂II型和含氯消毒剂的相关性能,为临床消毒剂的选择提供参考。方法本研究按照相关标准规范通过现场消毒试验方法,对一元过氧乙酸消毒剂II型和含氯消毒剂消毒后胃镜进行采样,比较分析两种消毒剂的消毒效果并进行稳定性及腐蚀性研究。结果一元过氧乙酸消毒剂II型对胃镜高水平消毒的合格率(98.5%)高于含氯消毒剂(88.9%),但有效成分含量的下降率低于含氯消毒剂(P<0.05)。两种消毒剂对不锈钢无腐蚀性,对碳钢、铝和铜均为轻度腐蚀。结论一元过氧乙酸消毒剂II型能达到胃镜高水平消毒标准且稳定性高,综合性能优于含氯消毒剂。     

2007～2008年大连市部分医院消化内镜污染状况调查

[目的]了解大连市医院使用的胃镜和肠镜消毒现状,进一步规范消毒操作方法,提高消毒质量。[方法]20072008年对大连市17所二级以上医疗机构的胃镜、肠镜进行消毒效果检测。[结果]20072008年合计检测胃、肠镜内腔64件,细菌总数合格率为68.75%,其中胃镜合格率为73.47%,肠镜合格率为53.33%（P〉0.05）。检测内镜活检口27件,细菌总数合格率为70.37%,其中胃镜活检口合格率为89.47%,肠镜活检口合格率为2/8（P=0.002）。检测使用中的内镜消毒剂戊二醛有效含量24件,合格率为87.50%;测定8件样品的消毒剂染菌量,全部达到标准。[结论]大连市部分医院胃镜和肠镜消毒效果不佳,消毒剂的使用存在问题。